Frozen Section Samples Research Articles

Exploring the Diagnostic Challenges of Uterine Lesions in Frozen Section: A Comprehensive Study at a Tertiary Care Center.

Introduction Uterine masses are commonly submitted for frozen section, to guide the surgeon, regarding the type and extent of the procedure during surgery. Despite the technical difficulties in processing, sectioning, and staining of frozen section samples, it remains a fairly reliable intraoperative tool. Aim This study aims to analyze the diverse spectrum of uterine masses sent for frozen sections for two years. In addition, it aims to analyze the histomorphology of the uterine masses sent for the frozen section and correlate it with that of the routine histopathological findings, thereby justifying the diagnostic value of the frozen section with this study. Furthermore, the study aims to classify the lesions into benign and malignant, quantify their frequency, and listthe most common lesions seen in the uterine mass specimens sent for frozen section analysis. Methodology This retrospective descriptive study includes data from January 2021to December 2022, retrieved from the archives of the Department of Pathology at Saveetha Medical College.This study includes a total of 76 cases, including all the uterine masses sent for frozen section analysis during the study period. Results Of the total of 76 cases received, 17 (22.4%) were malignant and 59 (77.6%) were benign. Of the malignant cases reported, the most common was endometrial carcinoma, and the least common entities encountered were carcinosarcoma and leiomyosarcoma. Of the benign cases, benign endometrial polyp was the most common endometrial lesion and leiomyoma with and without degeneration was the most common myometrial lesion encountered. Of the 50 cases of leiomyoma encountered, 16 had extensive degenerative changes. The most common degeneration seen in the fibroid was hyaline degeneration, and the least common was xanthogranulomatous degeneration. Conclusions The intraoperative frozen section analysis is a very important diagnostic tool, but we need to be aware of its limitations. The accuracy, sensitivity, and specificity rates were found to be high. Thus, frozen section diagnoses can be very valuable in the clinical management of uterine tumors. Careful gross examination, sampling from representative areas, and good communication between the pathologist and surgeon may help in avoiding its limitations.

A Retrospective Study on Turnaround Time for Frozen Sections- A Tertiary Care Centre Experience from Southern India

Introduction: Intraoperative consultation by frozen sections is an integral and essential part of surgical pathology to provide critical real-time information and guide in further intraoperative management. Diagnostic accuracy and Turnaround Time (TAT) have been considered as essential parameters which decide its effectiveness. Although diagnostic accuracy has been studied extensively, very few studies have assessed TAT of frozen sections. Aim: To assess the TAT for frozen sections in a tertiary center and identifying the various practical factors determining it. Materials and Methods: This retrospective study was conducted in Department of General Pathology at Christian Medical college, Vellore, Tamil Nadu, India, on 615 frozen section samples obtained during the time period of June 2020 to June 2021. The TAT was defined as the time interval between receipt of sample and the time at which report was conveyed to the surgeon. The TAT for frozen sections should not exceed 30 minutes as per the criteria proposed by National Accreditation Board for Testing and Calibration Laboratories (NABL). Further details such as number of sites per frozen, number of pathologists involved, number of tissue blocks and slides made, requirement of deeper sections and special stains were documented and the factors influencing TAT were analysed based upon their subspecialty. Results: A total of 35,175 specimens were received during the study period, of which 615 cases had frozen sections. Out of 615, 16.9% had TAT of more than 30 minutes, however when only one tissue block was submitted (n=221), 90% were within TAT. The delay in TAT was likely to occur when more than two pathologists participated in the FS diagnosis, more number of sections/tissue blocks were required, the pathologist had to retrieve and review previous case material during the FS procedure, simultaneously receiving additional specimens and requirement of special stains. Conclusion: Turnaround time for frozen sections depends on several preanalytical and analytical reasons. An overall TAT that includes these factors cannot be taken as a standalone quality indicator of the laboratory. Therefore, a checklist that includes specimen receiving time, slide receiving time and time at which the diagnosis was conveyed to the surgeon needs to be documented to help understand where the delay happens. A periodic assessment of intraoperative frozen section TAT should be an integral part of an ongoing quality assurance program.

