Frozen Sections Research Articles

Intraoperative Evaluation of Pediatric Bone and Soft Tissue Lesions: Retrospective Analysis of 595 Frozen Sections With Emphasis on Discrepancy and Diagnostic Pitfalls.

Frozen section (FS) evaluation of pediatric bone and soft tissue (BST) lesions is infrequently encountered and may pose considerable diagnostic challenges. Limited data exist about the accuracy and related diagnostic difficulties. To identify and analyze discrepancy between the FS diagnosis and final diagnosis in order to increase the awareness of common diagnostic pitfalls in FS evaluation of pediatric BST lesions. We retrospectively reviewed 595 consecutive FSs of pediatric BST lesions from 373 patients and analyzed the accuracy and causes for interpretation errors. Discrepant diagnoses were found in 23 of 595 FSs (3.9%). Discrepancy rates were slightly higher in benign, soft tissue lesions and FSs requested for diagnosis/adequacy, although no statistically significant difference was observed. Pathologist misinterpretation contributed to discrepancy in 17 of 23 FSs (73.9%), which were classified into 6 patterns of error. For margin, 3 patterns were found: normal hematopoietic elements versus malignant cells in Ewing sarcoma bone marrow margin (n = 3), prominent sinonasal vasculature and stroma versus sinonasal tract angiofibroma (n = 3), and atrophic skeletal muscles versus malignant cells in rhabdomyosarcoma and Ewing sarcoma (n = 2). For diagnosis, another 3 patterns were identified: misclassification of benign bone tumors (n = 5), misclassification of benign spindle neoplasms (n = 2), and vascular malformation versus normal tissue (n = 2). FS is a valuable tool for guiding surgical management of pediatric BST lesions, which can be challenging entities and represent significant diagnostic pitfalls. Awareness of these FS pitfalls may help in further increasing diagnostic accuracy.

Impact of Implementing a Grossing Tumor-margin Distance Threshold for Frozen Section in Oncologic Lung Surgery.

Intraoperative frozen section (FS) examination of oncologic surgical specimens is frequently performed to ensure complete surgical resection. Data on the gross evaluation of surgical margins are limited. We recently published a study suggesting the use of a macroscopic 2.0cm tumor-margin cutoff during intraoperative evaluation to decrease the number of unnecessary FS. This study aimed to validate the safety and the clinical impacts of implementing a 2.0cm tumor-margin threshold for FS diagnosis in evaluating surgical margins during oncologic lung surgery. This retrospective analysis included patients who underwent lung resection for primary or metastatic neoplasms between 2018 and 2022 at the Institut Universitaire de Cardiologie et de Pneumologie de Québec, following the implementation of this practice. Clinicopathological data were retrieved from the medical files. Univariate and multivariate analyses were used to identify the variables associated with positive margins. This study included 1575 tumors in 1299 patients. FS evaluations were performed in 24.4% of patients. No positive margins were observed when the tumor-margin distance was >2.0cm. The incidence rate of positive margins was 2.95%, with parenchymal margins being the most affected. Multivariate analysis identified the tumor-margin distance as a significant predictor of positive margin status. This practice led to a 79.9% reduction in FS evaluations without compromising the margin assessment accuracy or patient safety. A 2.0cm tumor-margin distance threshold for intraoperative FS evaluation in oncologic lung surgery is safe and effective in reducing unnecessary FS evaluations while maintaining accurate margin assessments.

