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The accuracy of frozen-section diagnoses in 34 hospitals
P J Howanitz1, G G Hoffman, R J Zarbo
1Clinical Laboratories, UCLA 90024.
Abstract:
We compared the diagnoses from intraoperative frozen-section consultation with the final diagnosis using permanent tissue sections from 34 hospitals throughout North America. Participating pathologists who provided data from their practices volunteered for a pilot study of Q-Probes, a modular quality assurance program of the College of American Pathologists, Skokie, III. During 4 weeks, 186 pathologists evaluated 1952 frozen-section cases and deferred diagnoses to the final permanent sections in 77 cases (3.9%). Concordance between frozen-section and the final histologic diagnoses was 96.5%; whereas the mean and median concordance rates for participating institutions were 96.8% and 97.4%, respectively. Of 67 discordant diagnoses, 29 occurred from sampling of nonrepresentative tissue specimens, and 29 from diagnostic misinterpretations. The pathologists indicated that the diagnostic discordance had little or no effect on patient care in 94% of cases. We conclude that the North American pathologists studied interpret frozen sections with exceedingly high accuracy, approximating that reported from teaching hospitals.
Insights
North American pathologists demonstrate high accuracy in intraoperative frozen-section diagnoses. This quality assurance study found a 96.5% concordance rate with final diagnoses, indicating reliable frozen section interpretation.
Area of Science:
- Pathology
- Surgical Pathology
- Quality Assurance in Medicine
Background:
- Intraoperative frozen-section consultations are critical for guiding surgical decisions.
- Variability in frozen-section accuracy can impact patient management.
- Quality assurance programs are essential for assessing diagnostic performance.
Purpose of the Study:
- To evaluate the diagnostic accuracy of intraoperative frozen-section consultations compared to final diagnoses.
- To assess concordance rates across multiple institutions in North America.
- To identify factors contributing to diagnostic discrepancies.
Main Methods:
- A pilot study involving 186 pathologists from 34 North American hospitals.
- Analysis of 1952 frozen-section cases over a 4-week period.
- Comparison of frozen-section diagnoses with final diagnoses from permanent tissue sections.
Main Results:
- An overall concordance rate of 96.5% between frozen-section and final diagnoses.
- Mean and median institutional concordance rates of 96.8% and 97.4%, respectively.
- Diagnostic discordance in 3.9% of cases, with sampling errors and misinterpretations as primary causes.
- Minimal impact on patient care reported in 94% of discordant cases.
Conclusions:
- Pathologists in North America exhibit exceptionally high accuracy in interpreting frozen sections.
- The diagnostic performance approximates that reported from academic medical centers.
- Frozen-section consultations are a reliable tool in surgical pathology practice.