Accuracy Of Intraoperative Frozen Section Research Articles

Factors Affecting the Diagnostic Discordance Between Frozen and Permanent Sections in Mucinous Ovarian Tumors.

To investigate the accuracy of intraoperative frozen section (FS) diagnosis for predicting the permanent section (PS) diagnosis of mucinous ovarian tumors and evaluate the factors affecting the diagnostic discordance. This retrospective cohort study was performed in Tianjin Medical University General Hospital. All women who underwent ovarian surgery with FS between January 2011 and December 2022 were identified, and those with a diagnosis of mucinous ovarian tumor (MOT) by FS or PS were reviewed. Clinical and pathologic data were extracted. A total of 180 women were included, of which 141 (78.33%) had diagnostic concordance between FS and PS, yielding a sensitivity of 83.43% and a positive predictive value (PPV) of 92.76%. Under- and over-diagnosis occurred in 28 cases (15.56%) and 11 cases (6.11%). Tumor size > 13cm (OR 3.79, 95% CI 1.12-12.73) was an independent risk factor for under-diagnosis, and tumor size ≤ 13cm (OR 16.78, 95% CI 0.01-0.49), laparoscopic surgery (OR 0.14, 95% CI 0.02-0.92), the combination of other tumor components (including serous, Brenner tumor, and chocolate cyst; OR 7.00, 95% CI 1.19-41.12) were independently associated with over-diagnosis. The Kaplan-Meier survival curves and the Log rank test showed no significant difference between misdiagnosed and accurately diagnosed patients (all P > 0.05). Intraoperative frozen pathology of MOT is problematic for under- and over-diagnosis. The incorrect diagnosis of FS was related to determining the extent of surgery but had no impact on the patients' long-term recurrence and survival outcomes. In future clinical practice, surgeons need to obtain material accurately and enhance communication with pathologists during the operation to improve the accuracy of FS diagnosis.

Diagnostic accuracy of intraoperative frozen section for margin evaluation of oral cavity squamous cell carcinoma

ObjectivesIntraoperative frozen-section evaluation is a valuable technique for detecting positive margins intraoperatively for oral squamous cell carcinoma. We conducted this study to determine the diagnostic accuracy of frozen section in detecting margin status and the effect of tumor grade and stage on diagnostic accuracy.ResultsA total of 251 biopsy-proven cases of oral squamous cell carcinoma were included in this study. The tissue specimen resected during surgery was sent to the laboratory for frozen section evaluation. The frozen section results were then compared with the permanent section results to determine the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. The mean age of the patients included in the study was 51.65 ± 10.03 years, with male predominance (55.4%). The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of frozen section were 88.81%, 94.84%, 95.20%, 88.10%, and 91.63%, respectively. We conclude that frozen section is a useful technique in determining the margin status intraoperatively in oral cancers, with high diagnostic accuracy. Moreover, certain clinical parameters such as age, gender, disease duration, and tumor stage and grade appear to affect the diagnostic accuracy of frozen section.

Utility and diagnostic accuracy of intraoperative frozen sections in hepato-pancreato-biliary surgical pathology.

Hepato-pancreato-biliary (HPB) surgeries are one of the most challenging and complex procedures. Intraoperative frozen section (IFS) diagnosis plays a pivotal role in management decisions. Comprehensive large cohort studies evaluating utility of IFS in HPB malignancies are lacking. This study aimed to evaluate the accuracy of frozen section analysis and to analyse discrepancies and impact of IFS on the surgical decisions. This was a retrospective study of IFS received for the HPB specimens between years 2009 and 2021. The results were compared to the permanent sections to evaluate diagnostic accuracy, sensitivity and specificity. Indications, disagreements and impact on the surgical management were analysed. A total of 1008 specimens were evaluated: bile duct margin (279; 27.7%), gallbladder (203; 20.1%), liver lesions (125 cases; 12.4%), lymph nodes (147; 14.6%), pancreatic margin (120; 11.9%) and deposits (134; 13.3%). IFS were diagnosed as negative for malignancy (805; 79.9%), positive for dysplasia (8; 0.8%), suspicious for malignancy (6; 0.6%) and positive for malignancy (189; 18.8%). The overall diagnostic accuracy was 98.4%, and the discordant rate was 1.6%. The sensitivity, specificity, positive predictive value and negative predictive value were 94.7%, 99.4%, 97.5% and 98.6% respectively. The most important reason of discordant results was technical, followed by interpretational and sampling errors. The study demonstrates high diagnostic accuracy (98.4%) of IFS in a large dataset of HPB specimens. This comprehensive analysis apprises of the indications, errors and the impact of IFS diagnosis on subsequent HPB surgical management.

