Guidelines for practical utilization of intraoperative frozen sections.

Area of Science:

• Pathology
• Surgical Pathology
• Intraoperative Consultation

Background:

• Intraoperative frozen section (FS) diagnosis is a critical tool in surgical pathology.
• Assessing its accuracy, strengths, and weaknesses is essential for optimizing its use.
• Previous studies have highlighted variations in FS accuracy across different specimen types.

Purpose of the Study:

• To evaluate the diagnostic accuracy of intraoperative frozen sections.
• To identify specific sites where FS diagnosis is less accurate or unnecessary.
• To provide recommendations for improving the cost-effectiveness of FS procedures.

Main Methods:

• Retrospective review of 4057 intraoperative frozen sections performed between 1980 and 1984.
• Analysis of diagnostic concordance between FS and final diagnoses.
• Categorization of discrepancies, including false-negative and false-positive diagnoses.
• Evaluation of specimen types, with a focus on breast, lymph node, and skin.

Main Results:

• Overall agreement between FS and final diagnoses was 91.5%; disagreements occurred in 6.8% of cases, with 1.7% deferred.
• False-negative diagnoses stemmed from pathologist or surgeon sampling errors.
• Eight (0.15%) false-positive diagnoses were recorded, none impacting patient treatment.

Conclusions:

• Frozen section diagnosis demonstrates high accuracy for many specimen types.
• Recommends against using FS for lymph nodes in lymphoproliferative disorders and for breast tissue where malignancy does not necessitate immediate mastectomy.
• Implementing these recommendations can enhance cost-effectiveness without compromising patient care.