Frozen section diagnosis of pancreatic lesions

BACKGROUND: The clinical and radiologic diagnosis of pancreatic cancer and the safety of pancreatic resections have improved. These improvements, together with the indication for resection in some cases of complicated chronic pancreatitis, have reduced the necessity for confirmed preoperative tissue diagnosis. We investigated the clinical use and accuracy of frozen section diagnosis for pancreatic lesions. DESIGN: We searched archival files for the years 1989-2000 for patients with pancreatic lesions who had received a diagnosis based on frozen section results. We compared the diagnosis of all frozen section slides with that of the permanent sections and reviewed the clinical follow-up notes. We evaluated histologic features useful in differentiating between malignant and benign pancreatic lesions. RESULTS: A total of 538 patients underwent surgical biopsy and/or resection for suspected pancreatic lesions. Frozen section was requested in 131 cases (284 frozen sections). Ninety cases had frozen section of the pancreatic lesions, 70 cases had frozen section of metastatic sites, and 29 cases had frozen section of surgical margins. Of the 90 cases in which frozen section of the pancreatic lesions was requested, malignancy was diagnosed in 44, a benign lesion was diagnosed in 37, and the diagnosis was atypical and deferred in 9. In total, 3 false-negative frozen sections and 1 false-positive frozen section were identified for respective rates of 1.2% and 0.3%. In all cases in which the frozen section diagnosis was deferred or was inconsistent with the operative impression, and the surgeon acted on his/her impression, the operative diagnoses were subsequently confirmed by additional permanent sections and/or clinical follow-up. The most useful histologic features for the diagnosis of pancreatic adenocarcinoma in frozen sections were variation in nuclear size of at least 4:1, disorganized duct distribution, incomplete duct lumen, and infiltrating single cells. CONCLUSIONS: Frozen sections are useful in conjunction with the impression at surgery for the management of patients with pancreatic lesions. Frozen sections of resection margins were 100% accurate; frozen sections of pancreatic lesions or metastatic sites were accurate in 98.3% of cases. We found an acceptable rate of deferred frozen section (6.6%). The experienced surgeon's impression of malignancy is reliable in cases in which frozen section is deferred or has negative findings.     

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.     

Frozen section diagnosis in tumors of the pancreas

Accurate diagnosis utilizing frozen section techniques is critical to proper patient treatment. It can be accomplished reliably and consistently. Communication and cooperation between the pathologist and the surgeon are indispensible aspects in managing such cases. Proper treatment requires an ability to subclassify the pancreatic tumors, and this can be successfully performed using frozen sections.     

Frozen section diagnosis for axillary sentinel lymph nodes: the first six years.

Intraoperative frozen section of axillary lymph nodes for the detection of metastatic breast cancer has been controversial because of the labor-intensive techniques necessary to obtain a highly sensitive test, and because of the uncertain significance of frequently detected submicrometastatic carcinoma. In total, 874 consecutive axillary sentinel lymph node cases examined by intraoperative frozen section over a 6-year period were reviewed retrospectively. Frozen section had a sensitivity of 60% and was 100% specific, but when cases with submicrometastatic tumor cells were considered negative, the sensitivity rose to 83%. Rare cases were called 'atypical' on frozen section; almost all of these cases were negative for carcinoma on permanent sections.     

Frozen section diagnosis of ovarian epithelial tumours: a practical guide for pathologists

The most common indication for frozen section at our Centre (NGOC, Gateshead, UK) is for the diagnosis of ovarian masses. The other indications are to assess the nature of uterine masses, assess adequacy of resection margins in trachelectomy specimens and assessment of lymph nodes for metastases prior to extensive surgical procedures such as pelvic exenterations and laterally extended endopelvic resections. This article will focus on practical issues relating to ovarian epithelial tumours, the most frequent group of tumours submitted for frozen section diagnosis. It will provide guidance on the approach to common entities, diagnostic pitfalls, and strategies for dealing with less frequently encountered lesions. Emphasis will be placed on macroscopic examination, appropriate sampling, and the use of intraoperative cytology as an adjunct. The aim is to provide clinically useful frozen section diagnosis in order to reduce the number of diagnoses deferred to paraffin section and facilitate optimal intraoperative management decisions.     

