Accuracy Of Frozen Section Analysis Research Articles

Frozen section analysis of pancreatic resection margins during pancreaticoduodenectomy for pancreatic adenocarcinoma is not affected by neoadjuvant therapy.

The aim of our study was to evaluate if the histopathological changes occurring in the pancreas post neoadjuvant-therapy (PNAT) for pancreatic ductal adenocarcinoma (PDAC) may negatively affect the assessment of intra-operative frozen section (FS) analysis of pancreatic resection margins (PRMs). The clinicopathological data of patients who underwent pancreatoduodenectomy for PDAC between 2015 and 2022 were analyzed. Comparison of the accuracy of the FS analysis in treatment naïve (TN) and PNAT patients for all pancreatic margins was performed. We identified 81 patients with PDAC (40 female, 41 male) of which 47 (58.0%) were TN and 34 (42.0%) PNAT. Including FSs performed for re-excisions of initially positive PRMs, we identified 2/103 discrepancies for the pancreatic neck margin, one in a TN patient and one in a PNAT patient; one discrepancy for the common bile duct margin (1/47) in a TN patient; and 2/14 discrepancies for the uncinate margin, both in TN patients. In summary, accuracy of FS analysis was similar in the PNAT and TN groups (98.8% vs. 96.7%). The histopathological changes occurring in the pancreas PNAT for PDAC do not affect the histopathological interpretation of FS analysis of PRMs, and the accuracy of FS analysis is similar in the PNAT and TN patients.

Diagnostic Accuracy of Frozen Section Analysis and Factors Associated with Discordance of Final Histopathology in Mucinous Ovarian Tumor

Aim and Objective This article determines the diagnostic accuracy of frozen section (FS) in case of mucinous ovarian tumor (MOT) and tailoring of intraoperative treatment decision. Material and Methods This was an observational study in which retrospective data was analyzed prospectively from January 2008 to December 2015 at the Regional Cancer Center. This study included 158 patients with MOT who underwent FS analysis during staging laparotomy at our institute. FS's sensitivity, specificity, and diagnostic accuracy were calculated and compared with final paraffin histopathological examination (HPE). Univariate and multivariate analyses were done to decide factors associated with changes in final HPE. Results FS analysis and final HPE report were concordant in 77.8% (123/158) of the cases and discordant in 22.1% (35/158). Out of 35 discordant cases, 29 (18.3%) were upgraded and 06 (5.6%) were downgraded. Out of 33 borderline cases, 16 (48.4%) were upgraded to malignant MOT and 6 (18.1%) were downgraded to benign MOT on final HPE. Out of 40 malignant MOT, 40 (100%) showed malignancy on final HPE. In the case of benign MOT on FS, 13 out of 85 (15.2%) upgraded to borderline or malignant. Sensitivity and specificity of FS were 76.60 and 55.17%, respectively, for benign MOT, 55.17 and 86.96% for borderline MOT, and 86.96 and 100% for malignant MOT. Conclusion In MOT, due to its large size and heterogeneous nature, it displays spectrum of appearance ranging from benign cyst adenoma, and borderline tumor to adenocarcinoma. Our study showed significant discordance between FS and final histopathological diagnosis in borderline MOT.

A random forest algorithm predicting model combining intraoperative frozen section analysis and clinical features guides surgical strategy for peripheral solitary pulmonary nodules.

BackgroundIntraoperative frozen section (FS) analysis has been used to guide the extent of resection in patients with solitary pulmonary nodules (SPNs), but its accuracy varies greatly among different hospitals. Artificial intelligence (AI) and multidimensional data technology are developing rapidly these years, meanwhile, surgeons need better methods to guide the surgical strategy of SPNs. We established predicting models combining FS results with multidimensional perioperative clinical features using logistic regression analysis and the random forest (RF) algorithm to get more accurate extent of SPN resection.MethodsPatients with peripheral SPNs who underwent FS-guided surgical resection at the Shanghai Chest Hospital (January 2017–December 2018) were retrospectively examined (N=3,089). The accuracy of intraoperative FS-guided resection extent was analyzed and used as Model 1. The clinical features (sex, age, CT features, tumor markers, smoking history, lesion size and nodule location) of patients were collected, and Models 2 and 3 were established using logistic regression and RF algorithms to combine the FS with clinical features. We confirmed the performance of these models in an external validation cohort of 117 patients from Hwa Mei Hospital, University of Chinese Academy of Science (Ningbo No. 2 Hospital). We compared the effectiveness in classifying low/high-risk groups of SPN among them.ResultsThe accuracy of FS analysis was 61.3%. Model 3 exhibited the best diagnostic accuracy and had an area under the curve of 0.903 in n the internal validation cohort and 0.919 in the external validation cohort. The calibration plots and net reclassification index (NRI) of Model 3 also exhibited significantly better performance than the other models. Improved diagnostic accuracy was observed in in both internal and external validation cohort.ConclusionsUsing an RF algorithm, clinical characteristics can be combined with intraoperative FS analysis to significantly improve intraoperative judgment accuracy for low- and high-risk tumors, and may serve as a reliable complementary method when FS evaluation is equivocal, improving the accuracy of the extent of surgical resection.

