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. 2006 Feb;4(2):173-8.
doi: 10.1016/j.cgh.2005.11.002.

Frozen section analysis of esophageal endoscopic mucosal resection specimens in the real-time management of Barrett's esophagus

Ganapathy A Prasad  1 , Kenneth K Wang, Lori S Lutzke, Jason T Lewis, Schuyler O Sanderson, Navtej S Buttar, Louis M Wong Kee Song, Lynn S Borkenhagen, Lawrence J Burgart
Affiliations

Frozen section analysis of esophageal endoscopic mucosal resection specimens in the real-time management of Barrett's esophagus

Ganapathy A Prasad et al. Clin Gastroenterol Hepatol. 2006 Feb.

Abstract

Background & aims: The aim of this study was to assess the validity of frozen section analysis of endoscopic mucosal resection (EMR) specimens from Barrett's esophagus as compared with permanent sections for the detection of neoplasia. Frozen sections help to give immediate feedback for surgical procedures. It has not been determined whether EMR can be adequately interpreted by using frozen sections to aid endoscopists in completely resecting neoplastic lesions.

Methods: EMR specimens from Barrett's esophagus with high-grade dysplasia (HGD) and/or carcinoma were tested by frozen section. Pathologists evaluated EMR specimens for the depth of invasion as well as the appearance of clear margins of resection. The kappa statistic was calculated to assess the degree of agreement between the frozen section and permanent section diagnoses.

Results: Twenty-three consecutive patients underwent 30 EMRs with frozen section diagnosis. Frozen section revealed a carcinoma in 7 specimens (23%) and dysplasia in 20 (66%). Permanent sections found carcinoma in 8 specimens (26%), dysplasia in 19 specimens (63%), and normal or nondysplastic Barrett's esophagus in the remainder. The kappa statistic for the depth of invasion of EMR specimens was 0.93 (near perfect agreement). The kappa statistic for the margins of the EMR specimens was 0.80 (excellent agreement).

Conclusions: This study indicated that frozen section analysis of esophageal EMR specimens is valid as compared with permanent section. This technique might allow rapid evaluation about the degree and depth of involvement of cancers. This allows physicians to make decisions regarding further therapy if margins are involved or decrease the use of EMR for histologically benign-appearing lesions.

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Figures

Figure 1
Figure 1
EMR procedure: visible nodule in a background of Barrett’s esophagus, which is lifted with a submucosal saline-epinephrine injection. The lesion is then resected with a pre-loaded snare by using suction and electrocautery.
Figure 2
Figure 2
EMR specimen serially sectioned after the margins have been inked.
Figure 3
Figure 3
(A) Survey view of a frozen section EMR. Stratified squamous epithelium is seen at top. Arrow highlights an esophageal submucosal mucus gland within the frozen section (original magnification 10×; toluidine blue). (B) Infiltrating malignant glands of invasive adenocarcinoma as seen in a frozen EMR (original magnification 100×; toluidine blue). (C) Frozen section EMR showing submucosal extension of the carcinoma, which is also present at the deep margin (original magnification 40×; toluidine blue).
Figure 4
Figure 4
High-power views of a frozen section (A) and corresponding permanent section (B) from an EMR with low-grade dysplasia. The surface epithelium and underlying glands from both show nuclear hyperchromasia and stratification. Normal polarity with respect to the basement membrane is preserved. (A) Toluidine blue; original magnification 200×. (B) Hematoxylin-eosin; original magnification 200×.
See this image and copyright information in PMC

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