Proximal bronchiolar adenoma with malignant transformation to invasive mucinous adenocarcinoma with 4 years follow-up: a case report and literature review

BackgroundBronchiolar adenoma (BA) is a rare benign tumor originating in the bronchial mucosal epithelium and occurring primarily in the periphery of the lung. The most prominent histopathological feature of BA is a double-layer bronchial epithelium containing continuous basal cell layers. However, due to the high mutation frequency of the driver gene, there is still debate as to whether BA has the potential for malignant transformation. In frozen sections, basal cells are difficult to identify under the microscope, which makes it difficult to distinguish from mucinous adenocarcinoma, especially when BA malignancies transform into invasive mucinous adenocarcinoma (IMA), which can only be distinguished by histomorphological criteria, greatly increasing the difficulty of diagnosis.Case summaryIn this paper, we present a case study of a 59-year-old man whose chest computed tomography (CT) revealed a progressively enlarging, high-density nodule over a four-year period in the outer basal segment of the right lower lobe. Consequently, he underwent thoracoscopic wedge resection of the right lower lobe. The postoperative pathological diagnosis revealed BA with mucous gland structure formation combined with partial basal cell loss, raising the possibility of malignant transformation into IMA. Regular postoperative follow-up showed no recurrence or metastasis. Hybridization Capture-based next-generation sequencing (NGS) analysis detected driver gene mutations in Kirsten Rat Sarcoma viral oncogene homolog (KRAS) and Cyclin-Dependent Kinases (CDK) 6 in the case, thereby inferring the malignant transformation of BA into IMA.ConclusionIn this case, the detection of driver gene KRAS mutation and loss of continuity in the basal cell layer within the mucous glandular structures of the nodule suggests the malignant transformation of BA into IMA, inferring the malignant potential of BA.

Ex Vivo Fluorescence Confocal Microscopy for intraoperative evaluations of staple lines and surgical margins in specimens of the lung - a proof-of-concept study.

Intraoperative consultation is frequently used during the surgical treatment of lung tumors for the diagnosis of malignancy and the assessment of surgical margins. The latter is often problematic given the nature of the applied staple lines, which cannot be readily examined in frozen sections. Seventy-nine samples of surgical margins (71 staple lines and 8 open margins) from 52 lung specimens were examined using an ex vivo fluorescence confocal microscope (FCM). The diagnoses of the FCM scans were compared to the corresponding paraffin section images of the same material. The procedure provided intraoperative FCM imaging of the surgical margins and staple lines without having to remove the metal clips. Tumor-involved open margins (5/5) and tumor-involved staple lines (3/4) were correctly identified in the FCM images. The results also provided additional information to the conventional frozen sections. This is the first time staple lines of lung specimens have been visualized as preserved tissue using FCM. The method potentially provides an additional approach for intraoperative decisions when the margins in conventional frozen sections are unclear. Our promising results, however, need to be validated on a larger number of cases.

Software solution for integration of frozen section quality assurance into daily practice.

Diagnoses rendered using the frozen section (FS) technique during surgical procedures are used to guide intraoperative decisions. Therefore, diagnostic FS errors have the potential to affect patient safety and quality of care. Diagnostic FS errors arise due to both technical and interpretative factors and present a challenge to surgical pathology laboratories to recognize, document, and manage in a timely fashion. Thus, there is a need to monitor discrepancies between FS and permanent diagnoses and effectively communicate with the clinical teams when an error is discovered to ensure an opportunity for timely interventions, if clinically indicated. Our FS practice is complex, with many contributing variables, such as a partially generalized FS pathology practice model among pathology faculty and/or surgeons with specific subspecialty expertise and different physical locations of FS facilities. We implemented a comprehensive frozen section quality assurance (FSQA) program using custom software solutions aimed at improving patient safety by monitoring recognition, increasing documentation, and facilitating communication in cases where there is a discordance between intraoperative and permanent diagnoses. Our FSQA program allows for categorizing frozen section discrepancies according to the source of error, such as interpretive vs technical errors, to understand how errors arise and todevelop appropriate mitigation strategies for reducing errors. Overall, our intervention to improve FSQA has engaged pathology faculty in a uniform and systematic manner, and our data show that our new FSQA program led to a markedly shortened time interval of FSQA, allowing for timely management and resolution of errors.