Audit in surgical histopathology at a tertiary healthcare center: Study of preanalytical and analytical phase.

An audit aims to verify conformance to required processes, assess their implementation, and define the targets of quality control. To evaluate preanalytic and analytic phases of surgical histopathology in a tertiary healthcare center. An observational retrospective and prospective study over 3 months each of year 2013 and 2014. Biopsy, small resections, large organ resections, bone marrow aspirate/biopsy (BMA/BMB), and frozen section samples received in surgical histopathology were categorized as I to V, respectively. A manual audit was done for preanalytical phase (adequacy of clinical information and grossing adequacy) and analytical phase [turnaround time (TAT) and tissue section quality]. Qualitative data was assessed by Chi-Square test. Quantitative data was assessed using One-Way Analysis of Variance. Among 3179 total cases, category I to V had 1558 (49%), 1099 (34.6%), 342 (10.8%), 124 (3.8%), and 56 (1.8%) cases, respectively. Category I had shortest TAT but maximum number of inadequately sent specimens and recuts. Category III had maximum cases with inadequate clinical history, grossing errors, additional sections, and longest TAT. Category IV had maximum cases with poor quality sections. Category V had maximum cases with inadequate demographic details and clinical investigations. BMB (114, 91.9%) was more useful than BMA for diagnosis. Mean TAT for fixed tissues and frozen tissues was 3.6 ± 1.8 days and 26.6 ± 11.2 min, respectively. Total 25% of annual workload was studied by an observational, manual audit. Quality indicators were achieved as per international norms despite limited resources. Remedial actions were suggested for technicians, clinicians, and pathologists to minimize errors.

Mediastinoskopi: Küçük Hücreli Dışı Akciğer Kanseri N-Evrelemesinde Hala Geçerli Mi Yoksa Değersiz Bir Yöntem Midir?

This study compares the two most frequently used methods, combined positron emission tomography-computed tomography (PET/CT) and mediastinoscopy, in detecting mediastinal lymph node metastases. It has been investigated whether PET/CT can be used as an alternative method to mediastinoscopy which is considered the gold standard in detecting mediastinal lymph node metastasis. Mediastinal lymph node metastasis is an important factor in treatment and prognosis of non-small cell lung cancer. A total of 102 patients diagnosed with non-small cell lung cancer by our clinic between 2012 and 2017, were enrolled in the study. In total 277 lymph nodes were compared with respect to their histopathologic results and their involvement in positron emission tomography. Specificity value of PET/CT was detected as 84.5% while its negative predictive value, positive predictive value and sensitivity were 82.7%, 69.5% and 66.6%, respectively. In patients who underwent only mediastinoscopy and whose frozen section samples did not demonstrate any metastatic involvement, when histopathological results of lymph node dissection performed by thoracotomy were analyzed, the negative predictive value of mediastinoscopy was calculated as 97%. In total 65 stations including 46 stations smaller than 1 centimeter and 19 stations larger than 1 centimeter, which did not demonstrate any uptake in PET/CT, were sampled. No metastasis was detected in histopathologic staging of these lymph nodes. For patients who do not demonstrate any uptake in mediastinal lymph nodes on PET/CT, invasive lymph node sampling is redundant. However, with the aim of avoiding unnecessary thoracotomies, invasive lymph node sampling is required, even though mediastinal lymph node uptake detected with PET/CT is below the threshold of malignancy.

