Frozen Section Analysis Research Articles

Intraoperative Frozen Section Analysis for Margin Status in Breast Conserving Therapy: a Retrospective 6-Year Experience at a Tertiary Centre in North East India

Abstract Breast cancer is the commonest cancer among Indian women as it is globally. Margin status post lumpectomy remains an important predictor of local recurrence after breast conserving surgery. We set out to investigate the positive predictive value of intra operative frozen section analysis in a tertiary cancer center in North East India. Retrospective data from all women who underwent breast conserving Surgery (BCS) from 2017 to 2022 was included. Frozen section analysis reports were compared against final pathology reports. Comparison was in regard to margin status. Two hundred ten women underwent BCT, and mean age was 49.5 years. The sensitivity and specificity of frozen section was 92.5% (86.2–95.64% 95% CI) and 99.8% (62.23–99.9% 95% CI) respectively. The PPV and NPV was 94.8% (87.09–99.86% 95% CI) and 99.8% (95.53–99.9% 95 CI). Our analysis showed an accuracy of 99.63% (95.22–99.96%, 95% CI). We concluded that frozen section analysis is accurate and has a high positive predictive value and negative predictive value for margin status in breast conserving surgery.

Frozen section analysis in community settings: Diagnostic challenges and key considerations.

Frozen section analysis in community settings: Diagnostic challenges and key considerations.

The importance of frozen section analysis in head, neck, and endocrine pathology.

The importance of frozen section analysis in head, neck, and endocrine pathology.

Intraductal Papillary Mucinous Neoplasm of the Pancreas: An Overview of Surgical Management

AbstractIntraductal papillary mucinous neoplasms (IPMNs) are commonly identified cystic lesions in the pancreas that may carry malignant potential for pancreatic ductal adenocarcinoma. Risk stratification of identified lesions is critical to determine which patients may benefit from surgical resection. Key high-risk features include size, growth, main pancreatic duct involvement, obstructive jaundice, and enhancing solid components on imaging. The surgical technique of choice depends on IPMN location, with pancreatoduodenectomy being the most common procedure due to the high incidence of high-risk IPMNs in the head of the pancreas. The extent of resection is guided by imaging and/or endoscopic data, potentially including intraoperative frozen section analysis to assess for high-grade dysplasia or invasive IPMN. Postoperative surveillance of the remnant gland is crucial and based on the risk of disease recurrence after the surgery, which is determined by the anatomopathological report.

The impact of indocyanine green on tumor visualization and procedural adjustment in minimally invasive liver surgery

BackgroundMinimally invasive hepatobiliary surgery is performed increasingly either with robotic assistance or conventional laparoscopy. The lack of haptic feedback is one of the main challenges which has to be addressed during these procedures. Especially in oncological minimally invasive liver surgery Indocyanine green (ICG) can help to gain additional information for improved oncological quality.MethodsPatients who underwent minimally invasive liver surgery for liver tumors between 01/2019 and 09/2022 and matched the study criteria were selected from the Magdeburg Registry of Minimally invasive liver surgery (MD-MILS). Patient demographics, tumor characteristics and perioperative data were analyzed retrospectively. The benefit of ICG for tumor identification and the resection procedure was assessed as 'very helpful', 'helpful' and 'not helpful' depending on the surgeon´s estimation.ResultsSeventy-two patients who met the selection criteria were included in the analysis. Of these, 49 patients received ICG for intraoperative tumor visualization (ICG). Twenty-three patients with comparable demographics did not receive ICG and served as comparison group (nICG). A total of 69.4% robotic and 30.6% laparoscopic procedures were performed. In the ICG group procedural adjustments were significantly more frequent intraoperatively (p = 0.023). Intraoperative frozen section analysis on additional biopsies of ICG positive lesions were performed in 37% in the ICG group. In the nICG group suspect lesions, identified by ultrasound, went to frozen section in 17% (p = 0.006). Histopathological tumor positivity was identified in 12.2% in the ICG cohort vs no tumor positivity in the nICG cohort. This was one factor which led to the termination of surgery in 8% in the ICG vs the nICG 4.3% group (p = 0.485). In 88% intraoperative ICG visualization was scored as “helpful” when injected on preoperative day 4–7 with respect to the liver parenchyma structure and hepatocellular function.ConclusionICG can improve oncological quality in minimally invasive liver resections. It provides additional visual information which can help to compensate the loss of haptics and tumor identification during liver tissue palpation. The intraoperative use of ICG was associated with no adverse events and did not prolong operative time. We recommend its routine use during minimally invasive liver surgery.

