Final Paraffin Section Research Articles

Diagnostic accuracy and replicability of Frozen section diagnosis in Ovarian Masses- A Tertiary health care institutional experience

Introduction: Ovarian neoplasms are a composite group of tumors including surface epithelial, germ cell and sex cord stromal tumors. A subgroup of neoplasms, borderline tumors are also present. The surgical management of each group of neoplasm is varied. Since preoperative diagnosis is arbitrary, the role of the intraoperative frozen section has become beneficial.
 Purpose: In our study, we aimed to evaluate the diagnostic accuracy of the frozen section by comparing it with the definitive histopathological report.
 Methods: This was a 5 years retrospective study (June 2018 to June 2023). Data of the patients have been retrieved from archives of Histopathology from the Department of Pathology. The specimens received, after gross examination few blocks have been prepared on the frozen section and finally processed for routine paraffin sections for the final histopathological report. Then the results of the frozen section and H&E sections were compared and categorized as benign, borderline and malignant to get the accuracy of frozen section.
 Results: Out of 75 frozen section diagnoses included in our study, benign contributed 58.7%, borderline- 13.3% and malignant- 28%. The final paraffin sections revealed benign tumors- 57.3%, borderline- 10.7% and malignant- 32%. There were 7 discordant cases among which 2 were overdiagnosed and 5 were underdiagnosed.
 Conclusion: The overall accuracy rate of our study was 93.7% which is within the limit of the accuracy range reported in the literature. Hence, the intraoperative frozen section is an important diagnostic tool for surgeons in determining the treatment of ovarian masses with certain limitations.

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.

Could cytology supplant frozen section for intraoperative evaluation of thoracic lesions? A single institutional experience in a developing country.

The diagnostic performance of cytology was compared with the frozen results and its usability was evaluated as a rapid diagnosis method in intraoperative thoracic surgery in a single institution (Istanbul, Turkey). All 197 subsequent patient specimens (cases) from 158 patients who were sent to our department from the thoracic surgery clinic for an intraoperative diagnosis request between the years 2016 and 2021 were evaluated. Obtained results from frozen and cytology were compared with final paraffin section diagnoses. Lesions were grouped into three different groups as nonneoplastic, benign, and malignant neoplasms. Diagnostic accuracy values of cytology and frozen sections in intraoperative consultation were 98.8% and 99.4%, respectively. Sensitivity values of cytology and frozen sections in intraoperative consultation were 96.3% and 98.7%, respectively. Specificity values of cytology and frozen sections in intraoperative consultation were 100% and 100%, respectively. Negative predictive values of cytology and frozen sections in intraoperative consultation were 96.7% and 98.9%, respectively. Positive predictive values of cytology and frozen sections in intraoperative consultation were 100% and 100%, respectively. Kappa statistics between cytology and frozen revealed a very high interrater reliability (Cohen's Kappa value: 0.911; p=.001; p < .01). The difficulty in distinguishing primary and metastatic carcinoma, which is mostly undecided in frozen sections and the definitive diagnosis is left to paraffin sections, seems also be a problem in the cytological examination. Cytological diagnosis can be used in the evaluation of small biopsy specimens that require tissue preservation in intraoperative consultation, especially for immunohistochemical and advanced genetic studies.

The effect of adjuvant radiotherapy on oncological outcomes in patients with early-stage cervical carcinoma with only intermediate-risk factors: a propensity score matching analysis