Reliability of Imprint Cytology and Frozen Sections for Demonstrating Free Surgical Margins in the Periocular Basal Cell Carcinoma

Purpose: The present was conducted to measure the sensitivity and specificity of imprint cytology (IC) and frozen section (FS) in the evaluation of margin involvement of periocular basal cell carcinoma (BCC). Methods: This cross-sectional study was conducted on 36 patients who underwent an excisional biopsy of periocular BCC. The surgical margins of each excised mass were tested for involvement by tumoral cells using three pathologic methods as follows. Samples were obtained for IC from the marginal territory of the tumor. Then, FS samples were obtained and the tissue was prepared for permanent histopathologic evaluation, the results of which were considered as the gold standard to compare two other methods. Sensitivity, specificity, positive predictive value, and negative predictive value of each method were calculated accordingly. Results: Thirty-six patients (20 males and 16 females) with the mean age of 73±12 years who had periocular BCC were enrolled and a total of 121 samples were obtained from the margins. The sensitivity and specificity of FS were 94.3 and 97.7% and of IC were 51.4 and 84.9%, respectively. Also, Positive and negative predictive value for FS were 94.3 and 97.7 and for IC were 58.1 and 81.1%, respectively. Conclusions: Although less expensive and more feasible than FS, IC lacks diagnostic accuracy for demarcating the extent of resection of eyelid BCC.

The role of COX-2, caspase-1 and IL-17 in pericoronitis-related inflammation due to lower third molar impaction

Background: Inflammation of the pericorona due to lower third molar impaction (LTMI) is often diagnosed as pericoronitis. Expression of cyclooxigenase-2 (COX-2) and caspase-1 may be induced by lipopolysacharide (LPS) and cause pyroptosis with minimal inflammation. When LPS activates toll-like receptor (TLR-4), NOD-like receptors containing domain pyrin 3 (NLRP3) inflammasome will activate the release of pro-caspase-1 to caspase-1, followed by the secretion of interleukin (IL)-1β. IL-1β and IL-23 which induces CD4+ Tcells (Th17) to produce IL-17 as a pro-inflammation cytokine. Purpose: This study aimed to identify the respective roles of COX2, caspase-1 and IL-17 in pericoronitis inflammation of the pericorona due to LTMI. Methods: Frozen section samples were produced through LTMI pericorona tissue biopsy using material provided by the Dental and Oral Clinic at Muwardi Hospital, Surakarta. The paraffin block produced was subsequently cut using a clean microtome with the resulting thin slices being placed on an object glass coated with polylysine. A diagnosis of pericoronitis was subsequently made by a pathologist. Immunohistochemical staining for COX-2, caspase-1 and IL-17 was carried out by indirect tyramide signal amplification (TSA) method. Photos were obtained by means of 100X, 200X, 400X and 1000X objective lensed microscopes to qualitatively assess the above mentioned protein expressions. T-Test was conducted in order to establish the difference in expression between the control group and pericoronitis due to LTMI. Results: The presence of a brownish yellow color indicated the expression of COX-2, caspase-1 and IL-17 in pericorona epithelial cells which visible expression categorized as moderate (30-70%). The mean expression of COX-2, caspase-1 and IL-17 was categorized as mild and there was no significant difference between the expression of the three proteins. Conclusion: COX-2, caspase-1 and IL-17 play an important role in the phyroptosis signal of LTMI pericoronitis in cases of low inflammation.

Conversion to total hip arthroplasty in posttraumatic arthritis: short-term clinical outcomes.