Accuracy of Frozen Section Analysis in the Intraoperative Diagnosis of Uterine Leiomyosarcoma: Experience at a Large Metropolitan Hospital

Hagen, Jennifer A. MD; Tessier, Katelyn MS; Khalifa, Mahmoud MD, PhD; Rivard, Colleen L. MD Author Information

The accuracy of intraoperative frozen section analysis of sentinel lymph nodes in patients with breast cancer

Background: The biopsy of sentinel lymph nodes (SLNs) has widely replaced conventional axillary lymph node dissection (ALND) for assessing the axillary lymph node (LN) status. Rapid intraoperative frozen section (FS) analysis of SLNs enables surgeon to perform ALND during the same operative procedure. However, there is an ongoing controversy regarding the accuracy and usefulness of FS for the evaluation of SLNs. The aim of the study was to investigate the accuracy of FS analysis in the management of patients with breast cancer. Patients and Methods: Between 2007 and 2014, 214 breast cancer patients who underwent SLN biopsy procedure with intraoperative FS were included in this retrospective study. The SLNs were examined using standard FS procedures, and each section was stained with hematoxylin and eosin (H and E) only. The remaining tissues were then further sectioned and examined with H and E postoperatively. The results of FS and permanent sections were compared (the sensitivity, specificity and accuracy of FS were calculated). Results: FS analysis detected LN metastases in 50 patients, while the permanent histopathologic examination detected metastases in another 9 patients. The sensitivity of FS for all kinds of metastases was 84.7%, but it reached up to 98% for macrometastases, and the specificity was 100%. FS allowed immediate completion of ALND in 50 patients (96%) with positive SLNs, and second-step surgery was only performed in 2 patients with discordant FS results. Conclusion: FS examination of SLNs is a reliable and safe procedure for the diagnosis of LN metastasis. FS provides immediate completion of ALND in case of metastatic disease in the SLNs.

Use of Intraoperative Frozen Section during Mediastinoscopy

Introduction: Staging of mediastinal lymph nodes (MLN) by mediastinoscopy can be of critical importance in assessing candidacy for lung resection. Mediastinoscopy is often performed as a sole procedure, with permanent pathology results guiding subsequent intervention. Our practice has been to perform mediastinoscopy followed by immediate surgical resection, as indicated, based on intraoperative frozen section (FS) assessment. The goal of our review is to evaluate the reliability of FS when compared to permanent section (PS) and to investigate any discordant findings. Materials and methods: A retrospective review of patients with lung cancer that underwent mediastinoscopy from June 2006 to January 2011. All received clinical staging according to NCCN guidelines and were considered potential candidates for surgical resection. Results for FS and PS of MLN were assessed. Results: Staging mediastinoscopy was performed on 191 patients, with a total of 549 MLN undergoing FS and PS analysis. Concordance between FS and PS was found in 545 MLN (99.3%). Discordance was found in 4 MLN (0.7%), each in a different patient. All 4 discordant MLN were initially negative on FS and then found to be positive on PS. Overall accuracy of FS analysis for detecting all malignancy was 97.9%, with 94.3% sensitivity, 100% specificity, 96.7% negative predicted value, and 100% positive predicted value. Conclusion: Our data suggest that for lung cancer patients with potentially resectable tumors, immediate FS analysis of MLN followed by definitive surgery is a reliable and safe strategy. Discordance with final pathology was rare (0.7%) and resulted in improper staging in 1 (0.5%) patient. Advantages of this “fast-track” approach include less medical costs and hastening of time from diagnosis/staging to definitive treatment.

The clinical significance of intra-operative ureteral frozen section analysis at radical cystectomy for urothelial carcinoma of the bladder.