Frozen section diagnosis in donor liver biopsies: observer variation of semiquantitative and quantitative steatosis assessment

Donor livers are not generally accepted for liver transplantation if intraoperative frozen section histology on wedge biopsies provides evidence for more severe steatosis. In this reliability study, assessment of steatosis in donor liver biopsies by different approaches (frozen sections vs. paraffin sections; macrovesicular steatosis vs. microvesicular steatosis), different observers, and different evaluation methods (conventional microscopy vs. point grid analysis on digital microphotographs) was compared. One hundred twenty consecutive donor liver biopsies were investigated. Intraoperative diagnosis was made on hematoxylin and eosin (H&E)-stained frozen sections. The residual portion of each biopsy was analyzed later on H&E-, diastase-resistant PAS-, and Elastica van Gieson-stained paraffin sections. Microvesicular steatosis and macrovesicular steatosis were classified semiquantitatively into 5?% steps. Additionally, point grid counting was applied on ten digital microphotographs per slide. The values for steatosis revealed a wide range of data between 0 and 70 or 85?% (mean values, 12.0-18.3?%), considering all types of specimens. The results of the two observers were highly correlated for macrovesicular steatosis (r?≥?0.925) and for microvesicular steatosis (r?≥?0.880). The values for macrovesicular and microvesicular steatosis, however, showed poor correlation (r?≤?0.581). The rate of agreement between the two observers ranged between 84.2 and 95.8?% (κ, 0.763-0.937), depending on the threshold setting. For point grid analysis, significantly lower mean values and ranges for both types of steatosis compared to conventional histopathology were found (p?相似文献   

Frozen section diagnosis of hypertensive pulmonary vascular changes at surgery for congenital heart anomalies

Frozen sections of lung biopsy were prepared in 30 cases of congenital heart anomalies with pulmonary hypertension, and evaluation of severity of the pulmonary vascular changes was made during the surgery. Statistically, significant differences was not found between the diagnosis made by frozen sections and those made by paraffin sections. It is concluded that rapid and accurate diagnosis of pulmonary vascular changes can be made by means of frozen section diagnosis. This method will prove to be clinically important by assisting during operation in rapid assessment of indication for total correction of congenital heart anomalies.     

Frozen section telepathology by whole-slide imaging

Frozen sections represent an ideal niche application for telepathology. This review covers the key aspects of using telepathology for this purpose. While several options exist for remote reviewing of frozen section slides such as sending selected static images by e-mail, real-time video microscopy and statistic/dynamic robotic microscopy, the use of whole-slide imaging technology will be emphasized in this review. The performance characteristics of whole-slide imaging systems in various frozen section practice settings, based on validation studies or actual patient care, will be discussed as well as issues to consider when implementing whole-slide imaging telepathology to cover frozen sections.     

Telemedicine in support of peacekeeping operations overseas: an audit.

BACKGROUND AND OBJECTIVE: Since 1993, the Department of Defense has augmented the medical support for Army units on peacekeeping operations in Macedonia through the medium of telemedicine. This project, known as Operation Primetime 1, was the first satellite-based telemedicine system deployed in support of remote primary-care physician in the U.S. military. Its declared aims are: (1) to improve the standard of care; (2) to reduce evacuations; (3) to support junior physicians in the field; and (4) to improve the military effectiveness of the deployed units. This paper audits the success in attaining those goals for the period January 1994 to April 1995. METHODS: A log was collated from the referring units and questionnaires completed by both referring and consulting physicians. The referring physicians were interviewed on their return from Macedonia, and a more detailed study was undertaken of cases in which a change in outcome was noted. Follow-up interview of consultants was not possible. RESULTS: A total of 53 consults were undertaken on 47 patients. The use of telemedicine affected the decision to evacuate 13 times (13/47), with a net reduction of 9 evacuations. Management of individual cases was changed in 30 of the 47 cases in which telemedicine was used. Physician confidence and military effectiveness were also improved. The level of utilization of the system was largely dependent on a training and sustainment program. Units and General Medical Officers who were trained in the clinical use of telemedicine and the technical sustainment of the equipment used the system; those who were not, did not. Most patients (45/47) were treated satisfactorily with a single consult. Telemedicine under these circumstances seems to be cost effective. The deployed sites chose the referral centers that provided the best service. CONCLUSIONS: Telemedicine is a valuable tool capable of augmenting medical support to deployed military units. A successful deployed telemedicine project requires an integrated support package that includes adequate provision for training and equipment sustainment at both ends of the link. Experience with telemedicine in Operation Primetime indicates the potential for substantial cost savings as well as cost-effective medical care. Further application of telemedicine should be encouraged. Successful deployment of telemedicine projects may hinge on an integrated support package.