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PubMed1999

Frozen section analysis in the management of skin cancers.

Frozen section analysis is used routinely to ensure complete removal of basal cell and squamous cell carcinomas of the skin, but the current emphasis on controlling costs raises the question as to which lesions should be evaluated with frozen section histology. A retrospective study of the clinical records and pathological reports of 51 patients selected randomly from a total of 225 patients was undertaken to determine the overall impact of frozen section analysis on the surgical management of skin cancers at this institution. The results indicate that frozen section analysis was performed on 76% of the 277 lesions evaluated, and that the results of frozen section examination were 91.1% accurate in detecting the presence or absence of tumor involvement at the surgical margins. The data also showed that the surgeons were able to estimate the margin of the skin tumor clinically and remove it entirely during the first excision 91.1% of the time. The lesions that had not been removed completely with the initial excision were those located on the periorbital region, forehead, and cheeks; were recurrent lesions; or were lesions that required more involved reconstruction than primary closure. This study shows that frozen section analysis is a valuable tool in selected situations, but routine use is not indicated for the majority of basal and squamous cell carcinomas of the skin.

Aged↗
PubMed1994

[Quality control of intraoperative diagnosis. Annual review of 1490 frozen sections].

A retrospective evaluation of the accuracy of frozen section diagnoses over 1-year period has been carried out. Of 20998 surgical pathology specimens accessioned during 1991, 1265 (6.0%) had intraoperative pathologic consultation; 1490 were the frozen section examinations effectively carried out, with an average of 1.2 frozen section diagnoses per case. Of all frozen sections performed, 4.6% were deferred; in the remaining cases, the concordance between frozen sections and the final histologic diagnoses was 97%. The reasons for diagnostic discordances were gross sampling error (51.2%), misinterpretation (44.2%), microscopic sampling (9.3%), technical problems in sectioning (2.3%). We believe that a similar continuous monitoring should be performed in every pathology department, to recognize the reasons of errors and, if possible, to reduce them.

Academies and Institutes↗
PubMed2004

Role of intraoperative frozen section in the management of thyroid nodules.

BACKGROUND: The role of intraoperative frozen section in the management of thyroid nodules is controversial. Its potential benefit is to facilitate one-stage total thyroidectomy. Most literature on this topic originates from overseas tertiary referral centres with a high percentage of cancer cases and a fully resourced frozen section service. The aim of the present study was to review all patients undergoing frozen section at a typical general surgical department in New Zealand (North Shore Hospital, Auckland) to see how often frozen section altered surgical strategy. METHODS: A retrospective review of all frozen sections between November 1999 and June 2003 was performed. Patient records, operation notes and pathology reports were reviewed. RESULTS: Forty-seven sequential frozen sections were included in the study. Thirteen patients had thyroid carcinoma (five follicular, three Hurthle cell, and five papillary). In only one patient did the result of an intraoperative frozen section result in a total thyroidectomy being performed instead of a thyroid lobectomy. The reason for this was the rare condition of Riedel's thyroiditis. In no patients did frozen section detect a cancer that was not diagnosed on preoperative fine-needle aspirate biopsy. CONCLUSION: The present review found little benefit in performing intraoperative frozen section in this setting. As a diagnostic test the cost of frozen section (NZ $200 for each frozen section) needs to be weighed against its low clinical benefit.

Adolescent↗
PubMed1998

The value of intraoperative consultation (frozen section) in the diagnosis of ovarian neoplasms.

BACKGROUND: Frozen Section is an important diagnostic tool to determine the nature of ovarian masses. However, like other diagnostic tools, frozen section also has some pitfalls. We aimed to discuss the source and the nature of inaccuracies associated with this procedure. METHODS: In this retrospective study 360 cases of ovarian masses examined by frozen section were re-evaluated. The sensitivity, specificity and predictive values of frozen section diagnosis of ovarian tumors were calculated. The reasons for the erroneous frozen-section diagnoses were discussed. RESULTS: Overall diagnostic agreement for ovarian lesions was 94.2%. Disagreements were found in nine cases (2.5%). Diagnosis was deferred to permanent sections in 12 cases (3.3%). The sensitivity for malignant tumors was 93.1% and specificity was 99.2%. The sensitivity for benign tumors was 99.2% and specificity was 92.1%. Most problematic cases were mucinous tumors, followed by tumors resembling fibrothecomas, in addition sections without viable tissue fragments or presence of extensive hemorrhage and necrosis also obscured the frozen diagnosis. Another factor was the lack of an effective communication between the surgeon and the pathologist. CONCLUSIONS: For an effective usage of this method not only the pathologist but also the surgeons must know the pitfalls of this method and also there must be good communication between the pathologist and the surgeon. Especially deferred cases should be minimized by good communication. In fact it's an intraoperative consultation method that enables the pathologist to gather all the preoperative, intraoperative findings and to be familiar with the further treatment plan of the patient.