To evaluate the clinical significance of intra-operative ureteral frozen section analysis (FSA) at the time of radical cystectomy. A total of 402 patients underwent radical cystectomy for urothelial carcinoma of the bladder at our institution from January 1991 to December 2011. Except for 35 ureters who underwent nephroureterectomy, 769 ureters were finally identified. Among these, FSA was performed at 645 ureters (83.8 %). If the first FSA result was positive for malignancy (carcinoma in situ or carcinoma) or demonstrated atypia or dysplasia, sequential ureteral resection was undertaken until normal urothelium was identified, when possible. A total of 54 ureters (8.4 %) of 46 patients (11.2 %) had ureteral involvement (positive) on the first FSA. On permanent section analysis (PSA), ureteral involvement was noted in 40 ureters (6.2 %) of 35 patients (8.7 %). The sensitivity, specificity, and accuracy of FSA were approximately 75, 96, and 95 %, respectively. Intramural tumor invasion was correlated with ureteral involvement on both FSA and PSA (p < 0.05). There was no correlation between upper urinary tract (UUT) recurrence and ureteral involvement on FSA and PSA. Positive FSA and PSA were not risk factors associated with overall and cancer-specific survival (CSS) on multivariate analysis. Intra-operative FSA can reasonably detect ureteral involvement. However, a relatively high false-positive rate (44 %) may be problematic and has the likelihood to overestimate disease at the ureteral margin. Overall, routine FSA of the ureters shows no correlation with UUT recurrence as well as overall and CSS.

Accuracy of Frozen Section Analysis of Sentinel Lymph Nodes for the Detection of Asian Breast Cancer Micrometastasis - Experience from Pakistan

Intraoperative sentinel lymph node biopsy has now become the standard of care for patients with clinically node negative breast cancer for diagnosis and also in order to determine the need for immediate axillary clearance. Several large scale studies confirmed the diagnostic reliability of this method. However, micrometastases are frequently missed on frozen sections. Recent studies showed that both disease free interval and overall survival are significantly affected by the presence of micrometastatic disease. The aim of this study was to determine the sensitivity and specificity of intraoperative frozen section analysis of sentinel lymph nodes (SLNs) for the detection of breast cancer micrometastasis and to evaluate the status of non-sentinel lymph nodes (non-SLNs) in those patients subjected to further axillary sampling. We performed a retrospective study on 154 patients who underwent SLN biopsy from January 2008 till October 2011. The SLNs were sectioned at 2 mm intervals and submitted entirely for frozen sections. Three levels of each section submitted are examined and the results were compared with further levels on paraffin sections. Overall 40% of patients (62/154) were found to be SLN positive on final (paraffin section) histology, out of which 44 demonstrated macrometastases (>2mm) and 18 micrometastases (<2mm). The overall sensitivity and specificity of frozen section analysis of SLN for the detection of macrometastasis was found to be 100% while those for micrometastasis were 33.3% and 100%, respectively. Moreover 20% of patients who had micrometastases in SLN had positive non-SLNs on final histology. Frozen section analysis of SLNs lacks sufficient accuracy to rule out micrometastasis by current protocols. Therefore these need to be revised in order to pick up micrometastasis which appears to have clinical significance. We suggest that this can be achieved by examining more step sections of blocks.

Value of intraoperative frozen section examination in the diagnosis and surgical procedures selection of renal occupying lesions

Objective To evaluate the value of intraoperative frozen section examination (IFS) in the diagnosis and surgical procedures selection for renal occupying lesions. Methods From January 2006 to December 2010,IFS was used in 114 men and 81 women with renal occupying lesions.The mean age was 52 years (range 17 -78).In 104,89,and 2 patients,lesions were in the right,left and bilateral kidneys,respectively.All patients underwent physical examination,129 were asymptomatic at presentation while clinical symptoms were observed in 66.The largest dimension of the tumors were 4 cm or less in 128 patients,4- 7 cm in 49,and larger than 7 cm in 18,respectively.The outcomes between IFS and postoperative routine paraffin section examination were compared.In cases with renal tumors nephrectomy or partial nephrectomy was performed.The results of IFS were compared between the 2 groups. Results The sensitivity and specificity of IFS for renal malignant lesions was 96.6％ and 100％,respectively.The total accuracy rate of IFS for renal occupying lesions was 97.4％.By subgroup analysis,the accuracy rate of clear cell carcinoma,papillary cell carcinoma,chromophobe cell carcinoma,sarcomatoid cancer,nephroblastoma,benign tumor and urothelial cancer was 94.3％,25.0％,16.7％,0,0,97.6％ and 100.0％,respectively.Partial nephrectomy and nephrectomy were performed in 57 and 123 patients with renal tumors,respectively.The surgical procedures selection was significantly associated with the lesion size (4 cm or less for 80.7％ vs 62.6％,P =0.015) and the malignant lesion diagnosed by IFS (31.6％ vs 93.5％,P＜0.001). Conclusion The accuracy of frozen section analysis for renal malignant lesions during surgery is reliable and significantly high,and the results can exert an important impact on surgical procedures selection. Key words: Kidney neoplasms ; Pathology, surgical; Frozen sections; Diagnosis; Nephrectomy