Current surgical management of malignant parotid tumors.

Surgical treatment of parotid cancer presents challenges due to the rarity of the disease, the histologic heterogeneity, and the complex regional anatomy. Recently published international guidelines contain recommendations for surgical management of the primary tumor and the neck lymph nodes, but still allow both T and N to be managed in different ways. This review summarizes the remaining areas of discussion. The reference treatment for parotid cancer is total parotidectomy; however, for low-grade, low-stage tumors a superficial parotidectomy may be sufficient. The cN+ neck requires a comprehensive neck dissection; for cN0 multiple valuable options remain. Frozen section analysis on level II nodes can guide the extent of neck dissection. The definition of 'clear margins' remains debated; close margins in low-grade tumors appear to be acceptable, positive margins always require additional treatment. A thorough understanding of the guidelines, fine-tuned if needed based on accurate preoperative workup and intraoperative surgeon's decision-making will provide the best outcome for the patient with parotid cancer.

Increased attention should be given to frozen section analysis during re-operation for incidental gallbladder carcinoma

Increased attention should be given to frozen section analysis during re-operation for incidental gallbladder carcinoma

Incidental Findings of Internal Mammary Lymph Node Recurrence after Breast Cancer during Microsurgical Breast Reconstruction: Discussion of Treatment Options and Review of the Literature.

Lymphatic drainage through the internal mammary lymph nodes (IMLN) is a key pathway for breast cancer metastasis, although IMLN metastasis is rare following primary treatment. In earlier years, treatment protocols primarily addressed axillary lymph node metastasis.We present five cases where IMLN metastases were discovered incidentally during autologous free-flap breast reconstruction. These cases highlight implications for both the reconstructive plastic surgeon and subsequent adjuvant therapy.From a plastic-reconstructive perspective, we recommend performing routine biopsies on any incidentally identified IMLN during autologous breast reconstruction. Positive findings may upstage the patient's disease and influence further treatment planning. However, we do not recommend actively searching for or extending dissections to harvest IMLN specimens. Only in the presence of a suspicious perinodal tumour mass do we perform an intraoperative frozen-section analysis, with reconstruction paused if malignancy is confirmed. After complete staging and discussion in a multidisciplinary conference, we proceed with tumour resection according to oncological standards if curative resection is deemed feasible. Reconstruction can then be performed during the same procedure. For locoregional recurrence of breast cancer, treatment continues to be a multimodal approach involving surgery, radiation, and systemic therapy to ensure local control and optimise long-term survival. In primary treatment, current national and international guidelines now recommend locoregional irradiation of the internal mammary chain for high-risk cases, which may further reduce the incidence of incidental IMLN metastasis findings in the future.

Instant Intraoperative Histopathological Assessment of Fresh Parathyroid Tissue: Higher Harmonic Generation Microscopy as a Potential Alternative to Frozen Section.

Hypoparathyroidism is a complication associated with significant morbidity and results from inadvertent removal of the parathyroid during thyroid surgery. Therefore, intra-operative identification of parathyroid tissue is essential to minimize the risk of hypoparathyroidism. Current identification techniques come with significant limitations in logistics and accuracy. We therefore propose higher-harmonic generation microscopy (HHGM), a rapid, non-invasive, label-free method for the real-time visualization of human tissue, as a potential alternative. A prospective proof-of-concept study was conducted at the Amsterdam University Medical Centers from February to April 2024. Intra-operative HHGM imaging of presumed parathyroid tissue samples was performed, and the results were compared with conventional histopathology by an expert endocrine pathologist in order to evaluate the sensitivity and specificity of HHGM. The logistical process and its potentially associated benefits were also evaluated. Intraoperative imaging was performed on 32 fresh, unprocessed tissue samples from 18 patients. HHGM demonstrated a high sensitivity (85%) and specificity (83.3%) for the detection of parathyroid tissue. HHGM imaging was found to be more time-efficient than frozen section, taking ~5 min per biopsy compared to 30 min for FS. HHGM was able to produce high-quality images in cases where frozen section analysis was inconclusive due to insufficient tissue. Logistical challenges and extra workload associated with HHGM were minimal. This proof-of-concept study demonstrates that HHGM could be a promising intraoperative diagnostic imaging modality, offering rapid imaging and detailed visualization capabilities. These features suggest that HHGM might potentially reduce surgery duration and decrease demand on pathology resources.