We aimed to evaluate whether adjuvant radiotherapy had a survival benefit for patients with early-stage cervical carcinoma with intermediate-risk factors. This study included patients who underwent radical hysterectomy and lymphadenectomy according to Wertheim–Okabayashi for stage IB1-IIA2 cervical carcinoma. Each patient had at least one intermediate-risk factor including tumour diameter ≥4 cm, deep stromal invasion, and positive lymphovascular space invasion (LVSI). Patients with lymph node metastasis, parametrial invasion, and positive surgical margins according to the final paraffin section were excluded. In total, 183 patients were included. Seventy-three (39.9%) patients had one, 85 (46.4%) had two, and 25 (13.7%) had three intermediate risk factors. Sixty-seven (36.6%) patients received adjuvant radiotherapy. There was a statistically significant difference in terms of stage, LVSI, and endometrial/uterine invasion between the groups that did and did not receive adjuvant radiotherapy (p = .024, p = .018, and p = .001, respectively). These two groups were homogenised by performing propensity score matching (PSM) analysis. In the new matched cohort (n = 134), 5-year disease-free survival (DFS) was 89.5% in the group that received adjuvant radiotherapy and 82% in the group that did not (HR: 0.484, 95% CI: [0.171–1.369]; p = .171). Also, receiving adjuvant radiotherapy was not associated with an improvement in oncologic outcomes in patients with one, two, or more intermediate risk factors. In univariate analysis, none of the risk factors was associated with DFS. In conclusion, adjuvant radiotherapy had no favourable effect on survival outcomes in patients with early-stage cervical carcinoma with only intermediate risk factors. IMPACT STATEMENT What is already known on this subject? Radiotherapy after radical hysterectomy in cervical carcinoma is accepted as the standard of care when high-risk factors – positive surgical margins, lymph node metastasis, and parametrial involvement – are found in the surgical specimen. However, the necessity of adjuvant radiotherapy in patients with intermediate-risk factors – deep stromal invasion, positive LVSI, tumour diameter ≥4 cm – is controversial. What do the results of this study add? We compared patients who received adjuvant radiotherapy and those who did not. No significant difference was found between the two groups in terms of oncologic outcomes. There was no difference between the two groups in terms of pelvic and extrapelvic recurrence rates. The number of positive intermediate-risk factors did not affect survival. Moreover, age, tumour type, stage, number of removed lymph nodes, grade, bilateral salpingo-oophorectomy, and endometrial/uterine invasion were not associated with DFS among patients with stage IB–IIA cervical carcinoma with only intermediate-risk factors. What are the implications of these findings for clinical practice and/or further research? Debate remains over the prognostic factors and the adjuvant treatment options in patients with early-stage cervical carcinoma who possess intermediate-risk factors. Adjuvant radiotherapy can be ignored if initial adequate surgery has been performed in this patient group.

Utility of frozen section in pediatric and adolescent malignant ovarian nonseminomatous germ cell tumors: A report from the children's oncology group

PurposeIn adult women, most malignant ovarian tumors are epithelial in origin. The use of intra-operative frozen section to distinguish between benign and malignant histology is reliable in guiding operative decision-making to determine the extent of surgical staging required. Pediatric and adolescent patients with ovarian masses have a much different spectrum of pathology with most tumors arising from germ cell precursors. This review was undertaken to assess the concordance between the intra-operative frozen section and the final diagnosis as an aid to guide extent of surgical staging in a group of pediatric and adolescent patients with malignant ovarian germ cell tumors. MethodsRecords of patients aged 0 to 20 years with malignant ovarian germ cell tumors enrolled on Children's Oncology Group study AGCT0132 were reviewed. Pathology reports from patients who had both intra-operative frozen section diagnosis and final paraffin section diagnosis were compared using descriptive statistics. By inclusion criteria for the study, all patients had a final diagnosis of malignancy with required yolk sac tumor, choriocarcinoma or embryonal carcinoma histology. Available central review of pathology final paraffin section slides were compared with final institution pathology reports. ResultsOf 131 eligible patients with ovarian germ cell tumors, 60 (45.8%) had both intra-operative frozen section and final paraffin section diagnoses available. Intra-operative frozen section diagnoses were classified as: incorrect diagnosis of benign tumor (13.3%), confirmation of malignancy (61.7%), immature teratoma (16.7%), germ cell tumor not otherwise specified (5%) and no diagnosis provided (3.3%). Intra-operative frozen section was incorrect in 23 of 60 (38.3%) patients evaluated. Central pathology review was concordant with the final institution pathology diagnosis in 76.3% of patients. Central pathology review identified additional germ cell tumor components in 23.7% of patients. ConclusionsIn pediatric and adolescent patients with a confirmed final diagnosis of ovarian germ cell malignancy, intra-operative frozen section diagnosis is not reliable to inform the extent of surgical staging required. Central review by an expert germ cell tumor pathologist provides important additional information to guide therapy.

