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Discovery Medicine Jul 2019The goal of this study is to evaluate a novel direct immunohistochemistry staining method on frozen tissues for the intraoperative diagnosis of breast papillary lesions.
AIMS
The goal of this study is to evaluate a novel direct immunohistochemistry staining method on frozen tissues for the intraoperative diagnosis of breast papillary lesions.
METHODS AND RESULTS
Keratin 5 (CK5) and smooth muscle myosin heavy chain (SMMHC) antibodies were labeled with horseradish peroxidase polymers and used for direct immunohistochemistry (IHC) staining on frozen sections of breast tissues during surgical operations. The results from direct IHC on 102 cases of breast papillary lesions were compared with those obtained by the conventional staining method on formalin-fixed paraffin-embedded tissues (FFPE). Compared to the conventional method, direct IHC staining can significantly improve the accuracy of intraoperative diagnosis of breast papillary lesions from 70% to 97% (p < 0.01). No false negative cases were found with direct IHC in this study. In comparison, 53% of cases with the conventional method were found false negative. Direct IHC also significantly reduced the deferred diagnosis rate from 21% to 3% (p < 0.01). Furthermore, the entire procedure of direct IHC can be finished within 10 minutes, which makes it more feasible for the use of intraoperative frozen section diagnosis.
CONCLUSION
The direct IHC staining method can significantly improve the efficiency and accuracy of intraoperative diagnosis of breast papillary lesions. It also fits better for the quick turnaround time required for intraoperative diagnosis.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Breast Neoplasms; Female; Frozen Sections; Humans; Immunohistochemistry; Intraoperative Care; Keratin-5; Middle Aged; Predictive Value of Tests
PubMed: 31465723
DOI: No ID Found -
Archives of Pathology & Laboratory... May 2022Intraoperative consultation-frozen section diagnosis (FSD)-determines tumor pathology and guides the optimal surgical management of ovarian neoplasms intraoperatively.
CONTEXT.—
Intraoperative consultation-frozen section diagnosis (FSD)-determines tumor pathology and guides the optimal surgical management of ovarian neoplasms intraoperatively.
OBJECTIVE.—
To evaluate the diagnostic accuracy of the FSD and analyze the discrepancy between the FSD and final diagnosis.
DESIGN.—
This is a retrospective study of 618 ovarian neoplasm FSDs from 2009 to 2018 at a tertiary health care center. The discrepant cases were reviewed and reevaluated by gynecologic and general surgical pathologists. The outcomes of interest were performing unnecessary procedure, returning for a second surgery, and 30-day postoperative mortality.
RESULTS.—
The sensitivity and the positive predictive value of the FSD were lower in borderline tumors than in benign and malignant epithelial ovarian tumors. Major and minor discrepancies were identified in 5.3% (33 of 618) and 12.3% of (76 of 618) cases, respectively. A root cause analysis of the major discrepant cases showed that sampling error accounted for 43% (14 of 33). The discrepancy distributions of gynecologic and general surgical pathologists were statistically similar in the overall cohort (P = .65). The overall κ for diagnostic agreement among gynecologic pathologists, general surgical pathologists, and final diagnosis was 0.18 (0.10-0.26, P < .001), implying only a slight overall agreement. Of the major discrepant cases, only 3 had a clinical implication. One overdiagnosed patient underwent an unecessary procedure, and 2 underdiagnosed patients were recommended to return for a second surgery. No patient had 30-day postoperative mortality.
CONCLUSIONS.—
Frozen section diagnosis remains a definitive diagnostic tool in ovarian neoplasms and plays a crucial role in guiding intraoperative surgical management.
Topics: Female; Frozen Sections; Humans; Ovarian Neoplasms; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity
PubMed: 34402886
DOI: 10.5858/arpa.2020-0686-OA -
Asian Pacific Journal of Cancer... Feb 2019Glioma is the commonest primary intracranial tumour and it has been the most predominant tumour in many studies. It accounts for 24.7% of all primary brain tumour and... (Review)
Review
Glioma is the commonest primary intracranial tumour and it has been the most predominant tumour in many studies. It accounts for 24.7% of all primary brain tumour and 74.6% of malignant brain tumour. Intraoperative diagnosis plays a crucial role in determining the patient management. Frozen section has been the established technique in providing rapid and accurate intraoperative diagnosis. However due to some disadvantages like ice crystal artefact, high expenditure and requirement of skilled technician, there is increase usage of cytology smear either replacing or supplementing frozen section technique. The aim of this review is to determine the diagnostic accuracy of cytology smear and frozen section in glioma and to see whether there is significant difference between those techniques. The overall diagnostic accuracy for frozen section in glioma ranging from 78.4% to 95% while for cytology smear, the diagnostic accuracy ranging from 50% to 100%. Based on certain literatures, no statistically difference was observed in diagnostic accuracy of cytology smear and frozen section. Thus, cytology smear provides an alternative method in establishing intraoperative diagnosis. Both cytology smear and frozen section are complimentary to each other. It is recommended to use both techniques to improve the diagnostic accuracy in addition with adequate knowledge, clinical history, neuroimaging and intraoperative findings.