Frozen section in oncologic endocrine surgery

The aim of the present study is to discuss the benefits of intraoperative frozen sections (FS) for the surgical management of endocrine tumors. A systematic search of the literature of the last ten years on FS in the field of oncologic endocrine surgery was carried out and a discussion based on the available evidence and experience of the authors is provided. A group of publications focused on the role of intraoperative FS in thyroid surgery in identifying the malignant potential of thyroid nodules. The detection of lymph node metastasis and extrathyroidal growth in differentiated thyroid cancer (DTC) were also two other topical groups as well as the diagnosis of lymph node involvement based on stromal desmoplasia in medullary thyroid cancer (MTC). A further group investigated the possibilities of deep learning to overcome technical problems and another investigated the cost-benefit analyses. There is no relevant literature on the role of FS in the surgical treatment of parathyroid and adrenal cancers. The synthesis of the available evidence suggests that FS investigations of the thyroid glands should be restricted to BethesdaV nodules. The technical limitations in the exclusion of vascular and capsular invasion make the FS unsuitable for follicular neoplasms and oncocytic lesions. The Delphi lymph node seems to be suitable for investigation using FS and when positive represents an indication for lymphadenectomy in cN0 patients. Larger studies are necessary in the future to confirm if the absence of desmoplasia with an intact tumor capsule can reliably justify omitting lymph node resection in MTC, independent of the calcitonin level. The costs and benefits depend on the individual context so that generalization is difficult. Deep learning models could generally improve the performance of FS analysis in the future. In thyroid surgery awareness of the technical limitations of FS is crucial for correct implementation and thus to optimize its performance. A preoperative fine needle biopsy and surgical experience help in selecting the nodules that can benefit from FS. Deep image learning could help to overcome current problems in the future. In adrenal and parathyroid oncologic surgery FS do not play arelevant role.

Head and neck dermatofibrosarcoma protuberans: Case series of extensive resections and reconstructions with literature review

Dermatofibrosarcoma protuberans is a rare, locally aggressive soft-tissue sarcoma. Head and neck involvement accounts for only 10–15% of cases. Achieving clear margins in this region is challenging owing to anatomical constraints. Such cases often require extensive resection and complex reconstructions. This study presents a case series of extensive dermatofibrosarcoma resections in the head and neck, focusing on the surgical margins, reconstruction strategies, recurrence rates, and adjuvant therapy. We report four cases of head and neck dermatofibrosarcoma involving the cheek and scalp. Surgery included wide local excision with margins of 3–5 cm, which was confirmed intraoperatively by frozen section analysis. Reconstruction involved free flaps, local flaps, and healing with secondary intention. The choice depends on the defect size and location. Adjuvant radiotherapy was administered to selected cases. All patients achieved negative margins. One patient developed flap necrosis that required revision surgery. No local recurrence was observed during the follow-up (1–7 years). Head and neck dermatofibrosarcoma justifies aggressive surgical resection to achieve clear margins, which is the key to reducing the risk of recurrence. Free flaps and local reconstruction techniques ensure good functional and aesthetic outcomes. Adjuvant radiotherapy is indicated in patients with close margins or deep invasion. Long-term follow-up is essential owing to its high recurrence potential.

