Diagnostic Accuracy Of Frozen Section Research Articles

Diagnostic Accuracy of Frozen Section in Salivary Gland Neoplasms

Diagnostic Accuracy of Frozen Section in Salivary Gland Neoplasms

Intraoperative Frozen Section Analysis and an Audit of its Diagnostic Accuracy: A Cross-sectional Study from Maharashtra, India

Introduction: Frozen Section (FS) is a diagnostic technique performed intraoperatively to obtain relevant information about the primary diagnosis, margin status, or sentinel lymph nodes, which helps guide the course of surgery. With the prevalent use of FS, it is imperative to recognise and scrutinise its diagnostic pitfalls and make efforts for rectification. Aim: To compare diagnostic results obtained on FS with final paraffin-embedded histopathology and calculate the Diagnostic Accuracy (DA) of FS. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology at a tertiary care hospital, DVVPFs Medical College in Ahmednagar district, Maharashtra, India over a period of two years from January 1, 2020, to December 31, 2021. The diagnosis provided on specimens received for intraoperative FS was compared with the final histopathological diagnosis, considered as the gold standard for the same specimen. The results were categorised as concordant, discordant, and deferred cases. The diagnosis on FS and the final histopathological diagnosis, along with relevant clinical data, were entered into an excel sheet. Further, the DA of FS was calculated. All the discordant cases were analysed. Statistical analysis utilised simple percentage calculations from the excel sheet. Results: A total of 130 cases were analysed using FS, with the most common indication being sentinel lymph node analysis to detect metastatic deposits in 72 (55.4%) cases. Out of the total 130 cases, 119 (91.5%) were concordant, 10 (7.7%) were discordant, and 1 (0.8%) was deferred due to an insufficient specimen. Therefore, the overall DA rate was found to be 91.5% with an error rate of 8.5%. Upon analysis of the 10 discordant cases, the cause of inaccuracy was technical error in 7 (70%) cases and interpretation error in 3 (30%) cases. Conclusion: The DA obtained in the present study was somewhat lower than expected due to technical errors during FS sectioning, leading to artifacts, especially during lymph node processing. Analysis of the discordant cases unveiled this deficit. Therefore, such assessment studies should be performed periodically as they assist in highlighting the shortfalls and provide a plan to boost DA.

A Retrospective Analysis of Diagnostic Accuracy of Frozen Sections Compared to Permanent Sections: A 5 Years Study in A Single Tertiary Care Hospital In South Delhi

Introduction: Intraoperative frozen section pathology consultation has long been applied to verify/categorize a lesion, evaluate surgical margins, determine the organ of origin, and assess tissue adequacy for further diagnostic studies. Correlation of intraoperative frozen section diagnosis with final diagnosis can be an important component of an institution’s quality assurance process. The aim of this study was to evaluate the concordance and discordance between frozen section and histopathology diagnosis and to assess the reliability and challenges associated with this rapid diagnostic method. Materials and Methods: A retrospective review of all intraoperative consultation in the Frozen Section and Histopathology Department of Pathology, Hamdard Institute of Medical Sciences and Research and Hospital, New Delhi from 1st January 2018 to 31st December 2022 was performed. During this five-year study period, a total of 185 patients from surgical departments underwent intraoperative consultation. The final diagnosis from the surgical pathology report was compared to the intraoperative consultation diagnosis. Results: Frozen section diagnoses were evaluated on all the 185 cases, with 88 cases identified as positive for malignancy and 97 cases as negative for malignancy. On subsequent histopathology paraffin sections, 92 cases were positive and 93 negative for malignancy. The comparison revealed an approximate result concordance of 97.0% and a discordance of 3.0%. Conclusion: Frozen section intraoperative consultation is a reliable rapid method for patient diagnosis and management. Monitoring diagnostic accuracy of intraoperative consultation provides substantial information towards the causes of the errors. Our study suggests that more accurate sampling, and knowledge about clinical history and presentation can reduce the limitation and increase the diagnostic accuracy thus avoiding technical errors and reducing result discordance.

