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Discrepancies with Final Diagnosis in Head and Neck Intraoperative Frozen Section
Scott Albright1, Alexandra Isaacson2, Robert Robinson3
1Department of Pathology, University of Iowa, Iowa City, USA. scott.albrightdo@gmail.com.
Head and Neck Pathology
|August 14, 2026
Summary
Discrepancies in head and neck frozen section diagnoses often occur before microscopic review. Improving gross sampling and tissue sectioning can reduce errors in intraoperative pathology.
Area of Science:
- Pathology
- Surgical Pathology
- Oncology
Background:
- Frozen section analysis is critical for intraoperative decision-making in head and neck cancer surgery.
- This technique presents unique technical and diagnostic challenges, increasing the potential for errors.
Purpose of the Study:
- To identify discrepancies between intraoperative frozen section diagnoses and final diagnoses in head and neck pathology.
- To pinpoint the stages of the process where failures occur.
- To assess the root causes of these discrepancies.
Main Methods:
- A retrospective analysis of head and neck frozen section cases from 2020-2023 was conducted.
- Data were extracted from a quality assurance system within a Laboratory Information System (LIS).
- Discrepancies were categorized as major (altering surgical procedure) or minor, with a focus on major errors.
Main Results:
- Out of 1844 cases, 71 discrepancies (3.9%) were identified, with 48 (2.7%) classified as major.
- Major errors stemmed from inadequate gross sampling (29%), insufficient block sectioning (19%), and interpretative errors (48%).
- Common interpretative errors included issues with squamous dysplasia, minimally invasive carcinoma, and parathyroid/thyroid tissue identification.
Conclusions:
- Nearly half of diagnostic discrepancies occurred before microscopic interpretation, highlighting issues in grossing and tissue handling.
- Improving gross specimen evaluation, sectioning techniques, and adherence to diagnostic criteria for challenging entities can minimize intraoperative diagnostic errors.