Frozen Section Analysis in Submandibular Gland Tumors: Optimizing Intraoperative Decision-Making

Introduction: With around 25 different salivary gland tumor entities described by the World Health Organization, the correct preoperative identification of masses as benign or malignant remains a challenge. If preoperative needle biopsy is inconclusive, frozen section analysis is a possible alternative for accurate histological identification. The purpose of our study was to evaluate the diagnostic effectiveness of frozen section performed for primary submandibular gland masses. Methods: In addition to acquiring epidemiological data from patients who underwent submandibular gland excision over a 20-year period, we analyzed the diagnostic effectiveness of frozen section performed for submandibular gland masses. We also examined the impact of frozen section on overall survival. Furthermore, we investigated whether there was an impact on the surgical revision rate for malignant submandibular gland masses that required additional neck dissection within the submandibular triangle. Results: Frozen section was performed for 54 submandibular gland tumors, with a specificity of 100% and a sensitivity of 81.3%. Frozen section was conducted in 12 cases of primary salivary gland malignancies, of which 9 cases were identified correctly. In three cases, the frozen section results were inconclusive. We calculated a relative risk reduction of 27% for revision surgery by performing frozen section. There was no significant association between frozen section results and overall survival. Conclusions: Frozen section demonstrates a significant reduction in the need for revision surgery. With a specificity of 100%, frozen section is especially suited to identifying benign masses. It is a valid diagnostic tool when preoperative sampling is not possible or is inconclusive.

Confocal Laser Endomicroscopy: Enhancing Intraoperative Decision Making in Neurosurgery.

Brain tumors, both primary and metastatic, represent a significant global health burden due to their high incidence, mortality, and the severe neurological deficits they frequently cause. Gliomas, especially high-grade gliomas (HGGs), rank among the most aggressive and lethal neoplasms, with only modest gains in long-term survival despite extensive molecular research and established standard therapies. In neurosurgical practice, maximizing the extent of safe resection is a principal strategy for improving clinical outcomes. Yet, the infiltrative nature of gliomas often complicates the accurate delineation of tumor margins. Confocal laser endomicroscopy (CLE), originally introduced in gastroenterology, has recently gained prominence in neuro-oncology by enabling real-time, high-resolution cellular imaging during surgery. This technique allows for intraoperative tumor characterization and reduces dependence on time-consuming frozen-section analyses. Recent technological advances, including device miniaturization and second-generation CLE systems, have substantially improved image quality and diagnostic utility. Furthermore, integration with deep learning algorithms and telepathology platforms fosters automated image interpretation and remote expert consultations, thereby accelerating surgical decision making and enhancing diagnostic consistency. Future work should address remaining challenges, such as mitigating motion artifacts, refining training protocols, and broadening the range of applicable fluorescent probes, to solidify CLE's role as a critical intraoperative adjunct in neurosurgical oncology.

Intraoperative frozen section analysis for detection of fracture-related infection in nonunion of the upper limb. Diagnostic accuracy study.

Intraoperative frozen section analysis for detection of fracture-related infection in nonunion of the upper limb. Diagnostic accuracy study.

Efficacy of PDD-guided tumor excision combined with photodynamic therapy in cutaneous squamous cell carcinoma.

Efficacy of PDD-guided tumor excision combined with photodynamic therapy in cutaneous squamous cell carcinoma.

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

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

A rare finding of testicular epidermoid keratinized cyst in a prepubertal boy: case report and management standardization.

Testicular epidermoid cysts (TECs) are rare, benign lesions that can also mimic malignant testicular masses. Accurate preoperative diagnosis is essential for proper management. A 13-year-old male presented with a painless solid mass in the left testicle. Serum tumor markers were normal. Ultrasound, CEUS and MRI findings were consistent with TEC. Surgical enucleation of the mass was performed, after ruling out malignancy through intraoperative frozen section examination. Histopathology confirmed diagnosis of keratin-filled epidermoid cyst. At 3-month follow-up, the patient is well-being and scrotal US is normal. This case highlights the importance of considering epidermoid cysts in the differential diagnosis of testicular masses in young males. Ultrasound is the first-line imaging modality in the assessment of any testicular masses. Other imaging modalities such as CEUS, elastography and MRI can be helpful to distinguish between benign and malignant lesions. Testis-sparing surgery can be safely performed, after ruling out malignancy through intraoperative frozen-section analysis.

