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Intraoperative pathology consultation: error, cause and impact
Etienne Mahe1, Shamim Ara, Mona Bishara
1Hamilton Regional Laboratory Medicine Programme, Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ont., Canada. etienne.mahe@medportal.ca
Background:
Correlation of intraoperative frozen section diagnosis with final diagnosis can be an important component of an institution's quality assurance process.
Methods:
We performed a quality assurance review of 1207 frozen section diagnoses from 812 surgical cases performed in the Hamilton Regional Laboratory Medicine Programme during a 6-month period in 2007. We reviewed the frozen section and permanent slides from all potentially discordant cases using a multiheaded microscope to arrive at a consensus pertaining to the type and reason for error. We reviewed the clinical record to determine whether there had been a potential adverse impact on immediate clinical management.
Results:
Frozen sections were most commonly requested for head and neck, nervous system and female genital tract specimens. Twenty-eight frozen sections (3%) were deferred. We identified 24 discordant diagnoses involving 3% of cases and 2% of specimens. The organ systems showing the greatest frequency of discordance relative to the total number from that system were the nervous system, head and neck, and the lungs. Of the errors identified, most occurred owing to diagnostic misinterpretation, followed by problems related to tissue sampling. There was a potential adverse impact on immediate clinical management in 14 cases.
Conclusion:
Our results add to the Canadian data on the correlation between frozen sections and permanent sections; we note comparability to the concordance rates reported in the literature.
Insights
Frozen section diagnoses show high accuracy, with only 3% of cases having discordant diagnoses. This quality assurance study confirms the reliability of frozen section analysis in surgical pathology, comparable to established literature rates.
Area of Science:
- Surgical Pathology
- Diagnostic Accuracy
- Quality Assurance in Medicine
Background:
- Intraoperative frozen section diagnosis is crucial for quality assurance.
- Accurate correlation between frozen and final diagnoses is essential for patient care.
Purpose of the Study:
- To evaluate the accuracy of frozen section diagnoses.
- To assess the impact of discordant diagnoses on clinical management.
Main Methods:
- A quality assurance review of 1207 frozen sections from 812 surgical cases.
- Analysis of discordant cases using multiheaded microscopy for consensus.
- Review of clinical records for adverse impacts on management.
Main Results:
- 28 frozen sections (3%) were deferred.
- 24 discordant diagnoses (3% of cases, 2% of specimens) were identified.
- Nervous system, head and neck, and lung specimens showed highest discordance rates.
- Diagnostic misinterpretation was the primary cause of errors.
- Potential adverse impact on clinical management occurred in 14 cases.
Conclusions:
- The study provides Canadian data on frozen section accuracy.
- Concordance rates are comparable to existing literature.
- Frozen section diagnosis is a reliable tool in surgical pathology.
