HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by de Montpréville, V. T. Articles by Nashashibi, N. Search for Related Content PubMed PubMed Citation Articles by de Montpréville, V. T. Articles by Nashashibi, N.

Eur J Cardiothorac Surg 1998;13:190-195
© 1998 Elsevier Science NL

Frozen section diagnosis and surgical biopsy of lymph nodes,

tumors and pseudotumors of the mediastinum

Department of Pathology, Marie Lannelongue Surgical Center, 133 Avenue de la Résistance, 92350 Le Plessis-Robinson, France

Received 25 August 1997; accepted 16 December 1997.

Corresponding author. Tel.: +33 01 40942807; fax: +33 01 40942805.

Objective: Our experience with the use of frozen section (FS) was reviewed in order to assess its interest and limits, during minimally aggressive mediastinal surgery for staging of lung carcinomas and biopsy of primary lesions. Methods: The retrospective study was based on a series of 420 consecutive mediastinal biopsies with FS performed through cervicotomy (n=12), mediastinoscopy (n=345), mediastinotomy (n=43), manubriotomy (n=13) or videothoracoscopy (n=7), in 417 patients, aged 8–86 years (mean: 52.5±15.6). The FS diagnoses were compared with the final diagnoses and consequences of the FS analyses were analyzed. Results: Biopsies with FS had a 99.4% (351/353) efficiency rate for a precise definitive diagnosis (excluding normal lymph nodes). However, two patients required a second operation: one for typing a lymphoma and the other to correct a FS misdiagnosis of small cell carcinoma on a crushed normal lymph node. The sensitivity for detection of carcinoma lymph node metastases was 99% (200/202). The two false negative FS diagnoses, including one post-chemotherapy, were related to micrometastases. There were 46 correct FS diagnoses of non-metastatic lymph node which were followed by an immediate thoracotomy during the same anesthesia, for benign lung lesions (n=9) or for carcinomas (n=37), including 30 lung carcinomas that were immediately resected and proved to have no mediastinal involvement (n=24), or only a limited involvement in a non-biopsied site (n=6). In the 51 cases of primary mediastinal tumors excluding carcinomas, FS indicated a resectable lesion with a sensitivity of 87.5% (7/8) and a specificity of 97.7% (43/44). Five lesions were immediately resected: one Castleman’s disease, one intrathoracic goiter, two of six thymomas and a Hodgkin’s disease, which was diagnosed as thymoma on FS. An invasive thymoma was resected during a second operation after a FS diagnosis of carcinoma. FS had a sensitivity of 100% in the 62 cases of sarcoidosis and a sensitivity of 90% in the 20 cases of infectious lesions. One of the 18 cases of tuberculosis and an infectious pseudo-tumor of the anterior mediastinum had no microbiologic study because of FS diagnoses of tumor necrosis and lymphoma. Conclusions: FS efficiently secures the adequacy of the samples and guides the surgeon’s decision making for the resection of lung carcinomas, but is less effective for a precise diagnosis of some primary mediastinal lesions, which may have close histologic appearances.

Key Words: Frozen section • Mediastinoscopy • Mediastinotomy • Lung neoplasm-staging • Lymphoma • Thymoma • Sarcoidosis • Tuberculosis

This article has been cited by other articles:

				A. M. Schwartz and D. E. Henson Diagnostic Surgical Pathology in Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 78S - 93S. [Abstract] [Full Text] [PDF]

				M. Muraoka, S. Akamine, T. Oka, T. Tagawa, A. Nakamura, T. Tsuchiya, T. Hayashi, and T. Nagayasu Sentinel node sampling limits lymphadenectomy in stage I non-small cell lung cancer Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 356 - 361. [Abstract] [Full Text] [PDF]

				K. Okubo, T. Kato, A. Hara, N. Yoshimi, K. Takeda, and F. Iwao Imprint Cytology for Detecting Metastasis of Lung Cancer in Mediastinal Lymph Nodes Ann. Thorac. Surg., October 1, 2004; 78(4): 1190 - 1193. [Abstract] [Full Text] [PDF]

				H. Porte, D. Metois, L. Finzi, G. Lebuffe, A. Guidat, M. Conti, and A. Wurtz Superior vena cava syndrome of malignant origin. Which surgical procedure for which diagnosis? Eur. J. Cardiothorac. Surg., April 1, 2000; 17(4): 384 - 388. [Abstract] [Full Text] [PDF]