BackgroundFractures of the acetabulum are challenging and very difficult to treat, and even after fixation, they can lead to posttraumatic arthritis. Total hip arthroplasty (THA) has been the most common surgery performed for the complications of posttraumatic arthritis in this group of patients.AimIn this article, it is aimed to assess the functional results and complications of the conversion to THA for posttraumatic arthritis after acetabular fracture.Patients and methodsForty-nine patients were followed up for a mean of 3.7 years (range 2–5 years). The complications included four cases of sciatic nerve palsy, all of which had injury during the first operation. Two cases underwent two-stage surgery because of infection which was demonstrated by a high level of erythrocyte sedimentation rate/C-reactive protein and according to frozen section samples, which were sent intraoperatively with >10 neutrophil/high-power field; one case was then managed by a one-stage protocol for infection after THA was infected with methicillin-resistant Staphylococcus aureus. In 1 case, we used the Girdlestone operation for severe infections and uncontrolled diabetes; in 2 cases, we used cages; and in 47 cases, we used uncemented cups.ResultsThe mean of modified Hip Harris Score improved from 47 (31–66) before the conversion to 89 (79–95) at the final follow-up. The pain component of the Western Ontario and McMaster Universities also increased from an average of 15 (7–20) to 4 (0–11) at the final follow-up. No dislocation, deep vein thrombosis or pulmonary thromboembolism, new nerve injury, and heterotopic ossification occurred.ConclusionThe conversion to THA after posttraumatic arthritis in acetabular fracture can lead to reasonable pain relief and functional improvement.

Accuracy of Frozen Section with Histopathological Report in an Institute

Frozen section helps in rapid intra-operative diagnosis. It is commonly used during surgical procedures to detect malignancy so that modifications of surgery can be decided at the time of surgery on the table. Frozen section is also performed for evaluation of surgical margins and detection of lymph node metastasis. In addition it is applied for detection of unknown pathological processes.The objective of this study was to assess the accuracy of frozen section diagnosis in comparison to gold standard histopathological diagnosis and to find concordance and discordance rate of frozen section with histopathological report. This was a cross sectional study of 41 frozen section samples done in the department of pathology of BP Koirala Institute of Health Sciences from September 2014 to August 2015. All frozen section samples with their permanent tissue samples sent for final histopathological evaluation were included in the study. The overall accuracy of frozen section diagnosis was 97%. The sensitivity was 94%, specificity was 87%, positive predictive value was 90% and negative predictive value was 93%. The concordance rate was 90.2% and the discordance rate was 9.8%. The results of frozen section varied in different organ systems and the common cause of discrepancy in our study were the gross sampling error and the interpretational error.

Development of Whole Slide Imaging on Smartphones and Evaluation With ThinPrep Cytology Test Samples: Follow-Up Study.

BackgroundThe smartphone-based whole slide imaging (WSI) system represents a low-cost and effective alternative to automatic scanners for telepathology. In a previous study, the development of one such solution, named scalable whole slide imaging (sWSI), was presented and analyzed. A clinical evaluation of its iOS version with 100 frozen section samples verified the diagnosis-readiness of the produced virtual slides.ObjectiveThe first aim of this study was to delve into the quantifying issues encountered in the development of an Android version. It should also provide insights into future high-resolution real-time feedback medical imaging apps on Android and invoke the awareness of smartphone manufacturers for collaboration. The second aim of this study was to further verify the clinical value of sWSI with cytology samples. This type is different from the frozen section samples in that they require finer detail on the cellular level.MethodsDuring sWSI development on Android, it was discovered that many models do not support uncompressed camera pixel data with sufficient resolution and full field of view. The proportion of models supporting the optimal format was estimated in a test on 200 mainstream Android models. Other factors, including slower processing speed and camera preview freezing, also led to inferior performance of sWSI on Android compared with the iOS version. The processing speed was mostly determined by the central processing unit frequency in theory, and the relationship was investigated in the 200-model simulation experiment with physical devices. The camera preview freezing was caused by the lag between triggering photo capture and resuming preview. In the clinical evaluation, 100 ThinPrep cytology test samples covering 6 diseases were scanned with sWSI and compared against the ground truth of optical microscopy.ResultsAmong the tested Android models, only 3.0% (6/200) provided an optimal data format, meeting all criteria of quality and efficiency. The image-processing speed demonstrated a positive relationship with the central processing unit frequency but to a smaller degree than expected and was highly model-dependent. The virtual slides produced by sWSI on Android and iOS of ThinPrep cytology test samples achieved similar high quality. Using optical microscopy as the ground truth, pathologists made a correct diagnosis on 87.5% (175/200) of the cases with sWSI virtual slides. Depending on the sWSI version and the pathologist in charge, the kappa value varied between .70 and .82. All participating pathologists considered the quality of the sWSI virtual slides in the experiment to be adequate for routine usage.ConclusionsLimited by hardware and operating system support, the performance of sWSI on mainstream Android smartphones did not fully match the iOS version. However, in practice, this difference was not significant, and both were adequate for digitizing most of the sample types for telepathology consultation.