Diagnostic Accuracy of Intraoperative Frozen Section in Ovarian Neoplasms: A Tertiary Cancer Center Experience

Diagnostic Accuracy of Intraoperative Frozen Section in Ovarian Neoplasms: A Tertiary Cancer Center Experience

Evaluation of Accuracy of Intraoperative Frozen Section and Imprint Cytology in Gynecological Neoplasms-A Descriptive Cross-Sectional Study of 50 Cases in Tertiary Care Center.

Aims and Objectives Gynecological neoplasms are among the most common cancers in female population of India and worldwide. Various new advances have been made to diagnose gynecological pathologies which include imprint cytology and frozen sections in addition to the histopathological techniques. The aim of the study was to assess the diagnostic accuracy of intraoperative diagnostic procedure with gold standard histopathology. Method The study included 50 patients who had suspected gynecological neoplasm in a time period of 12 months. Their intraoperative diagnosis was made on frozen section and imprint cytology to rule out benign or malignant lesions and compared with gold standard histopathology. Results Our study concludes that maximum cases of female genital tract neoplasms belonged to the age group of 19 to 76 years, with 60% cases in postmenopausal age group. Overall diagnosis of 62, 52, and 76% malignancies were made on imprint cytology, frozen section, and histopathological examination, respectively. Conclusion The study concludes that diagnostic accuracy by intraoperative imprint cytology is higher (80%) than frozen section (76%). True positive cases were maximally reported by histopathology. True negative and false positive cases were equally reported by both frozen and imprint cytology. False negative cases were reported by frozen section more than by imprint cytology. The kappa statistical value was lesser in frozen versus histopathology and more in imprint versus histopathology. The sensitivity, specificity, positive predictive value, and negative predictive value for imprint cytology were 77.5, 90.0, 96.9, and 50%, respectively, whereas for frozen section, it was 72.5, 90.0, 96.7, and 45.0%, respectively.

Diagnostic Study of Multi-spectral Intelligent Analyzer in Diagnosis of the Infiltration Degree of Lung Adenocarcinoma

Lung cancer is one of the most common malignant tumors in the world. The accuracy of intraoperative frozen section (FS) in the diagnosis of lung adenocarcinoma infiltration cannot fully meet the clinical needs. The aim of this study is to explore the possibility of improving the diagnostic efficiency of FS in lung adenocarcinoma by using the original multi-spectral intelligent analyzer. Patients with pulmonary nodules who underwent surgery in the Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University from January 2021 to December 2022 were included in the study. The multispectral information of pulmonary nodule tissues and surrounding normal tissues were collected. A neural network model was established and the accuracy of the neural network diagnostic model was verified clinically. A total of 223 samples were collected in this study, 156 samples of primary lung adenocarcinoma were finally included, and a total of 1,560 sets of multispectral data were collected. The area under the curve (AUC) of spectral diagnosis in the test set (10% of the first 116 cases) of the neural network model was 0.955 (95%CI: 0.909-1.000, P<0.05), and the diagnostic accuracy was 95.69%. In the clinical validation group (the last 40 cases), the accuracy of spectral diagnosis and FS diagnosis were both 67.50% (27/40), and the AUC of the combination of the two was 0.949 (95%CI: 0.878-1.000, P<0.05), and the accuracy was 95.00% (38/40). The accuracy of the original multi-spectral intelligent analyzer in the diagnosis of lung invasive adenocarcinoma and non-invasive adenocarcinoma is equivalent to that of FS. The application of the original multi-spectral intelligent analyzer in the diagnosis of FS can improve the diagnostic accuracy and reduce the complexity of intraoperative lung cancer surgery plan. .

