Frozen Section Findings Research Articles

Role of Imaging in Predicting the Deep Surgical Margin in Gingivobuccal Complex Cancers: A Pilot Study.

Cancers arising from the gingivobuccal complex are one of the most common types of cancer in the oral cavity and are associated with poor prognosis. Among the various prognostic factors, positive surgical margin is the most important one that can be controlled by the operating surgeon. The deep surgical margins for buccal mucosa cancers is normally assessed by palpating the skin for induration and skin pinchability. The present study evaluates the role of imaging in assessing the deep surgical margin and its efficacy for skin preservation in buccal mucosa/ gingivobuccal carcinomas. The patients of gingivobuccal complex squamous cell carcinomas after histopathological confirmation were selected for the study. In imaging, the distance between the base of the tumour and skin (epidermis) of the cheek was measured by a senior radiologist preoperatively. The frozen section findings were confirmed by histopathological examination and the depth of invasion of the tumour was measured and the clearance of the deep surgical margin was confirmed. The correlation between imaging, skin pinch test and histopathological examination of the specimen was assessed. The sensitivity and specificity of imaging to predict the skin preservation (deep surgical margin more than 5mm) is 100% and 75% respectively compared to sensitivity and specificity of skin pinch test of 82.6% and 50% respectively. Imaging is an effective tool in predicting the skin preservation and skin excision compared to skin pinch test. Compared to the skin pinch test, imaging appears to be a useful tool for advising surgeons on skin preservation vs excision.

Correlation between fine needle aspiration and intraoperative frozen section findings for thyroid patients; a single center study

Introduction: Thyroid nodules are one of the most common diseases. Objectives: The aim of this study was to evaluate the correlation between fine needle aspiration (FNA) and intraoperative frozen section findings for thyroid disease patients. Patients and Methods: In this study, the FNA and intraoperative frozen section findings of 143 patients who were admitted to an educational hospital, Isfahan, Iran were collected and classified using these diagnostic methods during 2015. To find the correlation between FNA and intraoperative frozen section findings, statistical analysis was conducted using SPSS software version 16.0 (Chicago, IL). Results: Sensitivity and specificity of the positive FNA findings were 71% and 86.8%, respectively (P<0.001). The maximum concordance between FNA and intraoperative frozen section for papillary thyroid cancer was seen (P<0.001). Conclusion: In this study, a significant association between FNA and intraoperative frozen section of thyroid cancers, among our patients, however this finding requires further investigation by larger studies.

Hodgkin Lymphoma Presenting With Spinal Cord Compression: Challenges for Diagnosis and Initial Management.

Hodgkin lymphoma (HL) can present with extra-nodal disease, but spinal cord compression is exceptionally rare. We describe a 15-year-old presenting with hip/back pain with normal initial examination. Persistent pain and raised inflammatory markers prompted further investigation with MRI, which revealed an epidural mass causing spinal cord compression. On examination, there was no palpable lymphadenopathy or cauda equina syndrome, but absent lower limb reflexes were noted. Following multidisciplinary discussion, it was determined that cauda equina syndrome was imminent and therefore surgical debulking was undertaken, both to prevent this complication and establish a diagnosis. At surgery, the tumor was highly vascular. Frozen section confirmed lesional material. Following surgery, and given the frozen section findings, a short course of steroids was commenced to reduce any peri-surgical edema. Unfortunately, histopathology was ultimately non-diagnostic, due to failure of immunohistochemistry on technically challenging material. Consequently, ultrasound-guided excision biopsy of a (non-palpable) cervical lymph node was performed five days later; histopathology showed typical effacement of the normal architecture and a conspicuous population of CD15/CD30-positive larger pale cells present, confirming nodular sclerosis classic HL, despite recent steroids. We review the available literature for HL presenting with spinal cord compression and describe the challenges for diagnosis and initial management in such cases.

Sentinel lymph node biopsy in medullary thyroid microcarcinomas.