Issues and Challenges in Diagnoses of Borderline Ovarian Neoplasms by Frozen Section

Introduction: Frozen section is a rapid intraoperative method of tissue sectioning with the help of cryostat to arrive at a diagnosis and guide the operative procedure. It is an important diagnostic tool in the intraoperative management of ovarian neoplasms. Aims and Objectives: 1) To evaluate clinically suspected ovarian neoplastic lesions by frozen section. 2) To analyze the factors associated with difficulty in diagnoses of borderline ovarian neoplasms. Materials and Methods: This is a cross-sectional study conducted in the Department of Pathology for a period of 2 years. 60 cases of ovarian neoplasms undergoing Frozen section and subsequent histopathological examination are included in the study. Results: The mean age of patient is 39.49 years (21-72). Of the 60 cases, 73.33% are benign, 8.33% borderline and 18.3% are malignant on histopathological diagnosis. The concordance rate of frozen section with histopathological diagnosis is 91.67%. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Frozen section in the diagnosis of Benign, Borderline and Malignant ovarian neoplasms are 95.45%, 92.73%, 97.67%, 88.24% and 88.64%; 100%, 92.16%, 55.56%, 100% and 55.56%; 72.73%, 100%, 100%, 94.23% and 72.73% respectively. Conclusion: Frozen section of ovarian neoplasms helps to arrive at a diagnosis of whether they are benign or malignant with a high level of accuracy. Diagnosis of a benign lesion in a young patient guides the surgeon to a fertility conserving surgery. Likewise, diagnosis of a malignant lesion on table guides the surgeon to execute an extensive surgery in a single setting, saving the patient of the physical, emotional, psychological and financial strain of a second look operation.

Role of Frozen Sections in Diagnosing Female Genital Tract Lesions: A Tertiary Centre Study in Chennai, India

Introduction: Female Genital Tract (FGT) malignancies are common with ovarian cancers having high incidence and mortality. The asymptomatic character, difficult location and lack of effective screening methods make Intraoperative Frozen Section (IFS) an effective diagnostic test to guide the surgical decisions. Aim: To assess the performance of IFS, describe the associated demographic, clinicopathological factors and identify the errors leading to discordance when compared with Permanent Section (PS). Materials and Methods: A retrospective study of all the consecutive IFS consultations related to FGT lesions received in the Pathology Department between January 2013 to June 2022 was conducted between July 2022 to September 2022 at ESIC Medical College and Hospital, Chennai, Tamil Nadu, India. Cases with IFS deferred until PS section were excluded. The FS and PS reports, demographic, clinicopathological data, Risk of Malignancy Index (RMI), imaging and biochemical records were retrieved. In-depth descriptive analysis of clinicopathological parameters as frequency and percentage, frequency distribution of PS diagnosis, concordant and discordant categorisation, reasons for the discordance were described and the diagnostic accuracy of Frozen Section (FS) tool was calculated. Mean, Frequency (n) and percentage (%) analysis was done for the complete collected data. Results: Out of the total 35 FGT related IFS consultations received, 32 (91.43%) was for Ovarian Tumours (OT), which included 26 surface epithelial tumours, three sex cord stromal tumours, two germ cell tumours, one Krukenberg tumour. Two cases were deferred due to extensive haemorrhage and infarction. Confirmation of the diagnosis was the most common indication. The mean size of the OT (n=32) was 13 cm and ranged from 2 to 31 cm. RMI was low (<25) in 14 (44%, n=32), intermediate (25-250) in 10 (31%, n=32) and high (>250) in 8 (25%, n=32) of OT. The diagnostic accuracy of FS of all the FGT cases (n=35) was 85.71% (n=35 FGT cases) with an error rate of 14.29% was observed. Five OT cases had discordant FS diagnosis, 3 cases due to sampling error and mis-interpretation error in the remaining 2 cases. Artefacts like poor morphology due to tissue freezing, nucleomegaly, poor sectioning and section folding were observed in the discordant cases. Conclusions: Correct use of IFS along with careful preoperative work-up will help the surgeon intraoperatively. A good rapport among clinicians, pathologists and laboratory personnel will aid to improve the diagnostic accuracy. Periodic assessment of IFS tool is necessary as a quality check.