Intra‐operative frozen section analysis for suspected early‐stage ovarian cancer: 11 years of Gateshead Cancer Centre experience

In centres in which intra-operative frozen section (FS) analysis is not performed, 'apparent' early-stage ovarian cancer diagnosed after surgery on paraffin section may require further restaging laparotomy or adjuvant chemotherapy. Previous studies on FS analysis have reported high sensitivity, specificity and overall accuracy. The objective of this article is to present the largest published dataset on the accuracy of FS analysis over an 11-year period from a single institution. Diagnostic test accuracy. Northern Gynaecological Oncology Centre and Department of Cellular Pathology, Gateshead, UK. 1439 intra-operative FS analyses performed between January 2000 and December 2010 for suspected ovarian cancer. Prospectively collected data on FS analysis were compared with gold standard paraffin section. Sensitivity, specificity, likelihood ratios and post-test probability. The overall sensitivity and specificity of FS analysis were 91.2% and 98.6%, respectively. Positive and negative likelihood ratios were 64.7% and 0.09%, respectively. The pre-test probability of an ovarian tumour being borderline or malignant was 45.8%. When FS analysis was reported to be positive, the post-test probability increased to 98% (confidence interval, 97-99%). Conversely, when FS analysis was reported to be negative, the post-test probability decreased to 7% (confidence interval, 6-9%). The majority of false test results were either borderline tumours or of mucinous differentiation. Intra-operative FS analysis has excellent diagnostic test accuracy and assists gynaecological oncologists to perform the appropriate surgery in 95% of cases, thereby preventing the morbidity of surgical staging in benign cases and the morbidity of restaging procedures or chemotherapy in early-stage malignant tumours.

Ureteral frozen sections at the time of radical cystectomy: reliability and clinical implications

We hypothesized that the incidence of ureteral abnormalities on frozen section analysis (FS) at the time of radical cystectomy is much lower than historical values and that FS has minimal impact on outcomes. We also sought to determine the accuracy of FS and the associated costs. We reviewed the records of 301 patients who underwent a radical cystectomy for urothelial carcinoma of the bladder (UC) between March 2000 and January 2007. The ureteral margins were sent for FS and subsequent permanent hematoxyllin and eosin (H&E) sections and results were compared. Analyses were performed to determine the costs of FS and if any association was present with the pathological stage of the primary bladder tumour and regional lymph nodes, the presence of urothelial carcinoma in situ of the bladder (CIS) and survival outcomes with the FS. We identified 602 ureters for this study. The incidence of CIS or solid urothelial carcinoma in the ureter was 2.8%. The presence of CIS of the bladder and prostatic urethra was significantly associated with a positive FS (p = 0.02). The FS were not associated with survival outcomes. The cost to pick up 1 patient with any abnormality on FS was $2080. The cost to pick up 1 patient with CIS or solid urothelial carcinoma of the ureter on FS was $6471. The incidence of CIS and tumour on FS during radical cystectomy for UC is low. The costs associated with FS are substantial. Frozen section analysis should only be performed in select patients undergoing radical cystectomy.