The aim of this prospective study was to analyze accuracy of sentinel lymph node biopsy with methylene blue dye for intraoperative detection of lateral metastases in clinically N0M0 medullary microcarcinomas with calcitonin <1,000 pg/mL and selection of true-positive patients for one-time therapeutic lateral dissection. In addition to total thyroidectomy and central neck dissection, all patients had bilateral sentinel biopsy of jugulo-carotid regions after methylene blue injection to decide upon necessity for lateral dissection. If sentinels were benign on frozen section, additional non-sentinels were extirpated, with no further lateral dissection. If sentinels were malignant, one-time lateral dissection was performed. 20 patients were included in this study. Hereditary disease form was observed in 3/20 (15%) of patients with RET proto-oncogene mutation C634F; remaining 17/20 (85%) were negative for germline mutations. There were no allergic reactions to methylene blue and identification rate of sentinels was 100%. In total, 2/20 (10%) cN0 patients had lymphonodal metastases, thus were reclassified as pN1b. Remaining 18/20 (90%) were classified pN0 based on standard pathohistology. Frozen section findings on sentinels were 100% match with standard pathohistology, and there were no skip metastases in lateral compartments. Sensitivity, specificity and accuracy of sentinel biopsy method with methylene dye and frozen section were 100%. Dzodic's sentinel lymph node biopsy method can be used for intraoperative assessment of lateral compartments and optimization of initial surgery of medullary microcarcinomas with calcitonin <1,000 pg/mL. This way, cN0 patients with sentinel metastases can receive one-time lateral dissection, and those without benefit from less extensive surgery.

2378 Hepatic Actinomycosis Masquerading as Gastrointestinal Malignancy

INTRODUCTION: Abdominal actinomycosis is a rare cause of liver cysts and rectal masses. It remains a diagnostic challenge. CASE DESCRIPTION/METHODS: A 60 year-old male (patient L) presented with a rectal mass found on colonoscopy. Biopsies were inconclusive; however, staging CT demonstrated liver lesions presumed to be metastases from rectal carcinoma. The patient began to have recurrent fevers, night sweats, and unintended weight loss, prompting an extensive infectious work-up notable only for a positive quantiferon. In the interim, patient L underwent laparoscopy and liver biopsy to further evaluate his presumed malignancy. Frozen sections revealed caseating granulomas with negative AFB and stains. The patient was diagnosed with GI tuberculosis (TB) based on constitutional symptoms, positive quantiferon, and frozen section findings, and was started on standard four-drug therapy. Final pathology resulted in visualization of sulfur granules, diagnostic of actinomycosis. TB treatment was discontinued and augmentin was started for a 6 month course. DISCUSSION: Actinomyces colonizes the oropharynx and digestive and genital tracts. It infrequently causes disease. Abdominal infection accounts for 20% of actinomycoses; of these, only 15% report liver involvement. Infection is associated with compromise of the mucosal barrier, either due to instrumentation or appendicitis. Our patient had recently undergone colonoscopies to diagnose his rectal mass. As in Patient L, actinomycotic liver abscesses usually present with an indolent course; symptoms include insidious abdominal pain, fever, and weight loss. Although these symptoms may be associated with malignancy, fever even in cancer patients should be presumed infectious until proven otherwise. Imaging commonly shows loculated cysts in contrast to patient L’s simple cysts with no loculations. The signs, symptoms, and radiographic findings of abdominal actinomycosis are non-specific and indistinguishable from colorectal cancer, inflammatory bowel disease, and gastrointestinal TB, making diagnosis difficult. In one review, laparotomy was considered essential for diagnosis in 69% of cases; pre-operative diagnosis rate was less than 10%. Treatment generally involves 6-12 months of beta-lactams. In summary, GI actinomycosis poses a diagnostic challenge as it is a rare clinical entity with nonspecific symptoms and endoscopic and radiographic findings. Successful diagnosis often requires a collaborative, multi-disciplinary approach. Treatment is with prolonged antibiotics.

