Camilla Christine Qvist, Mie Bruun Elmbak, Julie Smith, Josefine Staldgaard, Gry Lipczak, Majbritt Wagner-Eckert, Tina Klitmøller Agander
Intraoperative frozen section (FS) analysis is critical in surgical pathology, but conventional hematoxylin and eosin (H&E) staining has limitations in poorly differentiated neoplasms and resection margins. Immunohistochemistry (IHC) provides higher diagnostic specificity, yet has traditionally been too time-consuming for intraoperative urgency. This study aimed to optimize, validate, and evaluate Fast Frozen Rapid Automated Immunohistochemistry (FFRA-IHC) using the Q-Stain X Autostainer to improve surgical diagnostics. After optimization with antibodies CKAE, CK5, CK7, CD45, and Synaptophysin, 44 tissue samples from patients undergoing surgery at Rigshospitalet, Copenhagen, were analyzed by FS H&E, FFRA-IHC, and standard formalin-fixed paraffin-embedded (FFPE) methods. Automated FFRA-IHC showed high diagnostic accuracy and supported immediate clinical decision-making: of 37 tumors not classifiable by FS H&E alone, 25 (68%) were classified into specific tumor types, and all five ambiguous resection margins were resolved. A cost–benefit analysis indicated efficiency gains with reduced hands-on time compared to manual IHC. In conclusion, FFRA-IHC demonstrated promising results for enhancing intraoperative diagnostics, leading to its implementation in the daily workflow at our department. Future studies should expand antibody panels and assess the broader clinical impact to further improve intra- and perioperative care.
术中冷冻切片(FS)分析在外科病理中是至关重要的,但传统的苏木精和伊红(H&E)染色在低分化肿瘤和切除边缘有局限性。免疫组织化学(IHC)提供了更高的诊断特异性,但传统上对术中急症诊断过于耗时。本研究旨在优化、验证和评估使用Q-Stain X Autostainer的快速冷冻快速自动免疫组织化学(FFRA-IHC),以提高外科诊断。经抗体CKAE、CK5、CK7、CD45和Synaptophysin优化后,采用FS H&E、FFRA-IHC和标准福尔马林固定石蜡包埋(FFPE)方法对哥本哈根Rigshospitalet手术患者的44份组织样本进行分析。自动FFRA-IHC显示出较高的诊断准确性,并支持即时的临床决策:在37个无法单独用FS H&E分类的肿瘤中,25个(68%)被分类为特定的肿瘤类型,所有5个模糊切除边缘都得到了解决。成本效益分析表明,与手工IHC相比,减少了动手时间,从而提高了效率。综上所述,FFRA-IHC在加强术中诊断方面显示出良好的效果,因此在我科的日常工作中得以实施。未来的研究应扩大抗体组,并评估更广泛的临床影响,以进一步改善术中和围手术期护理。
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