Utility of intraoperative consultation touch preparations

Although intraoperative touch preparations (TPs) often are performed in conjunction with frozen sections, the comfort level of using TPs in actual practice and the effect of TP quality and cytologic experience on diagnostic accuracy have not been measured. To investigate the utility of intraoperative TPs and to compare them with that of frozen sections, five pathologists of differing levels of cytologic experience retrospectively reviewed 122 intraoperative TPs and frozen sections. Accuracy rates for individual pathologists were calculated and the accuracy using TPs was compared to that of frozen sections. TP accuracy was correlated with TP quality and cytologic experience. The mean rates of correct, incorrect, and atypical TP diagnoses were 88.5%, 4.1%, and 7.4%, respectively. The mean rates of correct, incorrect, and deferred frozen section diagnoses were 86.1%, 2.5%, and 11.9%, respectively. For the four pathologists with cytologic experience, both TP and frozen section diagnostic accuracy rates were similar; however, the pathologist who lacked cytologic experience had lower TP diagnostic accuracy. All pathologists who had cytologic experience requested a frozen section for cases with an atypical or incorrect TP diagnosis. In cases with a correct TP diagnosis a frozen section was requested 46.3% of the time. TPs of greater technical quality were associated with higher diagnostic accuracy. In conclusion, the use of performing TP and frozen section are complementary and result in increased diagnostic accuracy. For some pathologists, TPs may replace frozen sections in over 50% of cases.