A biosafety algorithm for the protection of pathology staff during intraoperative examinations of pulmonary lesions

Area of Science:

• Pathology
• Surgical Pathology
• Cytopathology

Background:

• Intraoperative diagnosis of pulmonary lesions requires robust biosafety measures for pathology staff.
• Cytological imprints (IC) and frozen sections are common techniques for rapid intraoperative assessment.

Purpose of the Study:

• To develop a biosafety algorithm for pathology staff during intraoperative examination of pulmonary lesions.
• To optimize the use of imprint cytology and frozen sections for accurate intraoperative diagnosis.

Main Methods:

• Analysis of 148 intraoperatively obtained pulmonary surgical tissues for imprint cytology and frozen sectioning.
• Comparison of diagnoses from IC and frozen sections against final pathological diagnoses.
• Calculation of concordance, non-concordance rates, and diagnostic performance metrics.

Main Results:

• Scratch-IC showed diagnostic sensitivity, specificity, PPV, NPV, and accuracy of 91%, 100%, 100%, 50%, and 92%, respectively.
• Frozen sectioning demonstrated diagnostic sensitivity, specificity, PPV, NPV, and accuracy of 99%, 100%, 100%, 96%, and 99%, respectively.
• Frozen sectioning may be unnecessary for malignant diagnoses via IC but recommended for benign diagnoses or inadequate IC preparations.

Conclusions:

• The study proposes a biosafety algorithm to enhance staff protection during intraoperative pulmonary lesion diagnosis.
• The algorithm guides the judicious use of IC and frozen sections, recommending frozen sections for specific IC findings (benign, inadequate, abscess) and granuloma with caseous necrosis.
• Implementation includes immediate staff communication and PCR testing for suspected granuloma with caseous necrosis before permanent sectioning.