Abstract P2-14-09: A novel nipple aleolar complex involvement predictive index (NACPI) for indicating nipple sparing mastectomy in breast cancer patients

Abstract Background: While Preservation of NAC is concerned to increase the risk of local recurrences in the retroareolar glandular tissue, nipple sparing mastectomy (NSM) is increasing in patients with breast cancer and has been shown to result in better cosmetic outcome and the benefit for quality-of-life. It is necessary to predict accurately NAC involvement in order to select which patients may be candidates to NSM. The distance from the nipple to the tumor (DNT) is proposed as one of the best criteria to select the patient. The purpose of this study is to identify the predictors of NAC involvement retrospectively and to develop a clinical predictive model to select the patients who can be offered preservation of NAC.Methods: A total of 168 patients with primary operable breast cancer who received subcutaneous mastectomy for breast reconstruction at Saitama Medical Center during July 2013 to December 2017 were selected from the hospital's surgical database. NAC involvement was defined by the presence of invasive carcinoma and/or ductal carcinoma in situ at the subareolar margin. Results: Of the 148 patients who were preserved NAC, 89.9% (133/148) were NAC involvement negative and 10.1% (15/148) were positive in permanent pathological specimens. Of the 20 patients who were resected NAC, NAC involvement positivity was only 50.0% (10/20). This revealed that NAC involvement with a sensitivity (SN) of 40.0%, a specificity (SP) of 93.0%, a positive predictive value (PPV) of 50.0% and a negative predictive value (NPV) of 89.9% (AUC=0.665, 95%CI: 0.5345-0.796). In 140 patients who were performed intraoperative sub-nipple frozen section biopsy, the findings was significantly associated with NAC involvement (P&amp;lt;0.001), and which predict the NAC involvement with a SN of 93.3%, a SP of 89.6%, a PPV of 51.9%, and a NPV of 99.1% (AUC=0.915, 95%CI: 0.835-0.994). In the concordance rate between frozen section findings and definitive pathologic results, DCIS was 53% (9/17), atypical cell was 50% (2/4) and invasive ductal carcinoma was 100% (3/3). Correlation between NAC involvement and clinicopathological factors, tumor size ≥4cm (P&amp;lt;0.001), DNT &amp;lt;1cm by MMG (P=0.002), DNT &amp;lt;1cm by MRI (P&amp;lt;0.001), nipple contrast findings by MRI (P&amp;lt;0.001), tumor in central portion (P&amp;lt;0.001), multicentirc/focal lesion (P&amp;lt;0.001), c(N) positive (P=0.014) were significant relation with NAC involvement. Each predictors were scored 0 or 1, and the total score of 0-3 points was defined as low risk, 4 points as intermediate risk, and 5-7 points as high risk. Depending on this categorized classification, the NAC involvement rate was 3.5% (5/142) in low risk, 68.7% (11/16) in intermediate risk, 90.0% (9/10) in high risk and there was a significant correlation between the risk group and NAC involvement (P &amp;lt;0.001). Notably, assuming that NAC is preserved for low risk patients and is resected for intermediate and high risk patients, NACPI contributes to improve the accuracy of selecting the surgical procedures (SN 80.0%, SP 95.8%, PPV 76.9%, NPV 96.5% (AUC=0.879, 95%CI: 0.784-0.974)).Conclusion: This study suggests that NACPI can help us indicating subcutaneous mastectomy for the breast cancer patients who request preserve NAC with more oncological safety. Citation Format: Seki H, Sakurai T, Shimizu K, Mizuno S, Tokuda T, Kaburagi T, Seki M, Karahashi T, Nakajima K. A novel nipple aleolar complex involvement predictive index (NACPI) for indicating nipple sparing mastectomy in breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-09.

Pitfalls of Frozen Section Diagnosis for Paraganglioma: A Clinicopathologic Analysis and Review of the Literature.

Few paraganglioma (PG) cases include frozen section diagnoses, and therefore, the accuracy of frozen section diagnosis for PG remains unknown. To better understand the histologic characteristics and pitfalls of frozen section findings for PG, 15 PG cases with frozen section diagnoses were selected from 12 articles through PubMed (1984-2015). In addition, we included 3 cases of PG for which intraoperative consultations were requested during a 5-year period (2012-2016) in 2 hospitals. Seven PGs were from the thyroid; 2 from the pancreas; 4 from the mediastinum, retroperitoneum, or mesentery; 1 from the middle ear; and 4 from the urinary bladder (UB). Out of 18 PGs, correct diagnoses were rendered in only 2 cases, and no thyroid or UB PGs were correctly diagnosed on intraoperative consultation. Thyroid PGs were frequently misdiagnosed as medullary thyroid carcinomas (4/7, 57%) and UB PGs were frequently misdiagnosed as malignancies.

