Intraoperative Frozen Section -A Golden Tool for Diagnosis of Surgical Biopsies

Abstract

Background: Intra-operative frozen section plays an important role in the management of surgical patients but yet it must be used prudently to avoid the indiscriminate usage of this technique. As it is subjected to many limitations in comparison to the paraffin embedded sections, this study aims to highlight the important concepts and principles of intraoperative frozen section consultation as well as discussing the limitations of this technique. A comparison with other latest techniques. Aims and objectives:To evaluate the performance and limitations of frozen sections in the intraoperative evaluation of thyroid, breast, gastric, ovarian, central nervous system and lower extremities biopsies. Materials and methods:Retrospective and prospective study of frozen sections done over a period of one and half year were taken. Fine needle aspiration cytology, frozen and biopsy performed for various tumours in thyroid, breast, gastric, ovary, CNS and lower limb were studied. A Comparison for frozen, fine needle aspiration was done which was later confirmed by histopathology. Accuracy of frozen section in our study was 91%.Results: Out of 21 cases, 19 cases of frozen sections coincided with histopathological diagnosis and 20 cases of fine needle aspiration cytology coincided with histopathological diagnosis. Conclusions:The role, value, and limitations of frozen section and gross consultation were variable in different sites. Frozen section aided the surgeon to choose the best therapeutic approach and in rapid diagnosis of a pathological process. Confirmed the diagnosis of carcinoma if the fine needle aspiration cytology or core needle biopsies are inconclusive prior to major radical surgery. Also provided an assessment of resection margins in carcinoma. When unexpected disease process was found and required a definite diagnosis to decide what to do next frozen section was helpful.

A Acurácia Diagnóstica Das Patologias Cirúrgicas Nos Exames Por Congelação.

“…A seção por congelamento surgiu no século XIX, mas somente em 1960, com a utilização do criostato, o exame intra-operatório de seção congelada ganhou notoriedade como método altamente confiável para a análise histológica 1 . Atualmente, este exame constitui uma das atividades mais importantes exercidas pelo médico patologista, além de ter se consolidado como uma ferramenta significativa de tomada de decisão para o cirurgião, uma vez que pode direcionar e mudar o curso de ação em uma operação 1,2 .…”

“…O diagnóstico intra-operatório preciso demanda correlação clínica com os achados pré-operatórios, assim como a familiaridade do patologista com as entidades patológicas conhecidas e a compreensão de suas limitações pessoais, visto que nesta aplicação dos conhecimentos histopatológicos não há tempo para aconselhamento colegial aprofundado ou execução de pesquisas na vasta literatura 4 . Ademais, é importante a boa comunicação e uma atuação harmoniosa entre as equipes de patologia e cirurgia para uma aplicabilidade eficaz dos exames por congelação, os quais ocorrem todos os dias em diversos hospitais do mundo 1,2 .…”

Qualitative Comparison of Cryostat- versus Snap-Frozen Neurosurgical Intraoperative Consultations

“…Despite the critical relevance of this high-risk procedure, there is lack of evidence-based data about the optimal freezing technique for neurosurgical samples. [3][4][5] We conducted a case-control study of CNS-frozen sections using two of the most common freezing techniques: cryostat-freezing and snap-freezing. A qualitative analysis was performed using two semiquantitative scales created or modified for this study: the Histologic Preservation Score (HPS) and an Ice Crystal Vacuolization Score (ICVS) to determine if significant differences exist between these two freezing techniques.…”