Topics: Brain Neoplasms; Cytodiagnosis; Frozen Sections; Glioma; Humans; Intraoperative Period
PubMed: 30803189
DOI: 10.31557/APJCP.2019.20.2.321 -
Archives of Pathology & Laboratory... Jan 2022Pancreatic adenocarcinoma is the third leading cause of cancer death in the United States. Surgery remains the mainstay of treatment, and frozen section analysis is used...
CONTEXT.—
Pancreatic adenocarcinoma is the third leading cause of cancer death in the United States. Surgery remains the mainstay of treatment, and frozen section analysis is used to confirm diagnosis and determine resectability and margin status.
OBJECTIVE.—
To evaluate use and accuracy of frozen section and how diagnosis impacts surgical procedure.
DESIGN.—
We reviewed patients with planned pancreatic resections between January 2014 and March 2019 with at least 1 frozen section. Pathology reports including frozen sections, preoperative cytology, and operative notes were reviewed. Frozen sections were categorized by margin, primary pancreatic diagnosis, metastasis, or vascular resectability. The deferral and error rates and surgeons' response were noted.
RESULTS.—
We identified 898 planned pancreatic resections and 221 frozen sections that were performed on 152 cases for 102 margins, 94 metastatic lesions, 20 primary diagnoses, and 5 to confirm vascular resectability. The diagnosis was deferred to permanent sections in 13 of 152 cases (8.6%) on 16 of 221 frozen sections (7.2%): 6 for metastasis, 8 for margins, and 2 for primary diagnosis. Discrepancies/errors were identified in 4 of 152 cases (2.6%) and 4 of 221 frozen sections (1.8%). Surgeons' responses were different than expected in 8 of 221 frozen sections (3.6%), but their actions were explained by other intraoperative findings in 6 of 8.
CONCLUSIONS.—
Frozen section remains an important diagnostic tool used primarily for evaluation of margins and metastasis during pancreatectomy. In most cases, a definitive diagnosis is rendered, with occasional deferrals and few errors. Intraoperative findings explain most cases where surgeons act differently than expected based on frozen section diagnosis.
Topics: Adenocarcinoma; Diagnostic Errors; Frozen Sections; Humans; Pancreas; Pancreatectomy; Pancreatic Neoplasms; Retrospective Studies
PubMed: 33769446
DOI: 10.5858/arpa.2020-0483-OA -
Archives of Pathology & Laboratory... Jul 2017- The use of frozen section in thoracic pathology includes assessment of peripheral lung lesions with lepidic pattern, with greater emphasis on evaluating lung-sparing... (Review)
Review
CONTEXT
- The use of frozen section in thoracic pathology includes assessment of peripheral lung lesions with lepidic pattern, with greater emphasis on evaluating lung-sparing resections and margin assessment.
OBJECTIVE
- To review pitfalls of frozen section in thoracic pathology; in this setting, reduction of false-positive and false-negative diagnosis in lesion identification and margin assessment is critical.
DATA SOURCES
- PubMed search of frozen section lung pathology yielded specific references related to the use of frozen section in the identification of lepidic lesions and the clinical recommendation for margin distance.
CONCLUSIONS
- Frozen section diagnosis is overall accurate in assessment of lepidic lesions. Pitfalls include rare benign mimickers and more common reactive lesions. Standard approaches to gross assessment and margin measurement require further research with increasing use of lung-sparing resections.
Topics: Frozen Sections; Humans; Lung Diseases; Pathology, Clinical
PubMed: 27763791
DOI: 10.5858/arpa.2016-0415-RA -
Gynecologic Oncology Sep 2022In adult women, most malignant ovarian tumors are epithelial in origin. The use of intra-operative frozen section to distinguish between benign and malignant histology... (Review)
Review
PURPOSE
In adult women, most malignant ovarian tumors are epithelial in origin. The use of intra-operative frozen section to distinguish between benign and malignant histology is reliable in guiding operative decision-making to determine the extent of surgical staging required. Pediatric and adolescent patients with ovarian masses have a much different spectrum of pathology with most tumors arising from germ cell precursors. This review was undertaken to assess the concordance between the intra-operative frozen section and the final diagnosis as an aid to guide extent of surgical staging in a group of pediatric and adolescent patients with malignant ovarian germ cell tumors.