Female↗
PubMed2005

Frozen section diagnosis and indications in ophthalmic pathology.

CONTEXT: Frozen sections for ophthalmic tissues require very precise indications. OBJECTIVE: To describe indications and procedures for frozen sections in ophthalmic pathology based on review of my experience and reports in the literature. DESIGN: Frozen sections received by the ophthalmic pathology service at The Methodist Hospital from 1996 to 2004 were reviewed. A review of the literature also was performed. RESULTS: Of the 277 specimens received, most were eyelid lesions (138, 49.8%), followed by orbital (106, 38.3%), temporal artery (17, 6.1%), optic nerve (9, 3.2%), and conjunctival (7, 2.5%) lesions. A review of appropriate indications for intraoperative diagnosis is presented and a description of tissue handling and procedures to obtain better results in ophthalmic pathologic lesion cases is discussed. CONCLUSIONS: The most frequent indications for frozen sections in ophthalmic abnormalities are for margin control in eyelid and orbital lesions. At my institution, the second most frequent indications for ophthalmic frozen sections are the evaluation of adequacy of tissue sampling and triaging for flow cytometry and molecular techniques, especially in childhood malignancies.

Conjunctiva↗
PubMed1994

Accuracy of frozen-section (intraoperative consultation) diagnosis of ovarian tumors.

OBJECTIVE: Frozen-section evaluation of ovarian tumors can be used to establish a histopathologic diagnosis and guide the surgeon to perform the appropriate surgical procedure. A retrospective study was conducted to determine the accuracy of frozen-section diagnosis of ovarian tumors. STUDY DESIGN: Frozen- and permanent-section diagnoses were divided into three categories (benign, borderline, and malignant). The sensitivity, specificity and predictive values, and 95% percent confidence intervals of each frozen-section diagnosis were determined. RESULTS: Three hundred eighty-three ovarian tumors that underwent frozen-section evaluation between June 1983 and June 1993 were studied. The final histopathologic diagnosis was 61.1% benign, 7.6% borderline, and 31.3% malignant. Frozen section was accurate in 92.7% of all cases and inaccurate in 7.3%. The sensitivity for malignant tumors was 92.5% tumors (95% confidence intervals 87.7% to 97.2%), the sensitivity for borderline tumors was 44.8% (95% confidence interval 26.4% to 63.2%). The specificity for benign tumors was 92.0% (95% confidence interval 88.6% to 95.4%) but increased to 97.9% (95% confidence interval 96.1% to 99.7%) if borderline tumors were excluded. The positive predictive value and 95% confidence intervals were 92.0% (88.6% to 95.4%) for benign tumors, 65% (43.6% to 86.5%) for borderline tumors, and 99.1% (97.3% to 100.0%) for malignant tumors. Thirteen of 16 (81%) ovarian lymphomas and tumors metastatic to the ovary were correctly identified by intraoperative frozen section. The sensitivity for borderline serous tumors was 64.3% and for borderline mucinous tumors 30.8% (p = 0.48). CONCLUSION: With the exception of borderline tumors, the sensitivity and specificity of frozen-section diagnosis of ovarian tumors are high. Borderline tumors remain difficult to accurately diagnose at frozen section because of the extensive sampling required. Frozen-section diagnoses have important implications regarding the type and extent of surgery performed at the initial operation.

Adolescent↗
PubMed1991

The accuracy of frozen section diagnosis of ovarian tumors.