The Guiding Significance of the Number of Positive Sentinel Lymph Nodes in Frozen Section for Intraoperative Axillary Dissection in Early Breast Cancer.

PurposeThe results of large randomised trials have changed the treatment strategy of axillary lymph nodes. Axillary lymph node dissection (ALND) can be avoided in some patients with one to two sentinel lymph nodes (SLNs) metastasis based on final paraffin section (FPS) results which called into question the need for intraoperative frozen section (FS). This study aims to assess the guiding value of the number of positive SLN detected via FS for intraoperative ALND.Patients and MethodsThis study retrospectively analyzed data from 3303 patients with breast cancer who underwent SLN biopsy between 2015 and 2019. Combined with the FPS results, FS sensitivity, specificity, and false negative rate (FNR) were calculated and the difference in the number of positive SLNs between FS and FPS was analyzed.ResultsThe overall FNR of FS was 23.21%, which was 76.47% in isolated tumor cells, 62.28% in micrometastasis, and 12.09% in macrometastatic disease. The size of SLN metastasis were significantly associated with a higher FNR (p<0.001). The accuracy rate of the number of positive SLNs detected via FS was 92.62%. Human epidermal growth factor receptor 2 (HER2) (p<0.03) and Ki67 (p<0.02) were significant factors affecting the accuracy rate.ConclusionFS is a effective method for SLN biopsy, ALND can be avoided in patients with one or two positive SLNs detected via FS.

NeuroSAFE frozen section during robot-assisted radical prostatectomy: peri-operative and histopathological outcomes from the NeuroSAFE PROOF feasibility randomized controlled trial.

To report on the methods, peri-operative outcomes and histopathological concordance between frozen and final section from the NeuroSAFE PROOF feasibility study (NCT03317990). Between May 2018 and March 2019, 49 patients at two UK centres underwent robot-assisted radical prostatectomy (RARP). Twenty-five patient were randomized to NeuroSAFE RARP (intervention arm) and 24 to standard RARP (control arm). Frozen section was compared to final paraffin section margin assessment in the 25 patients in the NeuroSAFE arm. Operation timings and complications were collected prospectively in both arms. Fifty neurovascular bundles (NVBs) from 25 patients in the NeuroSAFE arm were analysed. When analysed by each pathological section (n = 250, average five per side), we noted a sensitivity of 100%, a specificity of 99.2%, and an area under the curve (AUC) of 0.994 (95% confidence interval [CI] 0.985 to 1; P ≤0.001). On an NVB basis (n = 50), sensitivity was 100%, specificity was 92.7%, and the AUC was 0.963 (95% CI 0.914 to 1; P ≤0.001). NeuroSAFE RARP lasted a mean of 3h 16min (knife to skin to off table, 95% CI 3h 2min-3h 30min) compared to 2h 4min (95% CI 2h 2min-2h 25min; P ≤0.001) for standard RARP. There was no morbidity associated with the additional length of operating time on in the NeuroSAFE arm. This feasibility study demonstrates the safety, reproducibility and excellent histopathological concordance of the NeuroSAFE technique in the NeuroSAFE PROOF trial. Although the technique increases the duration of RARP, this does not cause short-term harm. Confirmation of feasibility has led to the opening of the fully powered NeuroSAFE PROOF randomized controlled trial, which is currently under way at four sites in the UK.