<i>ILE655VAL</i> Genotyping Study of HER2 - Positive Breast Cancer of Patients from Padang - Indonesia With High Resolution Melting Technique

Transtuzumab has proven to be a great improvement in the treatment of HER2 + of breast cancer patients, but it is associated with relevant adverse cardiac events and with significantly elevated cost of treatment. One of the risk factors for cardiotoxicity due to transtuzumab is the I655V HER2 polymorphism (GTC> ATC mutation) in which the allele mutant (Ile val or val / val) has a higher risk than the wild type (Ile/Ile). The detection of specific alleles is very important for therapeutic decision-making. In this study, our group have developed a HRM with EvaGreen dye method to discriminate specific allele of I655V HER2 (wild type, heterozygote mutant or homozygote mutant) in 66 frozen section samples of HER2+ of breast cancer patients. Our group reported the wild type is the most prevalent allele (77,27%), whereas heterozygous mutation is significantly present in this research (21,21%) and only 1,52% of sample detected as minor allele. It showed that only one sample detected as a minor allele (val/val) and may have relatively low abundance in the population. This method has been compared with sanger sequencing and giving 100% of validity.

ILE655VAL Genotyping Study of HER2 - Positive Breast Cancer of Patients from Padang - Indonesia With High Resolution Melting Technique

Transtuzumab has proven to be a great improvement in the treatment of HER2 + of breast cancer patients, but it is associated with relevant adverse cardiac events and with significantly elevated cost of treatment. One of the risk factors for cardiotoxicity due to transtuzumab is the I655V HER2 polymorphism (GTC> ATC mutation) in which the allele mutant (Ile val or val / val) has a higher risk than the wild type (Ile/Ile). The detection of specific alleles is very important for therapeutic decision-making. In this study, our group have developed a HRM with EvaGreen dye method to discriminate specific allele of I655V HER2 (wild type, heterozygote mutant or homozygote mutant) in 66 frozen section samples of HER2+ of breast cancer patients. Our group reported the wild type is the most prevalent allele (77,27%), whereas heterozygous mutation is significantly present in this research (21,21%) and only 1,52% of sample detected as minor allele. It showed that only one sample detected as a minor allele (val/val) and may have relatively low abundance in the population. This method has been compared with sanger sequencing and giving 100% of validity.

Development of a Whole Slide Imaging System on Smartphones and Evaluation With Frozen Section Samples.