Diagnostic accuracy of frozen section and patterns of nodal spread in high grade endometrial cancer: A secondary outcome of the SENTOR prospective cohort study

ObjectivesThe study aimed to define the accuracy of intraoperative frozen section (FS) for the detection of metastases in sentinel lymph node biopsy (SLNB) and describe the pattern of lymph node (LN) spread and relation to molecular classifiers in patients with high-grade endometrial cancer (EC). MethodsWe performed a secondary outcome of clinicopathologic data from the Sentinel Lymph Node Biopsy versus Lymphadenectomy for Intermediate- and High-Grade Endometrial Cancer Staging (SENTOR) prospective cohort study evaluating SLNB in patients with clinical stage I high-grade EC (ClinicalTrials.gov ID: NCT01886066). The primary outcome was the sensitivity of FS of the sentinel lymph node (SLN) specimen, compared to a standardized ultrastaging protocol. Secondary outcomes included the pattern and characteristics of LN spread. ResultsThere were 126 patients with high-grade EC with a median age of 66 years (range:44–86) and a median Body Mass Index (BMI) of 26.9 kg/m2 (range:17.6–49.3). FS was performed on surgical specimens from 212 hemipelves; SLNs were identified in 202 specimens (95.7%) and fatty tissue alone was identified in 10 specimens (4.7%). Of the 202 hemipelves in which SLNs were identified, 24 were positive for metastatic disease on final pathology. Initial FS correctly identified only 12, yielding a sensitivity of 50% (12/24, 95% CI 29.6–70.4) and a negative predictive value of 94% (178/190, 95% CI 89–96.5). A total of 24 patients (19%) had LN metastases: 16 (13%) had isolated pelvic metastases, 7 (6%) had both pelvic and para-aortic metastases and 1 (0.8%) had an isolated para-aortic metastasis. ConclusionsIntraoperative FS of SLNs in high-grade EC patients has poor sensitivity. Since isolated para-aortic metastases are rare, para-aortic lymphadenectomy may be omitted in patients in which SLNs were successfully mapped to the pelvis.

Diagnostic accuracy of intra-operative frozen section at tertiary care center

Introduction: Frozen section is a valuable technique for immediate diagnosis in intraoperative management of patients. It helps the surgeon in the surgical management of the patient by helping in the intraoperative diagnosis of tumors, margins and lymph node assessment, and organ identification. Accuracy and limitation of frozen sections vary according to different anatomical sites. Study objective was to evaluate the diagnostic accuracy of frozen sections. Aims: Aim of this study was to analyze the frozen section results and compare it with final paraffin sections and evaluate the diagnostic accuracy. Material and methods: A retrospective study of 201 specimens of intra operative FS were carried out in histopathology section of B.J. Medical College, Ahmedabad. The diagnoses given on frozen section were compared with the final diagnosis given on permanent paraffin sections. The results were categorized into concordant and discordant. Results: The diagnostic accuracy of frozen section was found to be 86.6%. Discordant rate is 13.4%. Most common frozen section analysis was primary diagnosis or typing of neoplasms (97.5%). Discordant rate or false negative diagnosis was because of technical and interpretative error. Conclusion: Frozen section is a rapid diagnostic process which helps surgeons to choose best therapeutic approach. It confirms various benign and malignant lesions. When unexpected disease process is found and require a definite diagnosis and to take a definite decision on extent of surgery frozen section is very much helpful. However one needs to be aware of its limitations. By avoiding its limitation diagnostic accuracy can be improved.

The intraoperative frozen section analysis of thyroid nodules categorized under Bethesda III-IV-V, accompanied by concurrent imprint cytology as a diagnostic technique

Objective: Addressing therapeutic challenges posed by thyroid nodules classified under Bethesda categories III-IV-V is a primary concern. The aim of this study is to evaluate the diagnostic outcomes of intraoperative frozen section (IFS) when applied to these specific thyroid nodules, alongside evaluating the diagnostic performance of IFS when used in conjunction with concurrent imprint cytology (IC). Materials and Methods: We conducted a comprehensive search in the electronic hospital database to retrieve IFS results and final diagnosis of cases with category III-IV-V thyroid nodules. These patients had undergone nodule resection or partial thyroidectomy with IFS. We gathered information regarding patient demographics, nodule dimensions, and the execution of concurrent IC. Results: Our study comprised 81 eligible patients. Female/male ratio was 3.2. Mean patient age was 43.5 years. Average nodule size was 21.7 mm. IC was conducted in 20 cases as part of the IFS procedure. Sensitivity and specificity of IFS were 71% and 95%, respectively. Positive predictive value (PPV) was 83% and negative predictive value (NPV) was 90%. Diagnostic accuracy of IFS was 88%. We stratified cases into those with and without CIC. IFS with IC exhibited a sensitivity, specificity, PPV, NPV of 80%, 93%, 80%, 93%, respectively. In contrast, IFS without IC had sensitivity, specificity, PPV, NPV values of 68%, 95%, 83%, 90%, respectively. Conclusion: Inconsistent pathological assessments and varying malignancy rates present challenges when managing Bethesda category III-IV-V thyroid nodules. In addressing these challenges, IFS emerges as a potential effective method. Nonetheless, IFS exhibits restricted sensitivity in detecting malignancies within Bethesda category III-IV-V nodules. Inclusion of concurrent IC has the potential to improve the precision of IFS in identifying malignancies. A more extensive study in this regard is warranted.