Challenges of Frozen Section in Borderline Ovarian Tumors: A 10-Year Retrospective Analysis from a Tertiary Gynecological Cancer Center: Retrospective Analysis

Objective: Frozen section procedure gives a great advantage of fertility preserving in young women with borderline ovarian tumors (BOTs). However diagnostic accuracy of frozen section in BOTs is not as high as the other ovarian lesions. In the present study, we aimed to evaluate the comparison of frozen section results and final pathology results in patients with BOTs. Material and Methods: A total of 97 patients who had BOTs, either on the frozen section or final paraffin section in our clinic between 2007 and 2017 were included in the study. Frozen section and final pathology were compared with medical records of the patients such as age, menstruation, preoperative serum CA-125 and CA 19-9 values, histological diagnosis, subtype, size, localization, and capsule involvement. Results: In BOTs, the diagnostic accuracy of the frozen section was 67%. Frozen section has 74% sensitivity, 40% specificity, 83% positive predictive value and 29% negative predictive value. In the present study, the only factor that affects the accordance between the frozen section and the final paraffin section was the papillarity of the tumor, and it was observed that when the tumor was more papillary, the results had been more compatible. Conclusion: In BOTs, surgical management should be performed with caution depending on the frozen section to avoid overtreatment, especially in young women.

Accuracy of frozen section at early clinical stage of endometrioid endometrial cancer: a retrospective analysis in Germany.

The aim of this study was to estimate the accuracy of intra-operative frozen section (FS) diagnosis during hysterectomy for early-stage endometrial cancer (EC). At the Department of Obstetrics and Gynecology, University of Luebeck, between 2009 and 2014, the intra-operative FS pathology of 164 patients with pre-operative endometrial curettage, showing G1 or G2 endometrioid EC at an early clinical stage (FIGO I-II), was compared retrospectively with the final paraffin section reports. The accuracy of myometrial invasion (MI) in all patients and separately in stage FIGO I patients was calculated and the under- or overtreatment of the patients was analyzed. A subgroup analysis was performed focusing on the percentage of inadequate staging by FS with clinical consequences. Concordance of FS and final pathology results in terms of FIGO stage was 85.2%, with an under-diagnosis rate of 14% and an over-diagnosis rate of 0.8%. The subgroup analysis rate of patients who were inappropriately operated using FS was 6.6%, while 3.3% underwent a secondary operation. The overall accuracy of FS in predicting MI was 93.3% and in patients with stage FIGO I, 92.7%. Sensitivity, specificity, PPV and NPV were 98.25%, 89.06%, 88.89% and 98.28%, respectively, and in stage FIGO I, 98.25%, 84.62%, 90.32% and 97.06%, respectively. The authors consider that intra-operative FS is a reliable diagnostic method to identify the clinical stage of EC and especially MI, to determine the necessity of lymphadenectomy. Further development of diagnostic techniques is essential to maximize diagnostic accuracy.

Mucinous ovarian tumors and the importance of frozen section biopsy

Introduction: Intraoperative diagnosis of ovarian tumors via frozen section is an invaluable tool for surgeons in order to decide the extent as well as the kind of operation that will follow. However, mucinous ovarian tumours are a diagnostic problem for frozen section biopsy, associated with high inaccuracy compared to the final paraffin sections diagnosis.

Comparative Diagnostic Accuracy of Frozen Sections and Scrape Cytology in Ovarian Neoplasms.

