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Flash freezing of Mohs micrographic surgery tissue can minimize freeze artifact and speed slide preparation
Quenby L Erickson1, Trishina Clark, Kassandra Larson
1Department of Dermatology, Mohs and Dermasurgery Unit, MD Anderson Cancer Center, Houston, Texas, USA.
Background:
In Mohs micrographic surgery, excised tissue is traditionally prepared for cryotomy by freezing in the cryostat's refrigerated chamber. Any delay may cause drying artifact and tissue autolysis and affect slide turn around time (TAT). Flash freezing is used in frozen section processing of general pathology specimens to expedite TAT and enhance tissue histology by minimizing ice crystal formation (freeze artifact).
Design:
This was a pilot quality improvement study to compare flash freezing of Mohs sections with the traditional method of freezing in the cryostat. Mohs layers divided into at least two sections (one set) were enrolled. One half was flash frozen in an isopentane histobath (-56 to -62°C); the other half was frozen in the cryostat (-27 to -30°C).
Results:
Forty-one sets were enrolled. Average cryostat and histobath freeze times (range) were 144 seconds (90-240 seconds) and 22 seconds (15-40 seconds), respectively. Laboratory technicians felt that it was easier to achieve smooth, wrinkle-free sections in histobath frozen tissue in 90% of tissue sets. Physicians favored histology from flash frozen specimens (range 65-85%) over the traditional method of cryostat freezing.
Conclusion:
Flash freezing in a histobath produced a more rapidly opacified (frozen) specimen ready for cryotomy, expediting slide TAT. Tissue histology also demonstrated better quality and minimized freeze artifact.
Insights
Flash freezing Mohs tissue in a histobath significantly reduces freezing time and improves tissue quality compared to traditional cryostat freezing. This method enhances slide turnaround time and minimizes artifacts for better diagnostic accuracy.
Area of Science:
- Dermatology
- Pathology
- Surgical Techniques
Background:
- Traditional Mohs surgery uses cryostat freezing, which can cause delays and artifacts.
- Flash freezing is a technique used in general pathology to speed up processing and improve histology.
- Minimizing ice crystal formation is key to enhancing tissue quality.
Purpose of the Study:
- To compare flash freezing with traditional cryostat freezing for Mohs micrographic surgery specimens.
- To evaluate the impact on slide turnaround time (TAT) and tissue histology quality.
Main Methods:
- A pilot quality improvement study compared flash freezing in an isopentane histobath (-56 to -62°C) with standard cryostat freezing (-27 to -30°C).
- Mohs tissue layers were divided, with one half flash frozen and the other cryostat frozen.
Main Results:
- Flash freezing averaged 22 seconds, significantly faster than the cryostat's 144 seconds.
- 90% of tissue sets frozen in the histobath were easier to section smoothly.
- Physicians preferred the histology of flash-frozen specimens 65-85% of the time.
Conclusions:
- Flash freezing in a histobath expedites specimen preparation for cryotomy, reducing slide TAT.
- This method enhances tissue histology quality and minimizes freeze artifact compared to traditional cryostat freezing.
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