Abstract P1-02-07: Accuracy and predictive value of resection margin assessment by intraoperative frozen section after neoadjuvant therapy: An analysis of the ABCSG 24 and 34 trials

Abstract Data on the accuracy of intraoperative resection margin assessment and its influence on survival after neoadjuvant therapy (NT) are scarce. In the present study, we analyzed the accuracy of resection margin assessment by intraoperative frozen section (IFS) in the prospectively randomized neoadjuvant clinical trials ABCSG 24 and ABCSG 34.164 patients with early breast cancer who received NT within the ABCSG 24 and ABCSG 34 trials between 2005 and 2015, and received IFS resection margin assessment were included in our analysis. Resection margin status by IFS was compared to subsequent FFPE resection margin status, which was considered the gold standard. According to the rate of FFPE-based false-negative and false-positive diagnoses, we determined sensitivity and specificity of IFS. Correlation of IFS diagnosis with definitive FFPE assessment was described by Cohen´s kappa coefficient, the distributional probability was analyzed by McNemar test. The association of patient- and tumor-related factors (menopausal status, residual tumor size, tumor grade, lymph node status, multifocality, DCIS component, lymph vessel invasion, ER/PR/HER2/Ki67 expression and RCB category) with correct IFS diagnosis was analyzed by chi2 test and Fisher´s exact test. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using Kaplan-Meier method and log-rank test. Median age of patients was 55 years. IFS diagnosis for negative margins (no tumor on ink) was correct in 131 (80%) cases, translating into a sensitivity of 0.571 and specificity of 0.877 (false negative rate: 43%, false positive rate 12%). Correlation coefficient for IFS and FFPE diagnosis yielded a Cohen´s kappa value of 0.459. 58 patients (35%) were re-excised during the first operation, in 27 patients (17%), a second surgical intervention was performed. Overall re-excision rates in patients with true positive, false positive and false negative IFS diagnoses were 96%, 93% and 78%, respectively. Rate of second surgical interventions in patients with true positive, false positive and false negative IFS diagnoses were 38%, 7% and 44%, respectively. Correct IFS diagnosis correlated with smaller residual tumor size (p=0.032), lymph node status (p=0.007), HER2 negativity (p=0.049), presence of a DCIS component (p=0.013) and absence of lymph vessel invasion (p=0.007). Despite of re-operation resulting in negative margins, false negative IFS diagnosis was associated with worse recurrence-free survival (p=0.0278). The impact of IFS diagnosis on OS did not reach statistical significance (p=0.0995), although patients with false negative IFS diagnosis showed a shorter OS. IFS assessment of margins after NT displayed high specificity and limited sensitivity in the ABCSG 24 and ABCSG 34 trials. Residual tumor size, lymph node status, HER2 positivity, presence of a DCIS component and lymph vessel invasion correlated with accuracy of IFS. Patients with false negative IFS margin status showed a significantly shorter RFS despite of a second intervention yielding negative margins. Larger studies are needed to confirm the effects of IFS margin assessment on OS. Our data could help to lower rates of subsequent surgical interventions for re-excision after NT and identify patients by the above mentioned tumor characteristics who are at an increased risk of recurrence despite negative margin status. Citation Format: Karin Rokitte, Kristina Tendl-Schulz, Ulrike Heber, Kerstin Wimmer, Rupert Bartsch, Stephanie Kacerovsky-Strobl, Georg Pfeiler, Günther G. Steger, Christian F. Singer, Dominik Hlauschek, Michael Gnant, Florian Fitzal, Zsuzsanna Bago-Horvath. Accuracy and predictive value of resection margin assessment by intraoperative frozen section after neoadjuvant therapy: An analysis of the ABCSG 24 and 34 trials [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-02-07.