Intraoperative frozen section analysis of sentinel lymph nodes in breast cancer – a single laboratory audit

Background Intraoperative sentinel lymph node (SLN) assessment is currently under scrutiny for its utility in the immediate management of breast cancer patients. Aim To determine the utility of frozen section (FS) analysis of SLNs by calculating the sensitivity and specificity of metastatic deposit detection. Methods Breast cancer pathology reports including intraoperative SLN FS analysis were retrieved from our laboratory database from the period of July 2011 to the present. The final tumour diagnosis, tumour grade, number and size of SLNs analysed, frozen section findings, H&E and immunohistochemical findings, and size of tumour metastases within the sentinel node were recorded. Results To date, a total of 197 records including 310 sentinel lymph nodes have been retrieved. Of these nodes, 62 were identified as having metastatic tumour deposits. Thirty-eight lymph nodes containing metastatic deposits were identified at frozen section and 24 were initially reported as having no meta-static disease (sensitivity 61%, specificity 100%). No isolated tumour cell (ITC) deposits were identified on frozen section, and 35% and 84% of micro- and macrometastases were identified, respectively. Conclusions Intraoperative sentinel node analysis is a useful tool for detecting metastatic deposits. Larger metastatic deposits are more frequently identified in the first instance than mi-crometastasis or ITCs. Other tumour-related factors such as tumour type and grade may be considered in predicting SLN metastasis.

Utility of Conization With Frozen Section for Intraoperative Triage Prior to Definitive Hysterectomy

Patients with early-stage cervical cancer are usually treated with conization or simple hysterectomy without removal of regional lymph nodes. A critical prognostic factor in patients with this cancer is the depth of invasion. Previous studies have reported that conization with frozen section analysis correlates 75% to 100% of the time with the pathologic findings in distinguishing dysplasia from invasive carcinoma. These studies were conducted at single academic centers; their applicability to general practice is unknown. The aims of this retrospective study were to review data from a single tertiary cancer center on the accuracy of conization with intraoperative frozen section analysis and to compare results with those from 2 community hospitals. Data were obtained for women who underwent conization with intraoperative frozen section analysis between 1997 and 2011 at the University of Texas MD Anderson Cancer Center and 2 community hospitals—The Woman’s Hospital of Texas and St Luke’s Episcopal Hospital. Results of pathologic analysis of frozen sections, loop electrosurgical excisional procedure/conization specimens, and hysterectomy specimens were compared for each patient. A total of 153 patients met study inclusion criteria. Based on the pathologic findings, the overall accuracy of conization with frozen section analysis in detecting cervical cancer was as follows: no residual disease, 96.5% (95% confidence interval [CI], 86.9%–100%); cervical squamous carcinoma in situ, 95.4% (95% CI, 84.5%–100%); cervical adenocarcinoma in situ, 98.7% (95% CI, 92.7%–100%); and invasive carcinoma 3 mm or greater, 100%. The frozen section findings were 100% accurate for triaging patients to simple or radical hysterectomy. This approach performed equally well in the 2 community hospitals with general pathologists as in the major cancer center with specialized pathologists. These findings show that conization with frozen section analysis is an effective technique for intraoperative triage of patients to immediate simple or radical hysterectomy in both an academic center and community hospitals.