Introduction:Frozen section is a well-established method for providing rapid and accurate intraoperative diagnosis. Cytological techniques such as imprint and scrape cytology and intraoperative fine-needle aspiration cytology are conventionally considered as less accurate alternatives to the frozen section. However, inexperienced hands, scrape cytology has been shown to provide remarkably accurate results comparable to the frozen section.Aims:The aims of this study are as follows: (1) To evaluate the diagnostic utility of scrape cytology in the intraoperative diagnosis of ovarian neoplasms. (2) To compare the accuracy of scrape cytology with frozen section in the intraoperative diagnosis of ovarian neoplasms.Materials and Methods:This study was conducted over a period of 3 years from 2014 to 2017. A total of 60 cases of clinically and radiologically suspected ovarian masses were included in the study. Thirty cases were evaluated using frozen section and 30 cases using scrape cytology alone. The intraoperative diagnosis of both was compared with the final paraffin section histopathology.Results:The diagnostic accuracy of scrape cytology and frozen section in determining a benign and malignant nature of neoplasm was 96% and 100%, respectively. In 93% of cases, scrape cytology enabled correct categorization of the tumor as surface epithelial, germ-cell tumor, sex cord-stromal, or others.Conclusion:Scrape cytology is an adjunct to frozen section for providing an intraoperative diagnosis; however, in resource-poor settings, it can be used as a stand-alone method for aiding intraoperative decision-making.

Frozen Section in the Management of Ovarian and Uterine Tumors: The Past 5 Years in a Tertiary Centre.

Intraoperative frozen section (IFS) is a valuable resource, and its use in gynecological pathology has not been sufficiently emphasized. The main goal of the present study is to evaluate the reliability and agreement rates between IFS and the final paraffin section (PS) and determine how reliable IFS is. A retrospective study of all IFSs performed on uterine tumors and suspicious adnexal masses between January 2012 and December 2016 (excluding metastases) at the department of obstetrics and gynecology of the Centro Hospitalar Tondela Viseu. Frozen versus permanent section diagnosis were compared regarding the histologic type of the tumor, and the depth of myometrial invasion. A total of 286 cases were eligible for the present study, including 102 (35.7%) IFSs of uterine tumors, and 184 (64.3%) IFSs of ovarian tumors. The overall rate of deferred cases was 5.2% (15/286). The accuracy of the diagnosis in cases of endometrial carcinoma was 96.25% (77/80). Among the ovarian tumors, misdiagnoses occurred in 2 cases (1.1%), corresponding to a borderline tumor (serous type) and a clear cell intracystic adenocarcinoma. The IFS analysis plays an important role in selected situations and is associated to a high sensitivity and specificity in cases of ovarian and endometrial tumors. Its high accuracy is almost universally associated with the possibility of obtaining an optimal surgical treatment at the time of the first surgical approach.

Parathyroid Frozen Section Interpretation via Desktop Telepathology Systems: A Validation Study

Background: Telepathology can potentially be utilized as an alternative to having on-site pathology services for rural and regional hospitals. The goal of the study was to validate two small-footprint desktop telepathology systems for remote parathyroid frozen sections. Subjects and Methods: Three pathologists retrospectively diagnosed 76 parathyroidectomy frozen sections of 52 patients from three pathology services in Australia using the “live-view mode” of MikroScan D2 and Aperio LV1 and in-house direct microscopy. The final paraffin section diagnosis served as the “gold standard” for accuracy evaluation. Concordance rates of the telepathology systems with direct microscopy, inter-pathologist and intra-pathologist agreement, and the time taken to report each slide were analyzed. Results: Both telepathology systems showed high diagnostic accuracy (>99%) and high concordance (>99%) with direct microscopy. High inter-pathologist agreement for telepathology systems was demonstrated by overall kappa values of 0.92 for Aperio LV1 and 0.85 for MikroScan D2. High kappa values (from 0.85 to 1) for intra-pathologist agreement within the three systems were also observed. The time taken per slide by Aperio LV1 and MicroScan D2 within three pathologists was about 3.0 times (P < 0.001, 95% confidence interval [CI]: 2.8-3.2) and 7.7 times (P < 0.001, 95% CI: 7.1-8.3) as long as direct microscopy, respectively, while MikroScan D2 took about 2.6 times as long as Aperio LV1 (P < 0.001, 95% CI: 2.4-2.7). All pathologists evaluated Aperio LV1 as being more user-friendly. Conclusions: Telepathology diagnosis of parathyroidectomy frozen sections through small-footprint desktop systems is accurate, reliable, and comparable with in-house direct microscopy. Telepathology systems take longer than direct microscopy; however, the time taken is within clinically acceptable limits. Aperio LV1 takes shorter time than MikroScan D2 and is more user-friendly.

