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[Rapid immunohistochemistry applied to intraoperative diagnosis: a critical analysis]
L Viberti1, S Croce, C Pecchioni
1Sezione di Anatomia Patologica, Dipartimento di Scienze Biomediche e Oncologia Umana, Università degli Studi di Torino, Via Santena 7, I-10126 Torino, Italia.
Insights
Intra-operative frozen diagnoses show high agreement with final pathology. Rapid immunostaining (IS) on frozen sections aids in challenging cases, improving diagnostic accuracy without increasing costs.
Area of Science:
- Surgical Pathology
- Oncology
- Immunohistochemistry
Background:
- Intra-operative frozen section diagnosis is crucial for guiding surgical decisions.
- Evaluating the concordance between frozen and permanent sections is essential for quality assurance.
Purpose of the Study:
- To assess the diagnostic agreement between intra-operative frozen diagnoses and final diagnoses from formalin-fixed, paraffin-embedded sections.
- To evaluate the utility of a rapid immunostaining (IS) method on frozen sections for resolving diagnostic challenges.
Main Methods:
- A retrospective review of 1378 intra-operative frozen diagnoses was conducted.
- A rapid IS method was selectively applied to frozen sections in cases with diagnostic uncertainty.
- Routine reagents were used for rapid IS, and the method was not repeated on permanent sections.
Main Results:
- The study assessed the concordance between frozen and permanent section diagnoses.
- Rapid IS successfully determined histotype in poorly differentiated neoplasms.
- Rapid IS helped identify the origin of lung nodules and confirm neoplastic cells on resection margins.
- The rapid IS method added approximately 20 minutes to the intra-operative diagnosis time.
Conclusions:
- Intra-operative frozen diagnoses generally show good agreement with final diagnoses.
- Rapid IS is a valuable tool for intra-operative frozen section consultations, particularly for difficult cases.
- This method enhances diagnostic accuracy without additional costs associated with repeat staining on permanent sections.
Abstract:
A series of 1378 intra-operative frozen diagnoses performed in our department over two years (1998-1999) was studied in order to assess the agreement with the diagnosis on formalin-fixed, paraffin-embedded sections. In selected cases, a rapid immunostaining (IS) method was applied on frozen sections to solve diagnostic problems. Rapid IS allowed us to determine the histotype of poorly differentiated neoplasms, the origin of lung nodules and the presence of nests of neoplastic cells on resection margins. The method delayed the answer by about 20 minutes, and was always previously arranged with the surgeon. Rapid IS method was performed using routine reagents and was not repeated on formalin-fixed, paraffin-embedded sections of the same cases, thus avoiding additional costs.