Diagnostic Values of Fine Needle Aspiration Cytology and Frozen Section in Management of Parotid Tumors

Background: This study aims to investigate the diagnostic values of fine needle aspiration cytology (FNAC) and frozen section (FS) in evaluating parotid gland masses subjected to parotidectomy. Methods: A retrospective analysis of data from 274 patients who underwent parotidectomy for parotid gland masses was performed at the Department of Otolaryngology of the University Hospital between 2013 and 2019. We compared the preoperative FNAC and intraoperative FS records with the definitive histopathological diagnoses obtained from the surgical resection specimens. Results: The sensitivity, specificity, accuracy, positive predictive, and negative predictive value of FNAC in reaching the correct diagnosis were 65.1%, 94.1%, 88.7%, 77.1%, and 92.1%, respectively. The FS analysis values were 92.9%, 97.2%, 95.3%, 96.3%, and 94.6%, respectively. Additionally, the true-positive, true-negative, false-positive, and false-negative cases are documented and discussed. Conclusions: Although FNAC is a commonly used, easy, and reliable diagnostic method for parotid tumors, the diagnostic values observed in our study are low. FS analysis appears to be a more robust method. Therefore, we recommend a balanced use of these diagnostic tools, informed by clinical judgment, patient considerations, and available resources, to optimize outcomes in the management of parotid gland tumors.

Intraoperative Frozen Section Diagnosis of Adenoid Cystic Carcinoma of the Minor Salivary Gland: A Case Report

Background: Adenoid cystic carcinoma (ACC) is a rare malignant tumor of the salivary glands known for its slow growth, invasive behavior, and propensity for perineural invasion. The diagnosis of ACC can be challenging, especially during intraoperative frozen section consultation. This case report highlights the crucial role of frozen section diagnosis in guiding surgical management and ensuring tumor-free margins, which are critical for patient prognosis. Case presentation: A 44-year-old male presented with a slow-growing, occasionally painful nodule on his upper lip, without facial numbness or other systemic symptoms. A frozen section examination was performed intraoperatively to assess the lesion and determine the margin status. The frozen section revealed malignancy, characterized by tumor cell proliferation in tubular, cribriform, and solid patterns, all hallmarks of ACC, along with perineural invasion. A wide excision was performed, and subsequent frozen sections of the surgical margins confirmed they were free of tumor. The diagnosis of ACC was confirmed on histopathological examination of the paraffin block. Conclusion: This case underscores the importance of frozen section diagnosis in the management of ACC of the minor salivary glands. The accurate assessment of the lesion and margin status during surgery allows for appropriate surgical decision-making, ensuring complete tumor removal and minimizing the risk of recurrence.

Use of polyethylene glycol as an alternative to optimal cutting temperature medium in freeze sectioning for plant histochemical studies.

Plant anatomical and histochemical studies are concerned with the structural organization of tissues as well as localization of various metabolites and enzyme activity inside cells and tissues. Traditionally, rotary microtomes are used for paraffin and resin-embedded samples which provide excellent preservation of tissue morphology but removes enzymes, lipid components, and various specialized metabolites. Freeze sectioning apparently remained unexplored in plant histology because of the presence of rigid cell walls and highly vacuolated cytoplasm in plant tissues. In this study, we have described a simple cryostat-based sectioning technique using polyethylene glycol (PEG) as embedding medium after glycerol infiltration that protects the plant tissues from freezing and thawing damage. We have also compared the suitability of inexpensive aqueous PEG solution as compared to commercially available optimal cutting temperature (OCT) medium and obtained identical microscopic images. Diverse plant organs from different genera were sectioned to check the application of this method in plant anatomical studies. In all the cases, cross sections were shown to be well preserved similar to paraffin-embedded plant tissues. In addition, histochemical analyses showed retention of metabolites and even enzymes in the tissues, which can make this method an alternate choice in cryo-microtomy replacing the expensive OCT medium.

Correlation of Salivary Gland FNA Reporting Using the Modified Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) and Intraoperative Frozen Section Evaluation with Final Histopathology Report for Major Salivary Gland Neoplasms.