METHODS
Records of patients aged 0 to 20 years with malignant ovarian germ cell tumors enrolled on Children's Oncology Group study AGCT0132 were reviewed. Pathology reports from patients who had both intra-operative frozen section diagnosis and final paraffin section diagnosis were compared using descriptive statistics. By inclusion criteria for the study, all patients had a final diagnosis of malignancy with required yolk sac tumor, choriocarcinoma or embryonal carcinoma histology. Available central review of pathology final paraffin section slides were compared with final institution pathology reports.
RESULTS
Of 131 eligible patients with ovarian germ cell tumors, 60 (45.8%) had both intra-operative frozen section and final paraffin section diagnoses available. Intra-operative frozen section diagnoses were classified as: incorrect diagnosis of benign tumor (13.3%), confirmation of malignancy (61.7%), immature teratoma (16.7%), germ cell tumor not otherwise specified (5%) and no diagnosis provided (3.3%). Intra-operative frozen section was incorrect in 23 of 60 (38.3%) patients evaluated. Central pathology review was concordant with the final institution pathology diagnosis in 76.3% of patients. Central pathology review identified additional germ cell tumor components in 23.7% of patients.
CONCLUSIONS
In pediatric and adolescent patients with a confirmed final diagnosis of ovarian germ cell malignancy, intra-operative frozen section diagnosis is not reliable to inform the extent of surgical staging required. Central review by an expert germ cell tumor pathologist provides important additional information to guide therapy.
Topics: Adolescent; Adult; Child; Female; Frozen Sections; Humans; Neoplasms, Germ Cell and Embryonal; Ovarian Neoplasms; Paraffin; Retrospective Studies; Testicular Neoplasms
PubMed: 35750503
DOI: 10.1016/j.ygyno.2022.06.013 -
Indian Journal of Ophthalmology Dec 2019To analyze the diagnostic accuracy of frozen section in orbital and adnexal malignancies.
PURPOSE
To analyze the diagnostic accuracy of frozen section in orbital and adnexal malignancies.
METHODS
A total of 55 cases between January 2006 and December 2011 for which intraoperative frozen section was performed for various orbital and adnexal lesions were included in the study. The frozen section diagnosis was compared with the permanent section diagnosis. Margin clearance was also compared between the two. Data were analysed using SPSS version 14. Odds ratio and cross-tabulation was used to perform the analysis.
RESULTS
The mean age at presentation was 51.46 ± 20 years. Eyelid was the most common site of involvement. Out of 55 cases, diagnosis was deferred in four cases (7.27%) on frozen section. Among 51 cases, 44 (86%) cases were concordant, whereas 7 (13%) cases were discordant. The sensitivity and specificity of frozen section compared to permanent section for diagnosis of malignancy was found to be 87.2% and 87.5%, respectively. The sensitivity and specificity of frozen section for diagnoses of basal cell carcinoma was found to be 100%, while it was 83.3% and 100% respectively for sebaceous gland carcinoma and 87.5% and 94.9% respectively for squamous cell carcinoma.
CONCLUSION
Frozen section had high sensitivity and specificity when compared with permanent section for all three parameters studied. It is an important intraoperative tool that is increasingly being used in histopathological examination of ophthalmic lesions. However, it should not be used as a substitute for the permanent section and critical decisions based on it are best avoided.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Conjunctival Neoplasms; Eye Neoplasms; Eyelid Neoplasms; Female; Frozen Sections; Humans; Infant; Lacrimal Apparatus Diseases; Male; Middle Aged; Orbital Neoplasms; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity
PubMed: 31755434
DOI: 10.4103/ijo.IJO_2096_18 -
Neurology India 2022Pediatric central nervous system (CNS) tumors have a different histological spectrum as compared to adults with the infantile group having even more varied and distinct...
BACKGROUND
Pediatric central nervous system (CNS) tumors have a different histological spectrum as compared to adults with the infantile group having even more varied and distinct histological profiles. Intra-operative diagnosis is especially important as it guides the neurosurgeon to tailor an approach which is best suited for a particular case. The aim of the study was to evaluate the diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value of frozen section (FS) and squash cytology and to find out the degree of correlation (kappa value) between the two procedures.