Accuracy of intraoperative frozen section for the evaluation of ovarian neoplasms: an institutional experience.

BackgroundOvarian neoplasms are a heterogeneous group of tumors including surface epithelial, germ cell and sex cord stromal tumors with a subset having low malignant potential (borderline tumors). While the surgical management plan differs in different categories of tumors, preoperative diagnosis is seldom available. In these circumstances, the role of frozen section becomes invaluable. In the current study, we aimed to evaluate the accuracy of the frozen section of ovarian tumors in our setup.MethodsIt was a retrospective study involving 141 cases of ovarian tumors undergoing surgical resection with frozen section evaluation from January 2009 to December 2014. After gross examination, one to five blocks were prepared on the frozen section depending upon the size of the specimen. After frozen section reporting, specimens were processed routinely for final paraffin section evaluation. Results of frozen and paraffin sections were categorized in benign, borderline, and malignant, and accuracy of frozen section was determined.ResultsOut of 141 cases, 107 were diagnosed as benign on final (paraffin) examination, while 6 were borderline and 28 were malignant. Out of 107 benign cases, 45 were non-neoplastic cystic lesions of the ovary including endometriotic, follicular, and corpus luteal cysts. The most common benign neoplastic tumor was mature cystic teratoma (20 cases) followed by mucinous cystadenoma (19 cases), serous cystadenoma (14 cases), sex cord stromal tumors (8 cases), and Brenner tumor (1 case). Among borderline cases, four cases were serous and two of mucinous neoplasms. The most common malignant neoplasm was serous carcinoma (11 cases) followed by mucinous carcinoma (6 cases). The overall accuracy of frozen section diagnosis is above 99 %. The sensitivity and specificity for benign tumors were found to be 100 and 97 %, respectively. The sensitivity and specificity for borderline tumors was 83 and 99 %, respectively, while for malignant tumors, it was 96 and 100 %, respectively.ConclusionsWe found a high sensitivity and specificity of frozen section for the diagnosis of ovarian tumors and to determine its malignant potential. Therefore, it should always be used when the preoperative diagnosis is not definite to govern extent of surgical resection. However, under-diagnosis can occur in tumors of borderline category which can be minimized by increased sampling on the frozen section.

Role of frozen section in the intra-operative margin assessment during breast conserving surgery.

Breast conserving surgery (BCS) is increasingly done for early breast cancers in many countries since it has been demonstrated by randomized trials that survival rates after BCS followed by adjuvant therapy are equivalent to those obtained after mastectomy. Frozen section analyses (FSA) is a technique used for intra-operative assessment of margin status in BCS. The aim of this study was to assess the concordance of margin status assessment by FSA and permanent sections and to assess correlation with local recurrence. A total of 162 patients underwent BCS for in situ or invasive carcinoma with FSA of margins during the year 2008 at our center. The inclusion criteria in this study were patients with intact tumor at the time of surgery. After application of the inclusion criteria, 60 patients could be included in this study. After frozen section, 20 patients had an initial negative margin. 40 subjects underwent additional excisions at the time of initial surgery because of close or positive margins. Of these 40 patients, in 32 patients a negative margin could be achieved with re-excisions. Pathological analyses of frozen section showed concordance to permanent sections in all cases. At a median follow-up of 40 months, there were no local recurrences. Intra-operative FSA allows resection of suspicious margins at the time of primary conservative surgery and results in low rates of local recurrence and second surgeries. There is good concordance between results of FSA and the final paraffin section in assessing margin status.

Preoperative MRI and intraoperative frozen section diagnosis of myometrial invasion in patients with endometrial cancer.