BackgroundThe aim was to develop scalable Whole Slide Imaging (sWSI), a WSI system based on mainstream smartphones coupled with regular optical microscopes. This ultra-low-cost solution should offer diagnostic-ready imaging quality on par with standalone scanners, supporting both oil and dry objective lenses of different magnifications, and reasonably high throughput. These performance metrics should be evaluated by expert pathologists and match those of high-end scanners.ObjectiveThe aim was to develop scalable Whole Slide Imaging (sWSI), a whole slide imaging system based on smartphones coupled with optical microscopes. This ultra-low-cost solution should offer diagnostic-ready imaging quality on par with standalone scanners, supporting both oil and dry object lens of different magnification. All performance metrics should be evaluated by expert pathologists and match those of high-end scanners.MethodsIn the sWSI design, the digitization process is split asynchronously between light-weight clients on smartphones and powerful cloud servers. The client apps automatically capture FoVs at up to 12-megapixel resolution and process them in real-time to track the operation of users, then give instant feedback of guidance. The servers first restitch each pair of FoVs, then automatically correct the unknown nonlinear distortion introduced by the lens of the smartphone on the fly, based on pair-wise stitching, before finally combining all FoVs into one gigapixel VS for each scan. These VSs can be viewed using Internet browsers anywhere. In the evaluation experiment, 100 frozen section slides from patients randomly selected among in-patients of the participating hospital were scanned by both a high-end Leica scanner and sWSI. All VSs were examined by senior pathologists whose diagnoses were compared against those made using optical microscopy as ground truth to evaluate the image quality.ResultsThe sWSI system is developed for both Android and iPhone smartphones and is currently being offered to the public. The image quality is reliable and throughput is approximately 1 FoV per second, yielding a 15-by-15 mm slide under 20X object lens in approximately 30-35 minutes, with little training required for the operator. The expected cost for setup is approximately US $100 and scanning each slide costs between US $1 and $10, making sWSI highly cost-effective for infrequent or low-throughput usage. In the clinical evaluation of sample-wise diagnostic reliability, average accuracy scores achieved by sWSI-scan-based diagnoses were as follows: 0.78 for breast, 0.88 for uterine corpus, 0.68 for thyroid, and 0.50 for lung samples. The respective low-sensitivity rates were 0.05, 0.05, 0.13, and 0.25 while the respective low-specificity rates were 0.18, 0.08, 0.20, and 0.25. The participating pathologists agreed that the overall quality of sWSI was generally on par with that produced by high-end scanners, and did not affect diagnosis in most cases. Pathologists confirmed that sWSI is reliable enough for standard diagnoses of most tissue categories, while it can be used for quick screening of difficult cases.ConclusionsAs an ultra-low-cost alternative to whole slide scanners, diagnosis-ready VS quality and robustness for commercial usage is achieved in the sWSI solution. Operated on main-stream smartphones installed on normal optical microscopes, sWSI readily offers affordable and reliable WSI to resource-limited or infrequent clinical users.

Front-end genomics: using an alternative approach for the recovery of high-quality DNA from core needle biopsies

AimsDetermine whether a simple prewash step will provide adequate amounts of high-quality DNA from core needle biopsies for molecular sequencing studies.MethodsThe quantitative and qualitative metrics of DNA recovered from core...

Polymorphous Low-Grade Adenocarcinoma

A 60-year-old woman with a 3-year history of a gingivoalveopalatal mass underwent an incision biopsy.
 Microscopically, the lesion centered in the stroma is infiltrative (Fig. 1) and architecturally diverse, having cystic (Fig. 2), linear or “Indian file” (Fig. 3), solid, and tubular (Fig. 4) patterns. The cells are uniform in size, round to oval, and have bland cytologic features, with vesicular nuclei and inconspicuous nucleoli (Figure 4). The clinical data and histomorphologic features characterized by architectural diversity yet cytologic blandness lead us to the diagnosis of polymorphous low-grade adenocarcinoma. 
 Polymorphous low-grade adenocarcinoma (PLGA) is a malignant epithelial tumor characterized by cytologic uniformity, morphologic diversity, an infiltrative growth pattern, and low metastatic potential.1 It is the second most common intraoral malignant salivary gland tumor 1 following mucoepidermoid carcinoma. The tumor is found almost exclusively in minor salivary glands and is rare in extraoral locations, including major salivary glands.2 The tumor affects a wide age range (16 – 95 years; mean 60 years), with only 2 pediatric cases reported,1 and has a female predilection.3,4 It usually presents as a painless mass located within the oral cavity,3 60% of which are located in the palate.1 They are characteristically unencapsulated, although well-circumscribed.3 
 
 This entity is architecturally diverse (“polymorphous”) even within a single tumor, with solid, tubular, trabecular, cribriform, papillary and linear patterns being described. Perineural invasion is common although it was not seen in this case. The tumor cells are small to medium sized, and uniformly round to polygonal. The nuclei are bland and vesicular, with occasional small inconspicuous nucleoli. Mitotic figures can be found occasionally but are never numerous.3, 8
 