Utility and limitations of intraoperative frozen section diagnosis to determine optimal surgical strategy in suspected gallbladder malignancy

BackgroundPreoperative diagnosis of gallbladder cancer (GBC) remains a challenge. Unwarranted extensive surgery for benign disease and undertreatment for GBC pose challenges. We aimed to analyze the utility, diagnostic accuracy, and limitations of intraoperative frozen section (FS), for primary diagnosis of suspected gallbladder malignancy. MethodsPatients with suspected GBC underwent a cystic-plate cholecystectomy and FS for primary diagnosis. The procedure was considered adequate if FS suggested a benign pathology. A radical cholecystectomy was performed if FS favoured GBC, or in patients with high intra-operative suspicion of malignancy. All FS records were compared with final histopathology. ResultsFS guided the surgical strategy in 491 of 575 resections (85.4%). FS had a sensitivity of 88.3%, specificity of 99.6%, a positive predictive value of 99.4% and a negative predictive value of 92.7%. The diagnostic accuracy of FS was 95.1%. With routine use of intraoperative FS, only 10 out of 491 patients (2%) required a revised surgical strategy. ConclusionsFor radiologically suspected GBC it is prudent to confirm the histological diagnosis by use of intraoperative FS before undertaking radical resections. This study emphasizes the safety and accuracy of FS as an adjunct for directing optimal surgical strategy in suspected GBC.

Diagnostic Accuracy of Frozen Section in Musculoskeletal Tumors

ABSTRACT Introduction: 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. Objective: To evaluate the diagnostic accuracy of intra-operative frozen sections for musculoskeletal tumors i.e, bone and soft tissue benign and malignant. Study Design: Descriptive cross sectional study. Setting: Section of Orthopaedic, Department of Surgery, The Aga Khan University Hospital. Duration of Study: From 12th October 2018 to 5th August to 2019. Materials and Methods: 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. Results: 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%. Conclusion: 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.

Diagnostic Accuracy of Frozen Section and Its Influence on Intraoperative Management of Indeterminate Epithelial Ovarian Tumors.

The objective of this study is to determine the diagnostic accuracy of frozen section in detecting epithelial ovarian tumor histological types and its effect on management. A retrospective review was done of all patients who had an intraoperative frozen section for an indeterminate ovarian tumor over a six-year period. The reference standard was final histology. The validity indices for frozen section in diagnosing benign, borderline, and malignant lesions were determined. One hundred thirty-five intraoperative frozen section-diagnosed epithelial ovarian tumors were reviewed. The mean age was 44.9 ± 14.2years, the median parity was 2, and 57% (77/135) of patients were post-menopausal. The commonest histological subtype was mucinous 48.1% (65/135) on frozen section and 46.7% (63/135) on final histology. The overall concordance rate of frozen section to final histology was 81.5% (ƙ = 0.719, p = 0.0001). The accuracy, sensitivity, specificity, and positive predictive value of frozen section to diagnose benign lesions were 86.7%, 85.7%, 97.2%, and 79.2% respectively. In borderline tumors, the diagnostic test characteristics were 88.1%, 81.2%, 90.3%, and 72.2%. For malignant lesions, these values were 88.1%, 77.8%, 95.1%, and 91.3% respectively. The odds ratios for frozen section being correct were 40.9 (95% CI 14.8-113.5) for benign lesions, 40.3 (95% CI 13.4-121.3) for borderline tumors, and 67.4 (95% CI 20.5-222.0) for malignancy. Over-treatment or under-treatment occurred in 19.3% of patients. Intraoperative frozen section is useful in situations where the nature of the ovarian tumor is uncertain. However, borderline ovarian tumors are more likely to be over-diagnosed. About a fifth of patients received inappropriate treatments based on the frozen section report.

The Diagnostic Accuracy of Frozen Section Compared to Routine Histological Technique- A Comparative Study

The Diagnostic Accuracy of Frozen Section Compared to Routine Histological Technique- A Comparative Study

Accuracy of Frozen-Section Diagnosis of Brain Tumors: An 11-Year Experience from a Tertiary Care Center.

