Frozen sections examination for diagnosis of unexpected gallbladder neoplasm during cholecystectomy in acute cholecystitis

Objective To explore the clinical significance of intraoperative frozen sections for the diagnosis of unexpected gallbladder neoplasm during cholecystectomy for acute cholecystitis. Methods We retrospectively analyzed the clinical data of acute cholecystitis patients who underwent cholecystectomy at the First Affiliated Hospital of Zhengzhou University, from Dec 2012 to Dec 2017. Results In the 1 386 acute cholecystitis patients, 19 patients were found to have concurrent gallbladder neoplasm. Surgeons accurately recognized 9 gallbladder neoplasms by general observation alone, including 2 T2 and 2 T3 gallbladder neoplasms, but missed 10 gallbladder neoplasms. At the same time, we found that 3 Tis and 1 T1a gallbladder neoplasms were missed by frozen sections from 10 gallbladder neoplasms diagnosed by definitive histopathological examination. The sensitivity of frozen sections diagnosis was 60% and the specificity was 100%. Conclusions During cholecystectomy for acute cholecystitis, the accuracy of surgeons′ diagnosis with general observation in unexpected gallbladder neoplasm is poor. The accuracy of frozen sections to diagnose advanced gallbladder neoplasm is high, so we advocate frozen sections of every cholecystectomy sample in acute cholecystitis patients. Key words: Gallbladder neoplasm; Cholecystitis, acute; Cholecystectomy; Cryoultramicrotomy