 The morphologic heterogeneity in small biopsies and frozen section samples can be confused with pleomorphic adenoma and adenoid cystic carcinoma.6,7 Glial fibrillary acid protein may help as PLGA is typically non-reactive in contrast to pleomorphic adenoma.2 De Araujo and others site that uniformly positive vimentin, CK7, and S100 staining favors PLGA over adenoid cystic carcinoma.6 Tumor cytology and histology are quite characteristic - recognizing the constant cytological appearance despite the diversity of architectural tumor patterns should aid one in diagnosing PLGA.
 PLGA, despite its infiltrative growth pattern and propensity for perineural invasion, usually runs an indolent course. Nodal metastasis and distant spread are rare, occurring in less than 1% of cases.4 Seethala and others report that extrapalatal location is associated with a more aggressive clinical course.5 Complete surgical excision is the primary treatment with neck dissection reserved for nodal metastasis.1 One-third of patients may have a local recurrence and lifelong monitoring is suggested. Re-excision is amenable in these cases.5,6

Photodiagnosis for frameless stereotactic biopsy of brain tumor

Stereotactic biopsy is a minimally invasive method of reaching a pathological diagnosis. However, it is not always possible with this method to obtain the tissue samples required for an exact pathological diagnosis. The factors that can make histological diagnoses uncertain are the heterogeneity of tumors and/or brain shifts in the case of small tumors. In this study, we investigated the usefulness of fluorescence in determining the existence of tumor components in obtained tissues. Six patients underwent stereotactic biopsy. 5-Aminolevulinic acid (5-ALA) was administered orally prior to operation. Frameless stereotactic biopsies were performed. The obtained samples were irradiated with 405nm light and all samples showed red light excitation. Intraoperative rapid pathological diagnosis was made in each case by microscopic examination of frozen section samples. The final pathological diagnoses were of three glioblastomas, one astrocytoma grade 3, and two malignant lymphomas. One case was initially thought to be gliosis on rapid pathological diagnosis, but the final pathological diagnosis reached by examination of a permanent HE stained section was astrocytoma grade 3. Another case, finally diagnosed as malignant lymphoma, was initially diagnosed as infiltration of lymphocytes. The discrepancies between rapid and permanent pathological diagnoses might be caused by the destruction of cells. 5-ALA photodynamic diagnosis is not influenced by the destruction of tissues, simply because it does not depend on the structure of tissues. Stereotactic fluorescence biopsy is very useful in that it enables rapid and exact biopsy and obviates the necessity of waiting for an intraoperative report from a pathologist.

Frozen Section for the Management of Intraoperatively Detected Palpable Tumor Lesions During Nerve-Sparing Scheduled Radical Prostatectomy

ObjectivesThe intraoperative finding of palpable tumor lesions has been described as a contraindication for nerve-sparing (NS) radical prostatectomy (RP). However, its evaluation is subjective. Especially in patients with a strong demand to regain postoperative erectile function, a surgeon might be reluctant to sacrifice neurovascular bundles (NVBs) based on this information. We investigated the use of frozen section (FS) analysis to monitor the safety and efficiency of NS during RP in patients with intraoperatively identified subcapsular tumor lesions. MethodsIn 83 of 608 patients, who underwent NS-RP, intraoperative FS was performed because of a lesion palpable close to the capsule. A wedge of 4cm in diameter including the lesion was cut off and stained differently for capsule and intraprostatic margin. In case of presence of carcinoma adherent to the capsule, the NVB was resected; otherwise, the NVB remained in situ. ResultsPatients with palpable tumor lesions had pT3 tumors in 36% and 61% had Gleason 4 pattern, compared to 18% and 42% for the control group. Carcinoma was found in 93% of the FS specimens. In 42% of the FS samples, tumor had contact with the capsule and 14% of secondary resected NVB specimens demonstrated a carcinoma invasion. In 52% NVBs could be preserved despite an ipsilateral nodule without negatively affecting the margin status. However, the false-negative rate of the FSs was 6%. Conversely, FSs set the intraoperative decision to remove the NVB in 42% of FS patients, resulting in an additional 36% of negative margins. ConclusionsIn patients with intraoperatively detected tumor lesions during a NS planned RP, FS objectively supports the decision of secondary NVB resection as well as preservation.