To analyze the frozen section (FS) diagnostic accuracy in correlation with the final diagnosis of brain tumors. This retrospective study comprised all brain tumor cases with FS diagnosis and permanent section diagnosis in Jordan University Hospital from July 1, 2007 to December 31, 2017. Data were obtained by reviewing slides and reports from the histopathology archives. Statistical Package for the Social Science (SPSS) software v20 was used for analysis. A total of 179 cases with frozen section and permanent section diagnoses were analyzed. Eighty-four (47%) patients were males and 95 (53%) females.The ages ranged from 1 to 85 years. Diagnostic accuracy of FS was 88.8%. Discrepancy was noted in 20 cases. Of the discrepancies, misclassification of tumor type was the most common category (12 cases, 60%), followed by grading mismatch (7 cases, 35%) and misdiagnosis of tumor versus non-tumor conditions (1 case, 5%). Patient age and gender were not significantly associated with the discrepancy between FS and final diagnosis. Our results were comparable to international reports. However, more emphasis on diagnostic cytology in intraoperative consultation is required as an effective adjunct to frozen section to overcome limitations.

A Comparison between the Diagnostic Accuracy of Frozen Section and Permanent Section Analyses in Central Nervous System

Objective:Using diagnostic pathological methods during surgery is a valuable means of determining the appropriate management for patients. Application of Frozen Section in CNS surgeries might face challenges due to friability of brain tissue and its relative inaccessibility. Various studies have evaluated the diagnostic acuity of frozen section compared to gold standard but results have been quite inconsistent. We conducted the present study to evaluate the accuracy of cryostat in diagnosing central nervous system tumors compared to the Gold Standard method.Methods:In this descriptive retrospective study, patients with definite diagnosis of central nervous system tumors made through histopathological evaluations were identified by reviewing the archives of pathology reports during 1996-2013. Demographic data, clinical history, radiologic findings and results of pathologic evaluations were extracted from the medical records and entered into SPSS statistical software v.22 for analysis.Results:A total of 405 patients diagnosed with CNS tumors were identified, of which 16 patients were not eligible and eventually 389 patients were included in the study. Regarding tumor category, subtype and grade, the results of the two methods were totally compatible in 303 patients (77.9%) and discrepant in 22.1% of cases. The tumors located in the middle fossa (p=0.031; OR=2.27; 95% CI: 1.08-4.79) and the posterior fossa (p=0.021; OR=2.46; 95% CI: 1.15-5.26) and the tumors biopsied using the stereotactic method (p=0.050; OR=2.42; 95% CI: 1.001-5.83) were associated with an increased chance of discrepant results between the two methods.Conclusion:Frozen section can correctly diagnose and affect the management of CNS lesions in 77.9% of cases. Finding ways to increase the sensitivity and specificity of this method and providing surgeons with more definite and exact intra-operative diagnosis can improve management of central nervous system lesions to a considerable degree.

The Diagnostic Accuracy of Frozen Section Compared to Permanent Section: A Single Center Study in Iran.

The diagnostic accuracy of frozen section as an important source of information in surgical pathology is important not only in the management of surgical patients but also as a measure of quality control in surgical pathology. In this study, we evaluated the diagnostic accuracy of frozen sections over a 6-year period in a teaching hospital in Iran. We retrospectively reviewed frozen sections performed in the Pathology Department of Taleghani Hospital (Shahid Beheshti University of Medical Sciences), Tehran, Iran from 2007 to 2013. The results were compared to the permanent sections to evaluate diagnostic accuracy, sensitivity and specificity, of frozen section test. Discordant cases were reassessed to find the reasons for discrepancy. A total of 306 frozen section specimens from 176 surgical cases were evaluated. In eleven specimens (3.59%) the diagnoses were deferred. Of the remaining 295 specimens, 6 (2.03%) were discordant and 289 (97.96%) were concordant to permanent diagnoses. Specimens were primarily from the head & neck, thyroid, ovary, parathyroid and lymph nodes. The overall sensitivity, specificity, positive predictive value and negative predictive value of the frozen section compared to permanent section (as gold standard) were 92.95%, 99.55%, 98.50% and 97.80% respectively. Of the 6 discordant diagnoses, two (33.3%) were due to sampling error and four (66.6%) were due to interpretative errors. Frozen section is an accurate and valuable test and can be relied on in surgical managements. The results of this study also confirm that the accuracy of frozen section diagnosis in our institution compares well with internationally published rates.