The rate of lymph node metastasis is extremely low in patients with low-risk endometrial cancer; lymphadenectomy may be unnecessary for these patients under an accurate preoperative diagnosis. The aim of this study was to evaluate the diagnostic accuracy of myometrial invasion (MI) on preoperative magnetic resonance imaging (MRI) and intraoperative frozen sections (FSs). Endometrial cancer was diagnosed in a total of 378 patients by preoperative endometrial curettage, preoperative magnetic resonance imaging MRI, and intraoperative FSs; the 378 patients underwent hysterectomy. The depth of MI was evaluated between the preoperative MRI, intraoperative FSs, and final paraffin sections (PSs). The histologic grade was also evaluated between preoperative endometrial curettage, intraoperative FSs, and final PSs. The sensitivity, specificity, positive predictive value, and negative predictive value for deep MI (≥ 50%) on MRI were 57.8%, 92.0%, 69.3%, and 87.5%, respectively, with a kappa value of 0.53. These figures on FSs were 66.7%, 97.9%, 90.9%, and 90.4%, with a kappa value of 0.71. When grade 3 endometrioid adenocarcinoma, serous carcinoma, clear cell carcinoma, and carcinosarcoma were considered high-grade tumors, the grade evaluation at the time of FSs was 70.2%, 99.0%, 96.1%, and 89.7%, with a kappa value of 0.75. In the patients with low-grade tumors, including grade 1 or 2 endometrioid adenocarcinoma on preoperative endometrial curettage, the rate of unexpected lymph node metastasis did not differ significantly between the patients who had a diagnosis of MI and lymph node metastasis by MRI and those with diagnosis of MI and histological grade by FSs (4.0% vs 2.6%; P > 0.05). Frozen sections had a higher agreement rate for MI than MRI; however, MRI is still considered an acceptable modality to guide preoperative decisions regarding lymphadenectomy especially in grade 1 or 2 endometrioid adenocarcinoma.

Frozen section examination may facilitate reconstructive surgery for mid and low rectal cancer.

Distal margin >1 cm provides an oncologic safety in low-lying rectal cancers. We evaluated the accuracy of frozen section (FS) examination in estimating distal margins, and its impact on intraoperative decision making regarding restorative proctectomy. Retrospective study of patients who underwent surgery for adenocarcinoma of the mid or lower rectum during 2001-2010 and for whom a distal margin specimen was examined intraoperatively by FS, to confirm microscopically free margins. Intraoperative findings, and frozen and final paraffin section findings were retrieved from patient charts. A distal margin of ≤1 cm was compared with >1 cm, for free margins at final pathology and local recurrence (LR). The impact of a distal margin ≤5 mm was also assessed. The impact of FS on intraoperative decision making, in patients who did and did not receive preoperative chemoradiotherapy, was assessed. The mean age of the 63 patients studied was 66.4 ± 11.8 years, and median tumor distance from the anal verge 6 cm (range 1-10 cm). Seven patients underwent abdominoperineal resection, 54 anterior resection, and two Hartman procedures. FS sensitivity and specificity were 83% and 98%, respectively. Accuracy of FS was high for the 41 patients treated with preoperative chemoradiotherapy, and the 22 who were not. Distal margin >5 mm at FS examination ensured a free margin at final pathology. LR rate was comparable between patients with distal margin >10 mm and ≤10 mm, 8% vs 11%, P = 0.65. FS examination may help determine free distal margin and consequently, in selected cases, may facilitate a restorative procedure in patients with low rectal cancer.