Fine needle aspiration (FNA) is a commonly used investigation for salivary gland lesions. The modified MSRSGC was introduced to standardise the FNA reporting of major salivary gland lesions. A frozen section is also used intraoperatively for these lesions. In this retrospective study, we included all patients who were treated at our institute between January 2012 to December 2019. The FNA reports of all the patients were reclassified based on the modified MSRSGC, and the sensitivity, specificity, and positive and negative predictive values were calculated. We also assessed the indication for utilising the frozen section and correlated it with the preoperative FNA and the final histopathology report. A total of 325 patients satisfied the eligibility criteria and were included in this study. The sensitivity and specificity, positive predictive value, and negative predictive value of the modified MSRSGC were 64.18% and 91.94% and 92.27% and 63.11%, respectively. The frozen section (FS) was done in 131 patients, the commonest reason was for obtaining a primary diagnosis (n = 104,79.3%). When the FNA was type V and above the primary diagnosis was that of malignancy in the vast majority (p < 0.001, kappa 0.563). The values of the modified MSRSGC were comparable with available literature in all categories except categories I and II which were higher than what is reported in the literature. When the preoperative FNA was modified to MSRSGC V and above, the possibility of malignancy was high, and the use of FS for primary diagnosis may not add much value intraoperatively.

Evaluation of whole-slide imaging for diagnosing frozen sections.

A promising application of digital pathology is the use of Whole slide imaging (WSI) for rapid and remote intraoperative consultations. Based on recommendations from the College of American Pathologists, we compared diagnostic accuracy and technical analysis of WSI with optical microscopy (OM) for reporting frozen sections (FS). A series of 105 consecutive FS cases were included in our study and were categorized as primary diagnosis, assessment of margin status, and lymph node status. A surgical pathologist reviewed all WSI digital slides of FS cases online and their corresponding glass slides using OM after a 2-week washout period. Technical and diagnostic parameters for remote reporting of frozen sections using WSI were compared to routine OM. Diagnostic agreement between WSI and OM in the FS cases was 100%. In comparison with the reference standard (original sign-out diagnosis), the overall diagnostic accuracy of WSI and OM was 99.04%. Scan time per slide averaged 103.89s. Mean diagnostic assessment time for OM was 17.48s, while it was 26.62s for WSI, with a mean difference of 9.14s (P<.001). The overall mean turnaround time was 3.8min for reporting a single slide using WSI based digital pathology system. The diagnostic accuracy of WSI is comparable to that of conventional OM. Therefore, we conclude that WSI based digital pathology systems can be safely implemented and integrated into a laboratory workflow as an alternative to conventional OM.

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

The aim of our study was to evaluate if the histopathological changes occurring in the pancreas post neoadjuvant-therapy (PNAT) for pancreatic ductal adenocarcinoma (PDAC) may negatively affect the assessment of intra-operative frozen section (FS) analysis of pancreatic resection margins (PRMs). The clinicopathological data of patients who underwent pancreatoduodenectomy for PDAC between 2015 and 2022 were analyzed. Comparison of the accuracy of the FS analysis in treatment naïve (TN) and PNAT patients for all pancreatic margins was performed. We identified 81 patients with PDAC (40 female, 41 male) of which 47 (58.0%) were TN and 34 (42.0%) PNAT. Including FSs performed for re-excisions of initially positive PRMs, we identified 2/103 discrepancies for the pancreatic neck margin, one in a TN patient and one in a PNAT patient; one discrepancy for the common bile duct margin (1/47) in a TN patient; and 2/14 discrepancies for the uncinate margin, both in TN patients. In summary, accuracy of FS analysis was similar in the PNAT and TN groups (98.8% vs. 96.7%). The histopathological changes occurring in the pancreas PNAT for PDAC do not affect the histopathological interpretation of FS analysis of PRMs, and the accuracy of FS analysis is similar in the PNAT and TN patients.

