Diagnostic Discrepancies Between Intraoperative Frozen Section and Permanent Histopathological Diagnosis of Brain Tumors.

Maher Kurdi,Yazid Maghrabi,Anas Bardeesi,Saleh Baeesa,Alaa Samkari,Taghreed Al-Sinani,Ahmed Lary,Rothaina Saeedi,Sahar Hakamy

doi:10.5146/tjpath.2021.01551

Abstract

Intraoperative frozen section (IOFS) diagnosis of brain tumors plays an important role in assessing the adequacy of the sample and determining the treatment plan. The aim of this study was to investigate the diagnostic accuracy between IOFS and permanent sections. The authors reviewed the histopathological results of 383 brain tumors, including IOFS and permanent histological diagnosis. The cases were classified into three diagnostic compatibilities (i) Perfect fit; the diagnosis of IOFS was identical to the permanent diagnosis, (ii) Partial compatibility; IOFS diagnosis was not incorrect but was too broad to be considered full compatibility, (iii) Conflict; IOFS diagnosis is completely different from the permanent diagnosis. The permanent diagnosis was used as a primary criterion and was compared to IOFS diagnosis and recurrence rate using different statistical methods. 84% of the patients underwent craniotomy and tumor resection, while 15% only underwent tumor biopsy. Approximately, 53.8 % of the cases revealed perfect matching in the diagnosis between IOFSs and permanent sections, while 16.2% of the cases revealed complete mismatching in the diagnosis between the sections. The remaining 30% of the cases showed partial compatibility in the diagnosis between the two diagnostic methods. There was no significant difference in recurrence rate among all cases of different diagnostic compatibility (p=0.54). There is a diagnostic discrepancy between IOFSs and permanent sections. However, cases that revealed no consensus in the diagnoses showed no negative effect on the patient outcome. Further studies should be conducted to explore the reasons of this conflict in the two diagnostic methods.

Highlights

Brain tumors, known as intracranial tumors, are abnormal masses of tissue with cells that continuously grow and multiply
More than 150 types of brain tumors have been documented by the World Health Organization (WHO) [1]
Secondary metastatic brain tumors include any organ cancer that hematogenously spreads to the brain

Summary

Introduction

Known as intracranial tumors, are abnormal masses of tissue with cells that continuously grow and multiply. More than 150 types of brain tumors have been documented by the World Health Organization (WHO) [1]. They can be categorized as primary and metastatic tumors. Primary tumors arise from brain tissue or surrounding structures, which include neuroglial cells, meninges, or the ependymal layer. They can be benign (low-grade) or malignant (high-grade). Secondary metastatic brain tumors include any organ cancer that hematogenously spreads to the brain. To distinguish primary from secondary brain tumors, a detailed clinical history and body imaging are important to identify the origin of the tumor but not the exact histological subtype. Intraoperative examination of tumor tissue is the gold diagnostic tool to differentiate the two types and to determine the surgical treatment plan

Methods

Results

Discussion

Conclusion