Role of Intraoperative Pathology Consultation in Skeletal Tumors and Tumor-Like Lesions

Poonam Bhaker,Uma Handa,Harsh Mohan,Sudhir Kumar

doi:10.1155/2014/902104

Abstract

Early and accurate detection of bone tumors and their staging are important since some of them are highly malignant. Intraoperative pathological consultation in bone tumors and tumor-like conditions is quite complex; however, it allows improvement in prognosis and limb salvage. Present study was conducted on 52 patients who underwent surgical procedure after clinical and radiological diagnosis of bone tumors/tumor-like conditions. Fresh unfixed tissue was quickly inspected grossly, followed by preparation of imprint smears and frozen section which were evaluated by two pathologists separately and compared subsequently with reports of paraffin-embedded sections. Clinical reasons for intraoperative consultation were to make diagnosis in 65.4% of cases and to determine resection margin status in 21.1% while in 13.5% of cases, it was for both indications. Diagnostic yield of imprint smears was 87.8% (13 malignant, 22 benign, and 1 tumor-like) and of frozen section was 90.2% (16 malignant, 19 benign, and 2 nonneoplastic) while paraffin sections could diagnose specific tumors in 95.1% (18 malignant, 18 benign, and 3 nonneoplastic). Although frozen section had better sensitivity (88.2%), it had less specificity (94.7%) as compared to imprint smears (76.5% and 100%, resp.). Imprint cytology and frozen section together provide a quick, safe, and reliable intraoperative provisional tissue diagnosis in skeletal tumors and tumor-like conditions.

Highlights

Bone tumors are infrequent but their detection is important since some of them are highly malignant
Intraoperative consultation is considered as an integral part of surgical pathology and provides a rapid intraoperative diagnosis leading to timely and proper management of the patients [3]
This is because the primary bone tumors are uncommon and the characteristics of the material comprising these lesions render them difficult for quick sectioning [4]

Summary

Introduction

Bone tumors are infrequent but their detection is important since some of them are highly malignant. Incidence of sarcomas of the bone is about 8 to 9 per million population per year [1]. In contrast to various other tissues, it has been less often utilized for bone lesions. This is because the primary bone tumors are uncommon and the characteristics of the material comprising these lesions render them difficult for quick sectioning [4]. It is tough to cut well mineralized tissue for frozen section; almost all malignant tumors of bone have soft areas that are suitable for frozen section analysis [5, 6]

Methods

Results

Discussion

Conclusion