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Intraoperative examination (IOE) in pediatric extracranial tumors
Author(s) -
Dall'Igna Patrizia,
d'Amore Emanuele S.G.,
Cecchetto Giovanni,
Bisogno Gianni,
Carretto Elena,
Bitetti Stefania,
Famengo Barbara,
Alaggio Rita
Publication year - 2010
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.22309
Subject(s) - medicine , concordance , hepatoblastoma , lymph node , soft tissue , medical diagnosis , radiology , germ cell tumors , biopsy , pathology , surgery , chemotherapy
Background and objectives Intraoperative evaluation of surgical specimens by frozen sections (IOE) is required to distinguish benign and malignant lesions, assess surgical margins, and determine sample adequacy of biopsies. In the last years, it has been used also for therapeutic decisions, particularly in children, who may need other ancillary procedures, in case of malignancies. Our purpose was the evaluation of diagnostic accuracy, limits, and different role of IOE in pediatric pathology. Patients and methods From 1990 to 2001, 416 IOEs were performed in 341 children, affected by lymph node pathology, soft tissue tumors, neuroblastic tumors, gonadal germ cell, and stromal tumors, hepatic lesions, renal tumors, and others; the technique was also used to assess surgical margins during major surgeries. IOEs were obtained from Tru‐cut biopsies (<1 cm 3 ), wide biopsies (>1 cm 3 ), or from the whole lesions, and the subsequent final diagnoses were classified as concordant, discordant, and deferred. Results Three hundred seventy cases (88.9%) were concordant, 10 (2.4%) discordant, and 36 (8.6%) deferred. The disagreement was found in two small lymph node samples, three soft tissue tumors, one hepatoblastoma, one metastasis, and three surgical margins. The deferred diagnoses were related to lymph node and soft tissue lesions. Conclusions IOE in pediatric oncology may integrate the diagnostic process and supports the therapeutic guidelines of different tumors. In our study, the diagnostic concordance was satisfactory. A rational use of the technique and the awareness of its limits are, however, prerequisites to avoid the risk of overtreatment. Pediatr Blood Cancer 2010;54:388–393. © 2010 Wiley‐Liss, Inc.