We compared all frozen section examinations of ovarian tumors during a 6-year period in our institute with the final diagnosis from paraffin sections. In this period, 946 ovarian tumor specimens were removed for histologic assessment; 176 (18.6%) had frozen section examination. Final histological diagnosis was divided into benign (55.1%), borderline malignant (10.3%), and malignant (34.6%). Sensitivity of the frozen section method for malignant or borderline disease was 83.5% and specificity for a benign lesion, 92.8%. Predictive values and 95% confidence intervals were computed: 100% (93-100%) for malignancy, 62% (32-86%) for borderline malignancy, and 92% (85-96%) for a benign disease. Diagnostic problems occurred in large borderline tumors of mucinous cell type. Analysis of the 12 false negative diagnoses revealed that a sampling error was involved in 11 cases. A judgment error was made in the only false positive and in 1 out of 12 false negative frozen section diagnoses. It is concluded that when surgeons and pathologists are aware of the limitations of frozen section diagnosis of ovarian tumors, peroperative histologic examination can be worthwhile and prevent under- and overtreatment of gynecologic patients.

Adolescent↗
PubMed1993

Frozen section evaluation of donor livers before transplantation.

Frozen section examination was performed on 385 donor livers before transplantation. Exclusion criteria were applied to the donor livers examined to exclude potentially dysfunctional livers. The exclusion criteria included the following: severe macrovesicular steatosis, ischemic necrosis, prominent chronic portal inflammation, prominent periductular fibrosis, granulomatous inflammation, bridging fibrosis, and malignancy. Twenty-seven of the 385 donor livers examined were excluded before transplantation. The following histologic features were present in the excluded livers: severe steatosis (22), ischemic necrosis (2), portal inflammation (1), and periductular fibrosis (2). Steatosis was present in 51 of the 385 (13.25%) organs examined, including 22 of the donor organs excluded before transplantation. Twenty-nine livers with mild to moderate steatosis were implanted into size and blood type-matched recipients. Indicators of allograft function (prothrombin time and bilirubin) and damage (aspartate aminotransferase and alanine aminotransferase) were measured daily for the first 10 days after transplant. There was no statistically significant difference between the group of nonfat livers and donor livers containing mild steatosis. Statistically significant higher posttransplant serum alanine aminotransferase and prothrombin time levels were present in the patients with livers implanted with mild versus moderate steatosis. The 1-year survival rate for patients receiving fatty versus nonfatty donor livers was not statistically different (Kaplan-Meier, P = 0.592). No significant differences were found in the clinical and laboratory characteristics of donors whose organs were implanted compared with the clinical and laboratory characteristics of donors whose organs were excluded. The primary nonfunction rate after applying the exclusion criteria was 1.4%, which is a significant decrease compared with our primary nonfunction rate of 8.5% before using frozen section examination. Frozen section examination is useful in excluding donor organs which may become dysfunctional after transplantation.

Adenosine↗
PubMed1998

The accuracy of intraoperative frozen section in the diagnosis of ovarian tumors.

A retrospective study of 316 ovarian neoplasms which had frozen section evaluation between January 1, 1990 to December 31, 1995 was conducted to determine the accuracy of frozen section diagnosis of ovarian neoplasms. The frozen section results were compared with final diagnoses from paraffin sections. The frozen section diagnosis was accurate in 95.2% of all cases and inaccurate in 4.8%. The positive predictive value of a positive (or malignant) frozen section was 100%, the negative predictive value of a negative (or benign) frozen section was 98.2%. The sensitivity for malignant tumors as 87%. For tumors of borderline malignancy, the sensitivity and specificity were 60% and 98.6% respectively. Of the false negative frozen section diagnoses, 73% (8 cases) occurred in tumors of borderline malignancy. We concluded that with the exception of the sensitivity for the diagnosis of tumors of borderline malignancy, the sensitivity and specificity of frozen section diagnosis for benign and overtly malignant ovarian neoplasms are high.

Adolescent↗
PubMed1989

An immunohistochemical method for the study of aminoglycoside ototoxicity in the guinea pig cochlea using decalcified frozen sections.