Sensitivity of frozen section examination of pelvic lymph nodes for metastatic prostate carcinoma.

A Total Quality Improvement review of frozen section diagnoses yielded four sequential false-negative frozen section diagnoses in lymph nodes in the evaluation of metastases from prostate carcinoma. Because these results appeared to differ from the department's overall frozen section experience, frozen section diagnoses of pelvic lymph nodes in patients with prostate carcinoma were reviewed to benchmark the department's performance. All 220 pelvic lymph node frozen section samples from 110 patients with prostate carcinoma from January, 1986 to July, 1993 at Bridgeport Hospital (BH) were reviewed, and the department's frozen section diagnostic efficiency was compared with: (1) all BH frozen section procedures performed during the same period; (2) pelvic lymph node frozen section analysis and (3) imaging techniques for prostate carcinoma from other institutions found in MEDLARS literature searches from 1973 to 1993. Frozen section diagnostic efficiency for patients with prostate carcinoma from BH was 93.6% (sensitivity 63.2%, specificity 100%) compared with (1) 98% for all BH frozen section analyses (sensitivity 99%, specificity 98%); (2) 90.1% for MEDLARS search pelvic lymph node frozen section prostate carcinoma analyses (sensitivity 66.5%, specificity 100%); and (3) 88% for MEDLARS search magnetic resonance imaging (MRI) pelvic lymph node prostate carcinoma (sensitivity 41%, specificity 97%). Frozen section diagnosis of pelvic lymph nodes approaches the overall diagnostic efficiency of frozen section analysis and is more sensitive for the diagnosis of prostate carcinoma in pelvic lymph nodes than is MRI because more than half of the metastases are smaller than the 1.0-cm resolution limit of the MRI. False-negative frozen section diagnoses (67% sensitivity) occur because of errors in sampling microscopic metastases.

A dual immunocytochemical assay for oestrogen and epidermal growth factor receptors in tumour cell lines.

A new dual immunocytochemical assay for oestrogen receptor (ER) and epidermal growth factor receptor (EGFR) has been developed. It has been tested in a variety of conditions using cell culture lines and the results correlate well with those obtained from single immunocytochemical assays. MCF-7 and A431 cells and a mixture of the two types of cell were assessed immunocytochemically for ER and EGFR. ER showed immunopositivity of 30% in MCF-7 cells, 10% in the mixture and 0% in A431 cells. EGFR demonstrated immunopositivity of 0% in MCF-7 cells, 70% in the mixture and 100% in A431 cells. Dual immunocytochemical assays using anti-ER followed by anti-EGFR monoclonal antibodies on single histological sections showed similar reactivity to the single assays. Three staining patterns were seen in the mixture: ER+/EGFR- (MCF-7 cells), ER-/EGFR- (MCF-7 cells) and ER-/EGFR+ (A431 cells). ZR-75-1 and MDA-MB-231 cells and their retrovirally transfected counterparts ZR/HERc and MDA/HEGO cells were then analysed. The dual assay revealed the fourth phenotype (ER+/EGFR+) in 40% of ZR/HERc cells and in 10% of MDA/HEGO cells. This is the first description of a dual immunocytochemical assay system for ER and EGFR on single 5 microns frozen section samples. Studies are now underway assessing breast carcinoma sections which may allow investigation of the clonality of human breast cancer.