An intraoperative nomogram for predicting secondary margin positivity in breast conserving surgery utilizing frozen section analysis.

Breast conserving surgery (BCS) is a standard treatment for breast cancer. Intraoperative frozen section analysis (FSA) is widely used for margin assessment in BCS. In addition, FSA-assisted excisional biopsy is still commonly practiced in many developing countries. The aim of this study is to develop a predictive model applicable to BCS with FSA-assisted excisional biopsy and margin assessment, with a focus on predicting the risk of secondary margin positivity in re-excision procedures following positive initial margins. This may reduce surgical complications and healthcare costs associated with multiple re-excisions and FSAs for recurrent positive margins. Patients were selected, divided into training and testing sets, and their data were collected. The Least Absolute Shrinkage and Selection Operator (LASSO) was used to identify significant variables from the training set for model building. Model performance was evaluated using Receiver Operating Characteristic (ROC) curves, calibration curves, and Decision Curve Analyses (DCAs). An optimal threshold identified by the Youden index was validated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The study included 348 patients (256 in the training set, 92 in the testing set). No significant statistical differences were found between the sets. LASSO identified six variables to construct the model and corresponding nomogram. The model showed good discrimination (mean area under the curve (AUC) values of 0.79 in the training set and 0.83 in the testing set), calibration (Hosmer-Lemeshow test results (p-values 0.214 in the training set, 0.167 in testing set)) and clinical utility. The optimal threshold was set at 97 points in the nomogram, yielding a sensitivity of 0.66 (0.54-0.77), specificity of 0.80 (0.74-0.85), PPV of 0.56 (0.47-0.64) and NPV of 0.86 (0.82-0. 90) for the training set, and a sensitivity of 0.65 (0.46-0.84), specificity of 0.88 (0.79-0.95), PPV of 0.68 (0.53-0.85) and NPV of 0.87 (0.81-0.93) for the testing set, demonstrating the model's effectiveness in both sets. This study successfully developed a novel predictive model for secondary margin positivity applicable to BCS with FSA-assisted excisional biopsy and margin assessment. It demonstrates good discriminative ability, calibration, and clinical utility.

Optimum diagnostic pathway and pathologic confirmation rate of early stage lung cancer: Results from the VIOLET randomised controlled trial.

Optimum diagnostic pathway and pathologic confirmation rate of early stage lung cancer: Results from the VIOLET randomised controlled trial.

A case report on a rare primary bone tumour: sacral chordoma presenting as sacral swelling with sphincter dysfunction

Chordoma is a rare, locally aggressive malignant tumour arising from remnants of the notochord, primarily affecting the axial skeleton, seen twice often in males above 40 years. This case report presents a 50-year-old male with primary sacral chordoma, emphasizing the need for early evaluation, treatment modalities and focusing on the importance of sacral nerve preservation during surgery for better functional outcome. Purpose of the study was to demonstrate the significance of early evaluation and diagnosis, emphasizing the importance of at least unilateral sacral nerve root preservation for optimizing postoperative bowel and bladder function. A 50-year-old male presented with sacral swelling, saddle anaesthesia, lower backache, urinary incontinence, and constipation. Examination revealed a firm, immobile sacral mass with reduced anal sphincter tone. Magnetic resonance imaging (MRI) suggested the presence of a sacral chordoma, leading to the planning of surgical resection. Intraoperatively, frozen section analysis confirmed the diagnosis of chordoma. Intraoperatively, the lesion was found to extend predominantly toward the left side, necessitating careful dissection and preservation of the sacral nerve roots on the right side. Post-operatively, the patient experienced improved bowel and bladder function, along with significant pain relief. The patient showed substantial postoperative improvement, with resolution of urinary and bowel dysfunction. Follow-up imaging revealed no tumour recurrence. Preservation of sacral nerve roots was crucial to the patient’s recovery, improving overall quality of life. This case highlights the need to consider chordoma in the differential diagnosis of sacral masses and emphasizes the importance of sacral nerve root preservation during resection to optimize functional outcomes in patients with this rare tumour.