Comparison of Diagnostic Accuracy of Frozen Section with Imprint Cytology for Intraoperative Examination of Sentinel Lymph Node in Early-Stage Endometrial Cancer: Results of Senti-Endo Study

In early-stage endometrial cancer, intraoperative examination of sentinel lymph nodes (SLNs) can predict nodal involvement and avoid a second surgical procedure. Our goal was to determine the diagnostic accuracy (DA) of intraoperative examination in diagnosing metastatic pelvic SLNs. This was a retrospective study, including 125 patients with early stage endometrial cancer. Results of intraoperative examination by frozen section (FS) or imprint cytology (IC) were compared with final histology (serial sectioning and immunohistochemistry (IHC)). The diagnostic value of intraoperative examination was calculated. Of the 111 patients with SLNs detected (89%), 87 (78.5%) had an intraoperative examination (30 with FS and 57 with IC). Intraoperative examination detected SLN metastases in 9 of 16 patients with metastatic SLN at definitive histology (sensitivity = 56.3%): macrometastasis in 8 and micrometastasis in 1. Seven false-negative cases were found (43.7%; micrometastases in 6 and isolated tumor cells in 1). The DA of intraoperative examination was 92% (95% confidence interval (CI), 84-96.7). For FS and IC, DA was 97.3% (95% CI, 85.8-99.9) and 88% (95% CI, 75.7-95.5), respectively. FS has better DA than IC for intraoperative examination of SLNs in endometrial cancer. The main limitation of both techniques is in detecting micrometastasis and isolated tumor cells.

A Systematic Review and Meta-analysis of the Diagnostic Accuracy of Frozen Section for Parotid Gland Lesions

We conducted a systematic literature review using MEDLINE and Embase to identify articles on diagnostic accuracy of frozen section (FS) for salivary gland lesions published between January 1, 1985, and December 31, 2010. We also reviewed the reference lists of all identified articles and conducted a forward search using Scopus to identify all articles citing the reference set. Meta-analysis was used to produce a summary receiver operating characteristic (SROC) curve from which summary estimates of sensitivity and specificity were obtained. Study quality was assessed using the Quality of Diagnostic Accuracy Study (QUADAS) survey. The accuracy of FS was compared with that of fine-needle aspiration cytology using results from an earlier review. A set of 13 studies (1,880 cases) with extractable data met our inclusion criteria. The summary estimates for the area under the SROC curve, FS sensitivity, and FS specificity are 0.99 (95% confidence interval [CI], 0.98-1.00), 0.90 (95% CI, 0.81-0.94), and 0.99 (95% CI, 0.98-1.00), respectively. FS has acceptable accuracy (90% sensitivity, 99% specificity) and is consistently accurate across study centers.

Intraoperative cytology increases the diagnostic accuracy of frozen sections for the confirmation of various tissues in the parathyroid region.

The identification of parathyroid gland tissue and its distinction from adjacent structures such as thyroid gland, lymphoid, fibroadipose, and, rarely, thymic tissues on frozen section (FS) may be challenging owing to freezing artifact. Intraoperative cytology (IC) provides valuable complementary morphologic details. We evaluated 72 specimens with IC alone (group 1), followed by interpretation with FS to reach a final interpretation using IC and FS together (group 2). An additional 105 specimens were evaluated by FS alone (group 3). Permanent section diagnosis was used as the "gold standard." Sensitivity and specificity were 100% for group 2, compared with lower values for group 1 (98% and 100%, respectively) and group 3 (94% and 94%, respectively). IC is a valuable adjunct to FS during intraoperative consultation for evaluation of tissue in a parathyroid location.