Evaluation of a step-by-step approach to frozen section diagnosis in ovarian masses

Background: Ovarian cancer forms a significant proportion of cancer-related mortality in females. It is often detected late due to non-specific clinical presentation. Radiology and tumor markers may indicate an ovarian mass. However, exact diagnosis requires pathological evaluation, which may not be possible before surgery. Intraoperative frozen section (FS) is, therefore, an important modality for the diagnosis of ovarian masses. Aims and Objectives: This study was conducted to study step-by-step approach along with diagnostic utility and accuracy of intraoperative FS in diagnosis of ovarian masses. Materials and Methods: Retrospective comparative analysis was done to determine the diagnostic accuracy of FS as compared to routine histopathology in the pathology department of a tertiary care hospital. Diagnostic categorization was done into benign, borderline, and malignant. Overall accuracy, sensitivity, and specificity of FS technique were calculated. Results: Out of 51 cases, FS analysis yielded accurate diagnosis in 94.1% of ovarian masses. Intraoperative FS had a sensitivity of 94.7%, specificity of 96.9%, 3.1% false-positive rate, and 5.3% false-negative rate in malignant tumors. In benign lesions, FS had 91.7% sensitivity and 100% specificity. FS had 75% sensitivity and 96.4% specificity in cases of borderline tumors. Conclusion: FS is a fairly accurate technique for intraoperative evaluation of ovarian masses. It can help in deciding the extent of surgery. It distinguishes benign and malignant tumors in most cases with high sensitivity and specificity. A methodical approach is useful in determining accurate diagnosis on FS diagnosis.

Diagnostic accuracy of frozen section and patterns of nodal spread in high grade endometrial cancer: a secondary analysis of the SENTOR prospective cohort study

<h3>Objectives:</h3> Recent studies have shown that sentinel lymph node (SLN) biopsy accurately detects nodal metastases in patients with high-grade endometrial cancer (EC). SLN biopsy has the potential to replace complete lymphadenectomy for surgical staging in patients with high-grade EC, provided that an SLN algorithm is followed (side-specific pelvic and para-aortic lymphadenectomy for non-mapped hemipelves). The aim of this study was to define the accuracy of intraoperative frozen section for the detection of metastases in SLN biopsy and describe the pattern of lymph node (LN) spread in patients with high-grade EC. <h3>Methods:</h3> We performed a secondary analysis of clinicopathologic data from the SENTOR prospective cohort study evaluating SLN node biopsy at 3 designated cancer centres in Toronto, Canada (ClinicalTrials.gov ID: NCT01886066). Patients with clinical stage I high-grade EC (grade 3 endometrioid, serous, clear cell, carcinosarcoma, undifferentiated, or mixed tumors) undergoing laparoscopic or robotic primary hysterectomy were enrolled. The primary outcome was sensitivity of frozen section of the SLN specimen, compared to a standardized ultrastaging protocol. Secondary outcomes included the pattern and characteristics of LN spread. <h3>Results:</h3> There were 126 patients with high-grade EC with median age 66 years (range: 44-86) and median BMI 26.9 kg/m² (range: 17.6-49.3). Frozen section was performed on surgical specimens from 212 hemipelves; SLNs were identified in 202 specimens (95.7%) and fatty tissue alone was identified in 10 specimens (4.7%). Of the 202 hemipelves in which SLNs were identified, 24 were positive for metastatic disease. Frozen section correctly identified only 12, yielding a sensitivity of 50% (12/24, 95% CI 29.6-70.4) and negative predictive value of 94% (178/202, 95% CI 89-96.5). A total of 24 patients had LN metastases: 16 (13%) had isolated pelvic metastases, 7 (6%) had both pelvic and para-aortic metastases and 1 (0.8%) had an isolated para-aortic metastasis. All para-aortic metastases (n=8) occurred in non-sentinel LNs, among patients with serous (n=5), carcinosarcoma (n=2), and dedifferentiated (n=1) histology. One patient with isolated para-aortic metastases (carcinosarcoma, p53 abnormal) did not have a mapped SLN, but was identified by the SLN algorithm. Nodal metastases occurred in 10% of patients (3/30) with grade 3 endometrioid histology (all pelvic), compared to 33% of patients (15/46) with serous histology (10 pelvic alone, 5 pelvic and para-aortic). <h3>Conclusions:</h3> Intraoperative frozen section of SLNs in high-grade EC patients has poor sensitivity. However, frozen section may still be beneficial to confirm the presence of nodal tissue and ensure adherence to an SLN algorithm, including complete pelvic and para-aortic lymphadenectomy for non-mapped hemipelves. Because isolated para-aortic metastases are rare, para-aortic lymphadenectomy may be omitted in patients in which SLNs were successfully mapped to the pelvis.