Role of Laparoscopic Surgery in the Management of Endometrial Cancer

Minimum surgical treatment for endometrial cancer is removal of the uterus. The operative approach to achieve that goal ranges from vaginal hysterectomy alone to laparotomy with radical hysterectomy, bilateral salpingoophorectomy, bilateral pelvic and para-aortic lymphadenectomy with possible omentectomy, and resection of all metastatic disease. Stratifying the risk factors for predicting presence of metastatic disease has error rates exceeding tolerance for many gynecologic oncologists. Most accept routine laparoscopic surgical staging with hysterectomy, pelvic and para-aortic lymphadenectomy, and removal of adnexa as standard care for patients with endometrial cancer. Modifying the extent of surgical staging for low-risk intrauterine findings or excessive risk for postoperative morbidity is also accepted. Laparoscopic surgery has become the ideal initial surgical approach for this disease, allowing for visual inspection of common metastatic sites, biopsy of abnormal areas, and cytology from peritoneal surfaces. The extent of staging can be altered depending on frozen section findings from the uterus, adnexa, and peritoneal surfaces. Intraoperative medical decision-making can be individualized, encompassing all known risk factors for metastases and balancing comorbidities and potential adverse outcomes. This article documents how laparoscopic surgery satisfies the needs of individual patients and surgeons treating this disease.

Botryoid fibroepithelial polyp of the urinary bladder. A clinicopathological case report including frozen section findings

HistopathologyVolume 51, Issue 5 p. 704-707 Botryoid fibroepithelial polyp of the urinary bladder. A clinicopathological case report including frozen section findings D J Lum, D J Lum Department of Histopathology, Auckland City Hospital, Auckland, Department of Paediatric Surgery, Starship Children’s Hospital, AucklandSearch for more papers by this authorV Upadhyay, V Upadhyay Department of Histopathology, Auckland City Hospital, Auckland, Department of Paediatric Surgery, Starship Children’s Hospital, AucklandSearch for more papers by this authorA Smith, A Smith Department of Radiology, Auckland City Hospital, Auckland, New ZealandSearch for more papers by this authorJ McFarlane, J McFarlane Department of Histopathology, Auckland City Hospital, Auckland, Department of Paediatric Surgery, Starship Children’s Hospital, AucklandSearch for more papers by this author D J Lum, D J Lum Department of Histopathology, Auckland City Hospital, Auckland, Department of Paediatric Surgery, Starship Children’s Hospital, AucklandSearch for more papers by this authorV Upadhyay, V Upadhyay Department of Histopathology, Auckland City Hospital, Auckland, Department of Paediatric Surgery, Starship Children’s Hospital, AucklandSearch for more papers by this authorA Smith, A Smith Department of Radiology, Auckland City Hospital, Auckland, New ZealandSearch for more papers by this authorJ McFarlane, J McFarlane Department of Histopathology, Auckland City Hospital, Auckland, Department of Paediatric Surgery, Starship Children’s Hospital, AucklandSearch for more papers by this author First published: 07 September 2007 https://doi.org/10.1111/j.1365-2559.2007.02817.xCitations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume51, Issue5November 2007Pages 704-707 RelatedInformation

Beware the malignant jellyfish

Small pleural effusions that cannot be assessed by thoracentesis prior to surgery may represent a diagnostic challenge in the patient with a resectable, non–small cell cancer of the lung. Even if the effusion is drained preoperatively and analyzed, the cytology may be falsely negative. We have found that careful inspection of pleural effusions using a single small 2-cm incision and video-assisted thorascopy may reveal a gelatinous piece of clotlike material that resembles a jellyfish. This cohesive particulate piece of material lies in the effusion. This material can be sent for frozen section (unlike cytologic exams in most hospitals), and an immediate answer can be obtained. Cytology results of the surrounding effusion that return 24 hours later confirm the frozen section findings. If malignant, this avoids thoracotomy and pulmonary resection in a patient with unsuspected T4, stage IIIB lung cancer. It also avoids closing a patient with an unsuspected effusion and having to wait 24 hours for the cytology results. We review our experience with this jellyfish-like material.

Testis-sparing surgery for benign testicular tumors in children.