An immunohistochemical technique with decalcified frozen sections was used to study aminoglycoside ototoxicity. Decalcified guinea pig cochleas were cut with a fine blade parallel to the plane of the modiolus to facilitate the penetration of inclusion material and the manipulation of frozen sections. Light microscopy was carried out and additional frozen sections were employed for an immuno-electron microscopic study. Twenty-four hours after a single transtympanic injection of 10 mg gentamicin, there was a definite distribution of the drug in only type I hair cells of the ampullae as well as in both inner and outer hair cells along the length of the cochlea. In those animals treated intraperitoneally with 200 mg/kg amikacin for 8 days, the drug was located in the outer hair cells of the cochlea, with a tendency to decrease from base to apex and in the inner hair cells towards the apex.

Amikacin↗
PubMed1998

Accuracy of frozen section diagnosis in gynecology.

OBJECTIVE: A retrospective study was undertaken to evaluate the accuracy of frozen section diagnosis in gynecological surgery. METHODS: We compared the results of 792 consecutive gynecological frozen section diagnoses with their final diagnoses from January 1991 to June 1996. Slides for which the frozen section diagnosis was uncertain or incompatible with the final diagnosis were reviewed by an attending pathologist to determine the possible causes. RESULTS: A total of 299 ovarian, 390 lymph node, 56 uterine lesions, and 77 other tissue samples were obtained. The frozen section diagnosis was compatible with the final diagnosis in 97.5% of cases. The sensitivity for nonbenign lesions was 90.9%, and the specificity was 99.5%. There were no false positives or overestimated cases; 1.3% of cases were falsely negative, 0.4% underestimated the degree of malignancy, and 0.9% were uncertain. Possible causes for incompatible or uncertain frozen section diagnoses were analyzed. The accuracy of frozen section diagnoses for ovarian, lymph node, uterine, and other tissues was also evaluated. Frozen section was found to identify correctly 13 of 17 ovarian malignancies metastaic from other organs, 14 of 15 germ cell malignancies, and 3 of 4 dysgerminomas. The low sensitivity in ovarian borderline malignancy was due to the even lower sensitivity in its mucinous subgroup. The relationship between section numbers and accuracy of frozen section diagnosis in mucinous ovarian tumors was assessed. CONCLUSIONS: Frozen section diagnosis in gynecology is sufficiently accurate for clinical use, with a low false negative rate and an even lower false positive rate. Most incompatible frozen section diagnoses occurred in ovarian lesions, especially in mucinous ovarian tumors. Performing multiple sections (at least one section for every 10 cm in diameter) is recommended in the frozen section diagnosis of mucinous ovarian tumors.

Female↗
PubMed2000

Accuracy of frozen section diagnosis in borderline ovarian malignancy.

This study was conducted to determine the accuracy of frozen section diagnosis in borderline ovarian tumors. Thirty-three patients were evaluated on the basis of frozen sections between February 1992 and December 1997. Frozen section diagnosis and final diagnosis were divided into three categories: for frozen section diagnosis: 1 = benign, 2 = borderline, 3 = 'at least' borderline, and for final diagnosis: 1 = benign, 2 = borderline, 3 = cancer. Three patients with a benign diagnosis according to their frozen sections were reclassified as borderline in the final diagnosis and all of them were of the mucinous type. The frozen section diagnosis of tumors of borderline malignancy was inaccurate in 3 of 23 patients. Four of 7 patients with at least borderline according to their frozen section diagnosis had invasive cancer at the final diagnosis. The correlation between frozen section diagnosis and final pathological examination was 72.7% (24/33). We found 9% (2/22) inaccurate results in the serous type and 36.6% (4/11) in the mucinous type. The sensitivity and specificity of frozen section diagnosis were found to be 86.95 and 57.14%, respectively. We concluded that frozen section evaluation in identifying a borderline ovarian malignancy is accurate enough to exclude the presence of a benign pathology.

Adenocarcinoma, Mucinous↗
PubMed1987

An evaluation of frozen section biopsy in 4434 cases.

Frozen section diagnosis is a highly useful method of diagnosis. There were 4434 frozen sections, 24 false positive diagnosis, 65 false negative diagnosis and 30 deferred diagnosis. This method achieves the highest accuracy when there is a cooperation between experienced surgeon and reliable and careful pathologist. It is wise to defer the diagnosis of consult to other pathologist in difficult situation.