Impact of Histological Type and Grade on the Diagnostic Accuracy of Intraoperative Frozen Section for Detecting Breast Cancer Metastasis to Axillary Sentinel Lymph Nodes.

IntroductionIntraoperative sentinel lymph node (SLN) evaluation is the standard of care in patients with clinically node-negative breast cancer. The most common histological subtype of breast carcinoma is invasive ductal carcinoma (IDC), followed by invasive lobular carcinoma (ILC). Alternatively, histological grades vary from grades G1 to G3. Therefore, in this study, we evaluated the diagnostic accuracy of frozen section (FS) for detecting breast cancer metastasis to SLNs with respect to histological subtypes and grades.MethodsA retrospective observational study was conducted in the Department of Histopathology at Liaquat National Hospital and Medical College, Pakistan, from January 2013 till December 2020, over a duration of eight years. A total of 540 cases of primary breast cancer, undergoing upfront breast surgery were included in the study. Intraoperatively, SLNs were identified and sent for FS. After FS reporting, the remaining tissue was submitted for final (paraffin) section examination after formalin fixation, and results of FS and final (paraffin) sections were compared.ResultsThe mean age of the patients included in the study was 52.05±12.42 years, and the median number of SLNs was three (ranging from one to 14). The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of intraoperative FS were 88.2%, 100%, 100%, 92.5%, and 95.2%, respectively. The sensitivity of FS for IDC was 88.3%, whereas it was 85.7% for ILC. Alternatively, the sensitivity of FS for grade G1, G2, and G3 tumors was 78.3%, 91.5%, and 90.2%, respectively. The false-negative rate for grade G1 tumors was 21.7%, which was higher than G2 and G3 tumors (8.5% and 9.8%, respectively). Similarly, the false-negative rate for cases where the number of SLNs was more than three was only 5.4%, which was lower than cases with a single and two to three SLNs sent on FS (23.1 and 14.7%, respectively).ConclusionThe sensitivity of intraoperative FS for detecting ILC metastasis to axillary SLNs was not substantially different from IDC; however, histological grade affects the sensitivity of FS diagnosis, with lower-grade tumors having low sensitivity. Moreover, increasing the number of SLNs sent intraoperatively on FS improves the sensitivity of FS for detecting breast cancer metastasis to axillary SLNs.

Factors Influencing the Discordancy Between Intraoperative Frozen Sections and Final Paraffin Pathologies in Ovarian Tumors.

AimTo retrospectively investigate the pre-operative clinical factors and ultrasonographic features that influence the accuracy of the intraoperative frozen section (IFS) of ovarian tumors.Patients and methodsWomen with ovarian tumors that underwent IFS in one tertiary medical center were recruited from January 2010 to December 2018. Demographic and clinical data of these women were retrieved from medical records in the hospital’s centralized database.ResultsA total of 903 ovarian tumors were enrolled, including 237 (26.2%) benign, 150 (16.6%) borderline tumor, and 516 (57.2%) malignant. The overall accuracy of IFS among all specimens was 89.9%. The sensitivities of IFS in diagnosing borderline tumors (82.0%) and malignant tumors (88.2%) were lower than in diagnosing benign tumors (98.7%, p <0.001, Z-test). The specificity of diagnosing malignant tumors (99.7%) was significantly higher than that of diagnosing benign tumors (94.7%, p <0.001, Z-test). The group with discordant IFS and final paraffin pathology (FPP) had younger age (47.2 ± 14.0 vs. 51.5 ± 11.8 years, p = 0.013, Mann–Whitney U test), and higher percentage of early-stage disease (85.2% vs. 65.1%, p = 0.001, chi-square test) and mucinous (39.3% vs. 3.3%) and endometrioid histologic types (34.4% vs. 20.2%) than the concordant group (all by chi-square test). Menopause (OR 0.34, 95% CI 0.15–0.76, p = 0.009), multicystic tumor in ultrasound (OR 2.14, 95% CI 1.14–4.01, p = 0.018), and ascites existence (OR 0.33, 95% CI 0.14–0.82, p = 0.016) were factors related to the discordant IFS by multivariate analysis.ConclusionsIFS has good accuracy in the diagnosis of ovarian tumors. We recommend more frozen tissue sampling for sonographic multicystic tumors in premenopausal women to improve the accuracy of IFS.

