[Skip to Content]
[Skip to Content Landing]
Views 279
Citations 0
Original Investigation
October 24, 2018

Prevalence of False-Negative Results of Intraoperative Consultation on Surgical Margins During Resection of Gastric and Gastroesophageal Adenocarcinoma

Author Affiliations
  • 1Department of Surgery, Montefiore Medical Center, Bronx, New York
  • 2Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
  • 3Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey
  • 4Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
  • 5Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
JAMA Surg. Published online October 24, 2018. doi:10.1001/jamasurg.2018.3863
Key Points

Question  What is the prevalence of a false-negative result of intraoperative consultation on surgical margins during curative intent resection of gastric or gastroesophageal adenocarcinoma?

Findings  In this study of 2002 patients with 3171 intraoperative consultations on surgical margins, the prevalence of a false-negative result was 1.7%. Duodenal margins, diffuse or signet ring disease, and not receiving neoadjuvant radiotherapy were associated with less accurate results.

Meaning  The findings suggest that Intraoperative consultations on surgical margins are accurate but select clinical scenarios are at risk for false-negative results, providing a framework for expectations of the utility of intraoperative consultations on surgical margins during curative intent surgery.

Abstract

Importance  Intraoperative consultation (IOC) on surgical margins during curative intent resection of gastric and gastroesophageal adenocarcinoma presents sampling and interpretive challenges. A false-negative (FN) IOC result can affect clinical care. Many factors may be associated with higher risk for an FN result of IOC on surgical margins.

Objective  To assess the prevalence and clinical implications of FN results of IOC on surgical margins during resection of gastric and gastroesophageal adenocarcinoma.

Design, Setting, and Participants  This retrospective study assessed the results of IOC on surgical margins to determine the prevalence of FN results and the accuracy and clinical implications of the results for patients undergoing curative intent resection for gastric or gastroesophageal adenocarcinoma. The study examined patients with gastric or gastroesophageal adenocarcinoma who underwent resection with curative intent at a single-institution referral center from January 1, 1992, to December 31, 2015.

Interventions  Curative intent gastric and/or esophageal resection.

Main Outcomes and Measures  False-negative results of IOC on surgical margins, accuracy of the results, factors associated with decreased accuracy of the results, and clinical implications of FN results.

Results  This study included 2002 patients (median age, 65 years; 1343 [67.1%] male; 1638 [81.8%] white) who received 3171 IOCs on surgical margins. Of the 3171 IOCs, the prevalence of FN results was 1.7%, with an accuracy of 98.1%. The prevalence of an FN IOC result was 1.2% for esophageal margins, 2.0% for gastric margins, and 2.5% for duodenal margins (P = .04). The prevalence of an FN IOC result was higher for patients with diffuse or signet ring disease compared with those without (2.6% vs 1.2%, P = .002) and for those not receiving neoadjuvant radiotherapy compared with those receiving neoadjuvant radiotherapy (1.4% vs 0.7%, P < .001). The prevalence of FN results of IOCs performed by nongastrointestinal pathologists was similar to that of IOCs performed by gastrointestinal pathologists (2.3% vs 1.9%, P = .60). The disease-specific survival was 34 months (95% CI, 20.7-47.2 months) for those with an FN result and 26.9 months (95% CI, 18.3-35.4; P = .72) for those with a true-positive result. Half of the patients with FN IOC results received further margin-directed therapy, including subsequent resection or radiotherapy.

Conclusions and Relevance  This study found that IOC on surgical margins was accurate at a specialty center. Signet ring or diffuse disease, duodenal margins, and not receiving neoadjuvant radiotherapy were challenging scenarios for IOC on surgical margins. The use of IOC on surgical margins may be optimal when it will affect intraoperative decision making framed by the stage of disease, tumor location, and surgical fitness of the patient.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×