Accuracy of Intraoperative Frozen-Section Analysis of Breast Cancer Lumpectomy-Bed Margins

My colleagues and I have been using intraoperative frozen-section analysis (FSA) to evaluate lumpectomy margins in an attempt to reduce the number of additional operations that patients with ductal carcinoma in situ or stage I and II breast cancer would have to endure. We review our experience in breast-conservation therapy (BCT) at the University of Florida (Gainesville) to determine the effectiveness of this approach. Operative reports, operative logs, and pathology reports were retrospectively reviewed for patients who had BCT from January 2001 to January 2004. Ninety-seven patients (116 operations) were reviewed. Nineteen patients required an additional operation (19.6%). Forty-three patients had positive margins on paraffin-embedded histologic analysis (44.3%). Accuracy of FSA was 84% when evaluated on a per-case basis, and 96% on a per-slide basis. False negatives were identified in 22 patients, affecting the operative pathway of 19 patients (19.6%) and were identified more frequently in cases of ductal carcinoma in situ (p < 0.001). There were no false positives. Additional operative time required for FSA was approximately 13 minutes per case. Eighty-four (86.6%) patients had successful BCT and 13 patients (13.4%) required mastectomy. Intraoperative analysis of margins using FSA is effective at minimizing the number of additional operations, with 19 patients benefiting from immediate intervention in this study. The authors believe that the number of second operations prevented and the high BCT rates justify performing FSA. Ductal carcinoma in situ is more difficult to identify in FSA. Preoperative discussions with the patient should reflect these findings.

Accuracy of frozen-section analysis in the diagnosis of ovarian tumors: a systematic quantitative review

A quantitative systematic review was performed to estimate the diagnostic accuracy of frozen sections in ovarian tumors. Studies that compared frozen sections and paraffin sections within subjects for diagnosis of ovarian tumors were included. Fourteen primary studies were analyzed, which included 3 659 women. For benign ovarian vs borderline/malignant tumor cases, the occurrence of a positive frozen-section result for benignity (pooled likelihood ratio [LR], 8.7; 95% confidence interval [CI], 7.3-10.4) and posttest probability for benign diagnosis was 95% (95% CI, 94-96%). A positive frozen-section result for malignant vs benign diagnosis (pooled LR, 303; 95% CI, 101-605) increased the probability of ovarian cancer to 98% (95% CI, 97-99%). In borderline vs benign ovarian tumor cases, a positive frozen-section result (pooled LR, 69; 95% CI, 45-106) increased the probability of borderline tumors to 79% (95% CI, 71-85%). In borderline vs malignant ovarian tumor cases, a positive frozen-section result (pooled LR, 18; 95% CI, 13-26) increased the probability of borderline tumors to 51% (95% CI, 42-60%). We conclude that diagnostic accuracy rates for frozen-section analysis is high for malignant and benign ovarian tumors, but the accuracy rates in borderline tumors remain relatively low.

Accuracy of frozen-section analysis in the diagnosis of ovarian tumors: a systematic quantitative review

A quantitative systematic review was performed to estimate the diagnostic accuracy of frozen sections in ovarian tumors. Studies that compared frozen sections and paraffin sections within subjects for diagnosis of ovarian tumors were included. Fourteen primary studies were analyzed, which included 3 659 women. For benign ovarian vs borderline/malignant tumor cases, the occurrence of a positive frozen-section result for benignity (pooled likelihood ratio [LR], 8.7; 95% confidence interval [CI], 7.3–10.4) and posttest probability for benign diagnosis was 95% (95% CI, 94–96%). A positive frozen-section result for malignant vs benign diagnosis (pooled LR, 303; 95% CI, 101–605) increased the probability of ovarian cancer to 98% (95% CI, 97–99%). In borderline vs benign ovarian tumor cases, a positive frozen-section result (pooled LR, 69; 95% CI, 45–106) increased the probability of borderline tumors to 79% (95% CI, 71–85%). In borderline vs malignant ovarian tumor cases, a positive frozen-section result (pooled LR, 18; 95% CI, 13–26) increased the probability of borderline tumors to 51% (95% CI, 42–60%). We conclude that diagnostic accuracy rates for frozen-section analysis is high for malignant and benign ovarian tumors, but the accuracy rates in borderline tumors remain relatively low.

Place et résultats de l'examen extemporané dans la stratégie chirurgicale des tumeurs épithéliales malignes et à la limite de la malignité de l'ovaire

The management of ovarian tumors discovered during laparoscopy depends equally on the surgeon and the pathologist. Thus, the surgeon will undergo a more or less radical surgery depending on frozen section analysis (FSA),which depends mainly on the pathologist's skills, the histopathologic type and the volume and the localization of the tumor. The accuracy of FSA is higher in ovarian cancer than in borderline tumor. In patients treated initially with a laparoscopic approach, if the FSA demonstrates the presence of an invasive carcinoma, a conversion to laparotomy should be performed in order to complete the surgical staging. If the FSA demonstrates the presence of a borderline tumor, an exclusive laparoscopic approach could be discussed.