Biopsy↗
PubMed2001

Randomized prospective evaluation of frozen-section analysis for follicular neoplasms of the thyroid.

OBJECTIVE: To evaluate the clinical utility of frozen section in patients with follicular neoplasms of the thyroid in a randomized prospective trial. SUMMARY BACKGROUND DATA: The finding of a follicular neoplasm on fine-needle aspiration prompts many surgeons to perform intraoperative frozen section during thyroid lobectomy. However, the focal distribution of key diagnostic features of malignancy contributes to a high rate of noninformative frozen sections. METHODS: The series comprised 68 consecutive patients with a solitary thyroid nodule in whom fine-needle aspiration showed a follicular neoplasm. Patients were excluded for bilateral or nodal disease, extrathyroidal extension, or a definitive fine-needle aspiration diagnosis. Final pathologic findings were compared with frozen sections, and cost analyses were performed. RESULTS: Sixty-one patients met the inclusion criteria. Twenty-nine were randomized to the frozen-section group and 32 to the non-frozen-section group. In the non-frozen-section group, one patient was excluded when gross examination of the specimen was suggestive of malignancy and a directed frozen section was diagnostic of follicular carcinoma. Frozen-section analysis rendered a definitive diagnosis of malignancy in 1 of 29 (3.4%) patients, who then underwent a one-stage total thyroidectomy. In the remaining 28 patients, frozen section showed a "follicular or Hürthle cell neoplasm." Permanent histology demonstrated well-differentiated thyroid cancer in 6 of these 28 patients (21%). Of the 31 patients in the non-frozen-section group, 3 (10%) showed well-differentiated thyroid carcinoma on permanent histology. Complications were limited to one transient unilateral vocal cord dysfunction. All but one patient had a 1-day hospital stay. There were no significant differences between the groups in surgical time or total hospital charges; however, the charge per informative frozen section was approximately $12,470. CONCLUSIONS: For the vast majority of patients (96.4%) with follicular neoplasms of the thyroid, frozen section is neither informative nor cost-effective.

Adenocarcinoma, Follicular↗
PubMed1987

Frozen section diagnosis and the thyroid.

The diagnostic problems arising from frozen section evaluation of thyroid lesions are complex and beclouded in controversy. Prime examples include follicular and Hurthle cell neoplasms, both of which lack standardization in classification and management. The seemingly straightforward identification of papillary carcinoma is often complicated by the frequent absence of its distinguishing features, some of which are reportedly restricted to formalin-fixed paraffin embedded material. Thyroiditides and thyroidal ectopias present unique and separate differential diagnostic considerations that at the time of frozen section may pose problems for surgeon and pathologist alike. These issues and their controversial aspects are addressed, and potential diagnostic pitfalls related to frozen section diagnosis of thyroid lesions in general are outlined. An analysis of 300 thyroid frozen sections over a 5-year period and the histologic frozen section features of 40 papillary thyroid carcinomas are also presented. The presence of optically clear nuclei was identified in frozen sections from 15 cases, and was extensive in one. Thirty-eight of 40 cases displayed optically clear nuclei within permanent sections. It is suggested that this cytologic feature is not the exclusive domain of permanent section, and when present in the frozen section may be helpful in identifying papillary carcinoma, especially when an obvious papillary component is lacking.

Carcinoma, Papillary↗
PubMed2003

[Accuracy of intraoperative frozen section diagnosis in non palpable breast lesions: a series of 791 cases].

