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Intra-Operative Frozen Sections: Experience at A Tertiary Care Centre
Agarwal Preeti1, Gupta Sameer, Singh Kulranjan
1Department of Pathology, King George's Medical University, Lucknow.
Abstract:
The present study was conducted to assess error rates with diagnosis using intra-operative frozen sections, and to indicate ways to increase overall performance. Over a period of two years, 227 cases were biopsied intra-operatively. Errors were observed in 14 cases. Four of these were sampling errors, one by a pathologist and three by surgeons. In seven cases incorrect interpretations were made. Epithelial dysplasia was observed on definitive histology in two cases which was not reported intra-operatively. One case was of ectopic thyroid. In cases of oral cancer where sentinel lymph nodes were sampled, immunohistochemistry for cytokeratin was performed to facilitate identification of micrometastasis. Only single case displayed tumor deposits which was not evident morphologically. Resection margins were reported in seventy eight cases. Some 18% (14/50) benefited from revision of margins; overall sensitivity of intra-operative frozen sections for marginal status was 71.4%, with a specificity of 90.3%. Overall sensitivity was 75% and specificity was 97.5%. Careful observation, pathologist experience and knowledge of limitations help in improving the overall diagnostic outcome.
Insights
This study assessed diagnostic errors in intra-operative frozen sections, finding 14 errors in 227 cases. Improving pathologist experience and careful observation can enhance diagnostic accuracy for frozen section analysis.
Area of Science:
- Pathology
- Surgical Pathology
- Oncology
Background:
- Intra-operative frozen sections are crucial for timely surgical decisions.
- Accurate diagnosis during surgery impacts patient outcomes.
- Understanding error rates in frozen section analysis is essential for quality improvement.
Purpose of the Study:
- To evaluate the diagnostic error rates associated with intra-operative frozen section analysis.
- To identify factors contributing to diagnostic errors.
- To propose strategies for enhancing the performance of frozen section diagnoses.
Main Methods:
- Retrospective analysis of 227 intra-operative frozen section cases over two years.
- Categorization of errors into sampling errors and interpretation errors.
- Assessment of diagnostic concordance with definitive histology.
- Evaluation of resection margin status and benefit from margin revision.
- Calculation of sensitivity and specificity for marginal status detection.
Main Results:
- A total of 14 errors (6.17%) were identified in 227 cases.
- Sampling errors occurred in 4 cases (1 pathologist, 3 surgeons).
- Interpretation errors occurred in 7 cases, including missed epithelial dysplasia and ectopic thyroid.
- Immunohistochemistry identified micrometastasis in one oral cancer case.
- Intra-operative frozen sections had a sensitivity of 71.4% and specificity of 90.3% for marginal status.
Conclusions:
- Diagnostic errors in intra-operative frozen sections can occur due to sampling and interpretation issues.
- Pathologist experience and meticulous observation are key to minimizing errors.
- Enhanced diagnostic accuracy in frozen sections improves surgical decision-making and patient care.