In this retrospective survey we identify preoperative and intraoperative criteria of nonmalignancy and analyze the result of conservative treatment of a testicular mass. A total of 22 surgeons responded to a questionnaire concerning lesions treated during the last 15 years in children between 0 and 15 years old. By definition alpha fetoprotein and beta human chorionic gonadotropin are within the normal limits at this age. The results were evaluated regarding evolution, growth of the preserved testis and local or distant recurrences. Benign tumor of the testis (83 cases) represented 48% of all cases. Orchiectomy was performed in 27 cases and conservative treatment in 56. The final histopathological diagnosis was benign germinal tumor in 48 cases, cysts in 18, gonadal stromal tumor in 13 and rare lesions (lipoma, hemangioma) in 4. No definitive clinical criteria of nonmalignancy were identified but some symptoms were suggestive of nonmalignancy. Ultrasound results were more conclusive and provided the diagnosis of teratoma, epidermoid cyst and particularly simple cyst. The conservative treatment performed 56 times was a simple biopsy in 2 children with bilateral lesions and enucleation in 52. Enucleation was performed in 43% of cases using a pedicle clamp and in 50% with frozen section. The frozen section was changed in 12 cases due to therapeutic decision for preservation (10) and orchiectomy (2). There were no contradictions between the definitive histopathological examination and frozen section. Secondary orchiectomy was performed for neonatal granular tumor. Average followup in 56 cases of conservative treatment was 4.8 years (range 6 months to 15 years). Neither secondary testicular atrophy nor any local or distant recurrence was recorded. A testicular tumor in children has a 50% chance of being benign. Treatment selection according to some clinical, biological, radiological and frozen section findings should allow us to decide on testis-sparing surgery without additional oncological risk, and with an aesthetic, psychological and functional benefit.

Surgical management of duodenal leiomyomas.

Duodenal leiomyomas are rare neoplasms and when present are usually asymptomatic. There are, however, isolated case reports of such leiomyomas giving rise to complications including gastrointestinal hemorrhage and obstruction. The purpose of this study was to review the surgical experience with duodenal leiomyomas at a large tertiary referral center. A retrospective review was performed of all patients with histologically proven duodenal leiomyomas encountered from 1975 to 1995. Twelve patients with surgically treated duodenal leiomyomas were identified. There were eight men and four women with a mean age of 57 years (range 20-73 years) at diagnosis. Anemia was the presenting sign in 10 patients (83%). The mean hemoglobin level at presentation was 10.8 +/- 2.67 g/dl. Other presenting signs included melena (n = 5) and epigastric tenderness (n = 4). No patient had obstructive symptoms. Upper endoscopy visualized the lesion in 9 of 10 patients, but endoscopic biopsy provided an accurate histologic diagnosis in only two of six patients biopsied. All resected specimens underwent frozen section and permanent histopathologic analysis. Local excision was performed in eight patients, as benignancy was anticipated at surgical exploration and frozen section findings. Two patients underwent segmental duodenal resection with primary end-to-end anastomosis, and two patients underwent a Whipple procedure. There was no perioperative mortality. Morbidity was minimal. There was no tumor recurrence during a median follow-up of 8.4 years. Gastrointestinal blood loss is the most common complication of duodenal leiomyomas requiring surgical intervention. Small symptomatic leiomyomas with benign features may be safely treated with local excision.

Laparoscopic management of organic ovarian cysts: is there a place for frozen section diagnosis?

Only benign ovarian cysts can be treated by laparoscopic surgery. Although clinical examination and the results of pre-operative work-up do make a real contribution in indicating the benign or malignant nature of cysts, only histology can provide the absolute diagnosis. In this context, the goal of this study was to establish whether there is any advantage in performing frozen section during laparoscopic surgical management of organic ovarian cysts. Between January 1989 and March 1996, 228 patients underwent an adnexectomy for an ovarian mass. After the pre-operative work-up and the diagnostic phase of laparoscopy, 26 patients (11.4%) presented with suspected signs of malignancy restricted purely to the ovary. These 26 patients underwent a laparoscopic adnexectomy with extraction of the excised tissues using an endoscopic bag, followed by frozen section. For all these patients the results of the frozen section concluded that the lesion was benign. In every case the definitive histological results confirmed the frozen section findings. This strategy enabled us to avoid laparotomy, especially for the nine post-menopausal patients whose adnexal masses appeared to be complex by ultrasound. These encouraging preliminary results need to be confirmed by a larger series of patients, so as to specify the place of frozen section in the laparoscopic surgical management of organic ovarian cysts.