Intra-operative frozen section results reliably predict final pathology in endometrial cancer

ObjectivesTypically, complete surgical staging is necessary for patients with high-risk endometrial cancer. However, patients with low-risk disease may be able to avoid lymphadenectomy and its associated morbidity. We sought to evaluate the agreement rates between the intra-operative frozen sections (FSs) and the final paraffin sections (PSs) at our institution, and to determine if this was a reliable method for guiding our intra-operative decision-making with regard to the necessity of lymphadenectomy. Materials and methods116 patients with a pre-operative diagnosis of endometrioid adenocarcinoma of the uterus or complex atypical hyperplasia (CAH) underwent surgery at our institution. Demographic data, as well as information on stage, grade, histology and depth of invasion determined at FS and on PS were collected. Cohen's kappa statistic was used to assess the agreement rate between FS and final PS with regard to depth of invasion, grade, and histology. ResultsOur correlation rate between FS and final PS for histologic subtype, grade, and depth of myometrial invasion was 97.5%, 88%, and 98.2% respectively. Seven cases identified as complex atypical hyperplasia on FS were later determined to be cancerous on final PS, resulting in two patients being undertreated. ConclusionsOur results support the use of FS analysis as a means to guide intra-operative decisions regarding lymphadenectomy. Determination of histologic subtype, depth of invasion and grade is reliable at our institution, and demonstrates high concordance rates between FS and PS. These factors should be used to guide intra-operative decision-making regarding the necessity of a lymphadenectomy in patients with endometrial cancer.

Intraoperative evaluation of sentinel lymph nodes in breast carcinoma by imprint cytology, frozen section and rapid immunohistochemistry

Sentinel lymph nodes (SLN) isolated in 40 patients of breast carcinoma (stage T(1)/T(2)) were evaluated intraoperatively by imprint cytology and frozen section. Rapid immunohistochemistry (IHC) was done in cases where both imprint smears and frozen sections were negative for any metastatic tumor deposits. The results of these different techniques were compared with postoperative paraffin sections taken as "Gold Standard." Nottingham modification of Bloom Richardson scoring system was used for grading the tumors. Further, the correlation of the SLN status with tumor size, grade, and lymphovascular invasion was studied. The sensitivity, specificity, and overall accuracy of imprint cytology were 91.7, 100, and 95% respectively, and those of the frozen section were 95.8, 100, and 97.5% respectively. Examination of multiple serial sections improved the sensitivity and overall accuracy of frozen section. Results of intraoperative rapid IHC were equivalent to final paraffin sections. Histological grade and lymphovascular invasion were in direct correlation with SLN metastasis (P < 0.05). The risk of lymphovascular invasion increased from 22.2% in grade I tumors to 85.7% in grade III tumors. SLN biopsy is a reliable method to evaluate the status of the axillary lymph nodes. Imprint cytology can be used reliably where the facility of frozen section is not available.

Clinical impact of under-diagnosis by frozen section examination is minimal in borderline ovarian tumors

Aims The purpose of this study was to examine the clinical impact of under-diagnosis by frozen section examination in borderline ovarian tumors (BOTs). Methods We reviewed 209 consecutive patients with BOTs who were diagnosed and treated at our institute between March 1988 and July 2007. Tumors from 182 of 209 patients were evaluated by frozen section examination. After excluding a case with a deferred diagnosis, the results of frozen section examinations were compared with the final paraffin section examination. In 61 patients, the frozen section examination under-diagnosed a BOT as a benign tumor. In 120 patients, the frozen section examination correctly diagnosed or over-diagnosed a BOT. The clinical impact of under-diagnosis was evaluated by comparing the extent of surgery and treatment outcome between the patients who were under-diagnosed (study group) and the patients who were not under-diagnosed (control group). Results The study group had more mucinous ( P = 0.03) and/or stage 1A ( P = 0.02) tumors than the control group. Fewer patients in the study group received adjuvant chemotherapy than the patients in the control group ( P = 0.02). Fewer patients in the study group underwent radical surgery than the patients in the control group ( P = 0.02). However, the rates of treatment failure were similar between the two groups (no treatment failure in the study group and seven treatment failures in the control group; P = 0.10). Conclusions The under-diagnosis by frozen section examination did not compromise the outcome in patients with BOTs, although under-diagnosis was associated with more conservative surgery.