Diagnostic Accuracy of Frozen Section in Musculoskeletal Tumors

<strong>Introduction:</strong> Musculoskeletal tumors are rare group of disorders. To reach a diagnosis requires detailed medical history, physical examination, radiological investigations and histopathological correlation. Intra operative consultation plays an important role in the management of soft tissue tumors. However, there is a considerable lack of literature evaluating the diagnostic accuracy of frozen sections in musculoskeletal tumors. This study is aimed because no local data is available on the accuracy of frozen section in musculoskeletal tumors and frozen section allows intraoperative diagnosis. <strong>Objective:</strong> To evaluate the diagnostic accuracy of intra-operative frozen sections for musculoskeletal tumors i.e, bone and soft tissue benign and malignant. <strong>Study Design:</strong> Descriptive cross sectional study. <strong>Setting:</strong> Section of Orthopaedic, Department of Surgery, The Aga Khan University Hospital. Duration of Study: From 12th October 2018 to 5th August to 2019. <strong>Materials and Methods:</strong> A cross sectional descriptive study was designed to evaluate the Diagnostic accuracy of frozen section in musculoskeletal tumors at a tertiary care hospital, Karachi. All the patients meeting the inclusion criteria were enrolled in the study and sensitivity, specificity, PPV, NPV and diagnostic accuracy were calculated for frozen section keeping permanent section as gold standard. <strong>Results:</strong> Of the total 88 patient 48 (54.54%) were male and 40 (45.45%) were female. Mean age was 30.75 years (5–80 years). 63(71.59%) patients have bone tumors while 25(28.40%) have soft tissue tumors. 50(56.81%) patients have tumour involving lower extremity, 23(26.13%) have upper extremity tumors and 15 (17.04%) have tumour involving pelvis. Overall sensitivity of frozen section for benign and malignant tumour of bone and soft tissue was 96.66%, specificity was 100%, positive predictive value 100%, and negative predictive value 93.33% and accuracy was 97.72%. <strong>Conclusion:</strong> Frozen section serves as an invaluable and accurate tool in the intraoperative evaluation of musculoskeletal tumors. A diagnosis of musculoskeletal tumor by the frozen section method is highly reliable.

Accuracy of intra-operative frozen section in guiding surgical staging of endometrial cancer.

Surgery consists the main treatment of endometrial cancer; however, decision of lypmhadenectomy is controversial. Intra-operative frozen section (FS) is commonly used in guiding surgical staging; nevertheless, there are different reports regarding its adequacy and reliability. Aim of this study is to assess accuracy of FS in predicting paraffin section (PS) results in patients with endometrium cancer. Data of 223 cases, who were operated for endometrial cancer at a tertiary hospital in 2012-2019, were analyzed retrospectively. Histological type, grade, tumor diameter, depth of myometrial invasion, and cervical and adnexal involvement in frozen and paraffin section were evaluated. Positive and negative predictive values and accuracy of frozen results in predicting paraffin results for each parameter was assessed. Statistical significance was taken as 0.05 in all tests. Accuracy of FS in predicting PS results were 76.23% for histology, 75.45% for grade, 85.31% for depth of myometrial invasion, and 95.45% for tumor diameter. Surgery, based on FS results, caused undertreatment in 4 patients, while metastatic lymph node ratios were found in only 35.3-50.0% of cases who had high risk parameters at FS. Our FS results have reasonable accuracy rates in predicting PS results, in comparison with the previous literature. However, even if the high risk parameters detected in FS predict PS accurately, absence of lymph node involvement in all cases with high risk parameters indicates that FS-based triage cannot prevent unnecessary lymphadenectomies.