MATERIALS AND METHODS
A prospective study was conducted on 55 pediatric patients with clinicoradiologically diagnosed CNS lesions for a period of 2.5 years. Intra-operative squash smears and FS were made and stained with hematoxylin and eosin stain. Diagnosis made subsequently on paraffin embedded sections was taken as the gold standard.
RESULTS
Although the specificity (90%) and positive predictive value (96%) were comparable between the two procedures, sensitivity (91.4%) and negative predictive value (75%) of FS was more as compared to squash cytology. Both the diagnostic modalities showed substantial agreement (k = 0.728).
CONCLUSION
Even though the histological spectrum of pediatric CNS tumors is more varied than adults, FS gives a reasonable intra-operative diagnosis and better results when compared to squash alone.
Topics: Adult; Central Nervous System Neoplasms; Child; Cytodiagnosis; Frozen Sections; Humans; Predictive Value of Tests; Prospective Studies
PubMed: 35532645
DOI: 10.4103/0028-3886.344656 -
Ear, Nose, & Throat Journal Sep 2022This study aimed to compare the intraoperative frozen section with the surgical margin in the postoperative surgical margins of the postoperative pathology of oral...
PURPOSE
This study aimed to compare the intraoperative frozen section with the surgical margin in the postoperative surgical margins of the postoperative pathology of oral squamous cell carcinomas in order to examine the reliability of the frozen section.
METHODS
A retrospective analysis was conducted for patients who underwent surgery for oral squamous cell carcinoma in a tertiary hospital between January 2018 and 2019. The intraoperative frozen section examinations, grade of the tumor, number of lymph nodes, number of affected lymph nodes, depth of invasion, perineural invasion, lymphovascular invasion, and extranodal extension were recorded from the pathological records. The concordance between the frozen section examination and postoperative pathology 2 methods was examined using the Cronbach α coefficient. Sensitivity, specificity, positive predictive value, negative predictive value regarding surgical margins, and accuracy were calculated and reported.
RESULTS
Overall, 181patients who underwent surgery for oral cavity cancers were included; 118 (65.2%) were males. The mean (± standard deviation) age of the included participants was 57.4 ± 16.1 years. The most common tumour subsite was the tongue (n = 71, 39.2%). There was concordancy between the frozen, positive intraoperative malignancy and the postoperative pathology malignancy. The frozen, negative intraoperative malignancy and postoperative safe surgical margin did not significantly differ.
CONCLUSION
As a result of intraoperative frozen examination, we found conformity between the postoperative pathology results of patients with positive and negative surgical margins. Frozen section examination could be used safely to examine intraoperative surgical margins of oral squamous cell carcinoma.
Topics: Adult; Aged; Carcinoma, Squamous Cell; Female; Frozen Sections; Head and Neck Neoplasms; Humans; Male; Margins of Excision; Middle Aged; Mouth Neoplasms; Reproducibility of Results; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck
PubMed: 33155855
DOI: 10.1177/0145561320967334 -
Archives of Pathology & Laboratory... Dec 2005Frozen section of the liver is a comparatively frequent request that most often applies to a relatively limited number of situations. The only indication for frozen... (Review)
Review
CONTEXT
Frozen section of the liver is a comparatively frequent request that most often applies to a relatively limited number of situations. The only indication for frozen tissue examination of a gallbladder with any frequency is the presence of a polypoid mucosal lesion or a suspicious thickening of the gallbladder wall. A variety of intraoperative consultations may be applicable during surgery of the pancreas.
OBJECTIVE
To examine the indications and pitfalls regarding the gross examination and frozen section performance for liver, gallbladder, and pancreas.
DATA SOURCES
Author experience and review of the pertinent literature.
CONCLUSIONS
Although indications are relatively straightforward for frozen section of liver and gallbladder, handling of the pancreas specimens for frozen tissue examination is often a cause for a certain degree of anxiety. This situation is the result of a relative rarity of such specimens outside large tertiary referral medical centers coupled with a variety of confounding factors, including the presence of chronic pancreatitis with distortion of the normal structures and the frequent presence of variable degrees of dysplasia. The suboptimal preservation of the frozen tissue adds further angst to the scenario. In this article, the main issues are critically examined in light of the experience of the author and others.
Topics: Frozen Sections; Gallbladder Diseases; Humans; Intraoperative Period; Liver Diseases; Pancreatic Diseases; Pathology, Surgical; Referral and Consultation
PubMed: 16329733
DOI: 10.5858/2005-129-1610-FSEOLG