Skip metastasis and hidden N2 disease in lung cancer: how successful is mediastinal dissection?

Out of 703 consecutive patients who underwent lung cancer surgery from 1986 to 1994, 562 were studied with an emphasis on lymph node metastasis. Skip metastasis was defined as metastasis to the upper mediastinum without involvement of the carinal, hilar, or intrapulmonary nodes. Twenty-nine patients had skip metastasis, accounting for 17% of the 175 with N2 disease. Except for one patient with a huge tumor, there was no lower-lobe disease. Patients with N2 disease nodes were categorized into the following groups: (1) 32 with false negative N2 that could not be detected macroscopically on the specimen; (2) 64 with true positive N2, detected macroscopically on the specimen; and (3) 79 patients with obvious N2. Positive carinal nodes were found in 12 of 70 N2 patients who underwent upper lobectomy, and in 60 of the (105) remaining N2 patients who had other types of surgery. We conclude that upper mediastinal dissection should be carried out in patients with adenocarcinoma in the upper lobe, because skip and undetectable metastasis are not rare. However, dissection of the carinal nodes with upper-lobe tumors, and of the upper mediastinum with lower-lobe tumors, can be omitted when the gross and frozen section findings are negative in the upper mediastinum and both the carinal and hilar nodes.

The accuracy of a frozen section diagnosis of borderline ovarian malignancy.

While the accuracy of frozen section in the diagnosis of invasive ovarian neoplasms has been previously addressed, the frozen section diagnosis of borderline ovarian tumors has been less well characterized. The distinction between benign and borderline lesions is critical to the proper operative management of these patients. The records of 48 patients that had a frozen section diagnosis of borderline ovarian malignancy during surgical exploration between 1986 and 1993 were reviewed. Thirty-one patients were Stage I, 2 patients were Stage II, 10 patients were Stage III, and 5 patients were unstaged. Clarifying phrases were used frequently in the frozen section report, and these terms were categorized as "rule out" borderline tumor, borderline tumor, and "at least" borderline tumor. Of 33 cases with a frozen section report of borderline or at least borderline malignancy, no case were subsequently found to be benign. Errors in the intraoperative management could have occurred in 3 of 48 cases (6.25%), when benign neoplasms were thought to be of borderline malignancy on frozen section. However, in each of these cases, the clarifying term rule out was used, indicating the equivocal nature of the frozen section findings. Thirteen of the 48 patients (27.1%) were found to have a focus of invasive cancer within a borderline tumor on final pathologic review; the primary tumors in these 13 cases ranged in maximal diameter from 5 to 26 cm and were of varying histologic types. The level of experience of the pathologist responsible for the frozen section did not influence the accuracy of frozen section determination noted in this study. A frozen section evaluation identifying a borderline ovarian malignancy is accurate in excluding the presence of benign pathology. It is crucial to understand the meaning of specific clarifying terms used in frozen section diagnoses.

Frozen section diagnosis in tumors of the testis: Possibilities, limitations, indications

When the clinical diagnosis is in doubt, biopsies obtained from areas suspicious for tumor of the testis can be examined using frozen sections after prior inguinal clamping. The correct tumor diagnosis was established in 81% of cases in the first biopsy, and in 11% in the repeat biopsy, making a total of 93% (n = 70). Frozen section examination is of considerably greater importance within the framework of lymphadenectomy in patients with non-seminomatous testicular tumours. In 1014 of such frozen section examinations, 98.4% of the frozen section findings were correct, 0.3% undecided and 1.3% false. The diagnostic sensitivity was 100%, the diagnostic specifity 98.6%, the technical sensitivity 84%, the technical specifity 99.8%. Lymph node metastases of up to 2 mm are only rarely detected by frozen section; for sizes between 2.1 and 10 mm, they are recognized in 85% of cases. In the setting of lymphadenectomy, the frozen section examination can be employed to monitor the extent of the dissection.