The Accuracy of Intraoperative Frozen Sections in Epithelial Ovarian Tumor

Objective: To evaluate the accuracy of the intraoperative frozen section in the diagnosis of epithelial ovarian tumor. Materials and Methods: An observational study of epithelial ovarian tumor reports from patients that underwent surgery with intraoperative consultation at Ramathibodi Hospital, Thailand between 2013 and 2017 was done. The frozen section diagnoses were compared with the final surgical diagnoses and the overall accuracy, sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) were studied. Results: One hundred sixteen ovarian specimen reports were reviewed, comprised of 74 (63.8%) benign, 21 (18.1%) borderline, and 21 (18.1%) malignant neoplasms. Nine cases (7.7%) were discordant diagnoses. The overall accuracy was 92.2%. The sensitivity and specificity for benign, borderline, and malignant neoplasms were 100%, 80.9%, and 76.2%, and 88.1%, 95.8%, and 100%, respectively. The PPV and NPV for benign, borderline, and malignant neoplasms were 93.7%, 80.9%, and 100%, and 100%, 95.8%, and 95.0%, respectively. Conclusion: The intraoperative frozen section has high accuracy in the diagnosis of ovarian epithelial neoplasm. The results can be used in guidance on the extent and type of surgical management. Keywords: Frozen section, Accuracy, Epithelial ovarian tumor

Diagnostic Role &amp; Accuracy of Intra-Operative Frozen Section in The Surgeries for Gastric and Gastro-Esophageal Malignancies

Diagnostic Role &amp; Accuracy of Intra-Operative Frozen Section in The Surgeries for Gastric and Gastro-Esophageal Malignancies

Accuracy of Intraoperative Frozen Section in Detection of Acute Invasive Fungal Rhinosinusitis.

Acute invasive fungal rhinosinusitis (AIFRS) is an aggressive form of fungal sinusitis, which remains a significant cause of morbidity and mortality. Early diagnosis and intervention are keys to improving patient outcomes. Intraoperative consultation has shown promise in facilitating early surgical intervention, but the accuracy of frozen section has not been clarified in this setting. To assess the accuracy of frozen-section diagnosis in patients with clinically suspected AIFRS. All cases of clinically suspected AIFRS during a 10-year period (2009-2019) were retrospectively reviewed. The frozen-section results were compared with the final permanent sections as well as the tissue fungal culture results, following which the accuracy of frozen section was determined. Forty-eight patients with 133 frozen-section evaluations for AIFRS were included in the study. Thirty of 48 patients and 61 of 133 specimens were positive for AIFRS on final pathology. Of 30 positive patients, 27 (90%) had at least 1 specimen diagnosed as positive during intraoperative consultation; among the 61 positive specimens, 54 (88.5%) were diagnosed as positive during intraoperative consultation. Of 72 negative specimens, all were interpreted as negative on frozen section. Thus, frozen sections had a sensitivity of 88.5% (95% CI, 0.78-0.97), specificity of 100% (95% CI, 0.94-1), positive predictive value of 100% (95% CI, 0.92-1), and negative predictive value of 90.6% (95% CI, 0.82-0.97). This study represents the largest series assessing the diagnostic accuracy of frozen section analysis in AIFRS. These findings are useful in frozen section-informed intraoperative decision making.

Diagnostic Accuracy of Intraoperative Frozen Sections in the Diagnosis of Central Nervous System Lesions: A Hospital-Based Study

Introduction: Intraoperative frozen section (FS) is an important tool in the management of neoplastic and non-neoplastic central nervous system (CNS) lesions. Although the final pathological diagnosis is based on the findings in paraffin tissue sessions, interpreting FS of CNS lesion is to assist the neurosurgeon in making the accurate judgment regarding the nature of the lesion and tissue adequacy. This study was to evaluate the agreement between FS and paraffin sections (PS) results; and to highlight the possible causes of error in discrepancy between FS and PS. Materials &amp; Methods: This is a retrospective study of 85 cases of FS. H&amp;E stained sections of both FS and PS of all these cases were reviewed with their histopathological reports. FS and PS results were compared. Possible causes of errors were reviewed and recorded. Results: Out of 85 cases; 76 cases (89.4%) showed no discrepancy, 2 cases (2.4%) minor discrepancy and 7 cases (8.2%) discrepancy. Sensitivity and specificity of FS were 90.1% and 85.7% respectively. Positive predictive value was 97.0% and negative predictive value was 63.1%. The false positive rate was 14.2% and false negative rate was 36.8%. The overall accuracy of FS was 89.4%. Conclusion: Our results showed high accuracy and specificity of FS. Therefore, FS is still useful, an effective tool for neurosurgeon although there are some challenges for histopathologists in reporting FS. The commonest discrepancy was seen between reactive gliosis and low-grade glioma. Over-diagnosis or under-diagnosis of FS can be reduced by closed cooperation among pathologist, neurosurgeon and radiologist.