The aim of this study is to estimate the accuracy and reliability of intraoperative frozen section of nonpalpable breast lesions. In fact, frozen section of palpable breast lesions has proven to be valid, but its use in breast infraclinic lesions has been discussed recently, with the publication of European recommendations. Diagnosis on frozen section was routinely performed in a serie of 791 patients with nonpalpable mammographically detected abnormalities breast lesions from January 1990 through July 2000. The initial frozen section diagnoses with known mammographic pattern were compared with the diagnoses obtained on permanent paraffin sections to estimate the accuracy of frozen sections. Frozen section diagnosis was delayed until final diagnosis assessed on permanent paraffin sections in only 8 cases (1%). Frozen section diagnoses were accurate in 744 of 783 cases (95%). The diagnosis was modified on the basis of permanent sections in 39 cases; consisting of 39 false negative. No false positive diagnosis was noted. Sensitivity and specificity of frozen section diagnoses were 87,69 and 100, respectively. When the comparison between frozen and permanent section was analyzed according to the mammographic pattern, the sensitivity among patients with microcalcifications was lower (75,23) than among patients with opacities (93,86). When frozen section and permanent section diagnoses were related according to the mammographic size ( 10 mm) the sensitivity among patients with opacities measuring less than 10 mm was lower (91,75) than among patients with opacities larger than 10 mm (95,65) and the sensitivity among patients with microcalcifications larger than 10 mm was greater (77,14) than among patients with microcalcifications size less than 10 mm (74,28). This results are similar to those obtained on palpable breast lesions, and show that frozen section is a feasible and reliable procedure in nonpalpable breast lesions, particularly more relevant in mammographic opacities than in microcalcifications, whatever the lesion size.

Breast↗
PubMed2006

Surgical treatment of solitary thyroid nodules via fine-needle aspiration biopsy and frozen-section analysis.

BACKGROUND: Fine-needle aspiration biopsy (FNAB) and frozen-section analysis of managing solitary thyroid nodules continue to generate considerable controversy. METHODS: This study was a retrospective review of 619 patients with solitary thyroid nodules who underwent thyroidectomy. RESULTS: Of 540 FNABs, 35 (6.5%) were positive for malignancy, 276 (51.1%) were benign, and 229 (42.4%) were suspicious. Only 5.1% were false negative, and 11.4% were false positive. Diagnostic FNAB sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for malignancy were 86.1%, 59.7%, 33.0%, 94.9%, and 64.6%, respectively. Of 569 patients analyzed by frozen section, diagnosis was deferred in 86 (15.1%) patients, and results were positive for malignancy in 92 (16.2%) and benign in 391 (68.7%). No false-positive results were noted, but 2.3% (391) were false negative. Of 86 deferred frozen sections, 11 (12.8%) patients had malignant tumors confirmed by permanent section. Diagnostic frozen-section sensitivity, specificity, PPV, NPV, and accuracy for carcinoma were 82.1%, 100%, 100%, 95.8%, and 96.5%, respectively. Sensitivity, specificity, PPV, NPV, and accuracy for frozen-section analysis for diagnosis of carcinoma in patients with suspicious FNAB were 83.9%, 100%, 100%, 94.9%, and 96.0%, respectively. CONCLUSIONS: FNAB is a sensitive diagnostic modality in selecting patients who require surgery. Routine use of frozen-section analysis is unwarranted for benign FNAB results. Frozen section is specific and cost-effective in determining the extent of surgery in patients with suspicious or malignant FNABs.

Adolescent↗
PubMed2005

Diagnostic accuracy of frozen section diagnosis of the adnexal mass: a metaanalysis.

BACKGROUND: Frozen section diagnosis is a diagnostic procedure for the assessment of the adnexal mass during surgery. The purpose of the present study was to perform a systematic review of the literature on the accuracy of frozen section diagnosis in the assessment of the adnexal mass. METHODS: We performed a computerized Medline and EMBASE search to identify all registered articles published between January 1966 and June 2003, comparing frozen section diagnosis of ovarian pathology to the final histopathological diagnosis. For each study, we calculated the prevalence of malignant and borderline tumors, and the sensitivity and specificity of the frozen section diagnosis using the final histopathological diagnosis as reference. We performed the calculations in two ways. In the first analysis, tumors that were found to be borderline were considered as malignant in the 2 x 2 table. In the second analysis, tumors that were found to be borderline were considered as benign in the 2 x 2 table. RESULTS: Eighteen studies were included for analysis. When the diagnosis borderline was classified as malignant, the sensitivity of frozen section diagnosis varied between 65% and 97%, and the specificity between 97% and 100%. When the diagnosis borderline was considered to be benign, the sensitivity varied between 71% and 100%, for a specificity varying between 98.3% and 100%. CONCLUSION: The accuracy of frozen section diagnosis for the assessment of the ovarian mass is good, with acceptable sensitivities for almost perfect specificities. Future studies on patient preferences for the different outcomes as well as economic analysis are needed for definite position of this diagnostic technique.

Adnexa Uteri↗