Abstract
Background
Preoperative diagnosis of gallbladder cancer (GBC) remains a challenge. Unwarranted
extensive surgery for benign disease and undertreatment for GBC pose challenges. We
aimed to analyze the utility, diagnostic accuracy, and limitations of intraoperative
frozen section (FS), for primary diagnosis of suspected gallbladder malignancy.
Methods
Patients with suspected GBC underwent a cystic-plate cholecystectomy and FS for primary
diagnosis. The procedure was considered adequate if FS suggested a benign pathology.
A radical cholecystectomy was performed if FS favoured GBC, or in patients with high
intra-operative suspicion of malignancy. All FS records were compared with final histopathology.
Results
FS guided the surgical strategy in 491 of 575 resections (85.4%). FS had a sensitivity
of 88.3%, specificity of 99.6%, a positive predictive value of 99.4% and a negative
predictive value of 92.7%. The diagnostic accuracy of FS was 95.1%. With routine use
of intraoperative FS, only 10 out of 491 patients (2%) required a revised surgical
strategy.
Conclusions
For radiologically suspected GBC it is prudent to confirm the histological diagnosis
by use of intraoperative FS before undertaking radical resections. This study emphasizes
the safety and accuracy of FS as an adjunct for directing optimal surgical strategy
in suspected GBC.
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Article info
Publication history
Published online: December 16, 2022
Accepted:
December 9,
2022
Received:
July 18,
2022
Identification
Copyright
© 2022 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