Clinical significance of intraoperative histological examination of resection margins during organ-preserving operations

Introduction. Today, resection margins are assessed in different ways, but in clinical practice, preference is given to the histological method with macro- and microscopic examination of the margins. Assessment of resection margins can be carried out not only during planned histological examination, but also during intraoperative examination.Aim. To evaluate the feasibility of intraoperative assessment of resection margins when performing organ-preserving operations in patients with primary resectable breast cancer.Materials and methods. A retrospective study analyzed data from patients with early breast cancer who underwent surgical treatment at the Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia from June 2020 to May 2022. All patients underwent mammary gland resection with or without intraoperative marginal GI of resection, with sentinel lymph node determination or regional lymphadenectomy at the first stage. Patients included in the final analysis were divided into 2 groups: the study group consisted of patients who underwent intraoperative marginal GI of resection, and the control group consisted of patients who did not undergo intraoperative marginal GI of resection. Marginal GI of resection is performed by a pathologist by measuring the distance from the tumor node to the resection margins on a macropreparation. Frozen sections were always stained with hematoxylin and eosin.Results. The 451 patients with early forms of breast cancer included in the final analysis and subjected to breast resection at the first stage were divided into 2 main groups: the study group consisted of patients (n = 310) who underwent intraoperative microscopic histological assessment of resection margins, and the control group included patients (n = 141) who did not undergo intraoperative assessment of resection margins. During intraoperative histological assessment of resection margins, patients with positive resection margins were most often observed with invasive cancer – 20.3 versus 3.9 % with intraductal cancer.Conclusion. Further research is needed to determine the factors influencing the increase in the incidence of positive resection margins and their impact on patient survival rates.

3D-printed model for resection of positive surgical margins in robot-assisted prostatectomy.

To improve precision of secondary resection (SR) after positive surgical margin (PSM) detection by frozen section (FS) during nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) by employing a personalised three-dimensional (3D)-printed prostate model derived from pelvic magnetic resonance imaging (MRI). This model was used to mark positive surgical margins (PSM) and guide intraoperative SR during NS-RARP. Prospective multicentre cohort study with 100 patients undergoing NS-RARP between September 2018 and August 2021. Primary and secondary endpoints were the conversion rate of FS-identified PSM to a tumour-free margin and functional/oncological parameters within a 12-month follow-up, respectively. A PSM was identified in 23% of cases during FS, with a conversion to negative surgical margins (NSM) in 83% (19/23 cases) by model-guided SR. The tumour detection rate in SR specimens was 39% (nine of 23 cases). Among the 19 patients with converted margins, 18 (95%) achieved undetectable prostate-specific antigen levels 2 months postoperatively, with six (32%) having subsequent biochemical recurrence within 12 months. prostate-specific-membrane-antigen positron emission tomography computed tomography found one local recurrence, and five cases of metastatic disease. In converted patients, the baseline median five-item version of the International Index of Erectile Function score decreased by 16% after 1 year, with no significant difference compared to patients with primarily NSM. Limitations include the absence of a control group, the potential for false-negative FS results and limited accuracy of MRI. The integration of 3D-printed prostate models into NS-RARP has the potential to positively impact surgical outcomes by improving the precision of SR and optimising pathosurgical communication.

Xanthogranulomatous cholecystitis infiltrating anterior abdominal wall: a rare case report

Xanthogranulomatous cholecystitis (XGC) is a benign chronic inflammatory disease of the gallbladder often presenting as features of chronic cholecystitis. The disease closely mimics gallbladder carcinoma (GBC) and distinguishing XGC from gallbladder cancer preoperatively is very challenging. Biochemical or radiological investigations cannot differentiate XGC from GBC and they share overlapping symptoms. Reporting here is a 31 year old female patient who presented with features of failed attempt of cholecystectomy due to suspected carcinoma gallbladder at an outside hospital. Even CECT abdomen showed gallbladder mass with hepatic and anterior abdominal wall infiltration. Intraoperatively, there was a mass in the gallbladder with large calculi and extending into the adjacent liver, anterior abdominal wall and part of hepatic flexure of colon. Radical cholecystectomy with en block excision of anterior abdominal wall and part of hepatic flexure of colon was done. Frozen section and final histopathological reports confirmed the diagnosis of XGC.

From the Operating Theater to the Pathology Laboratory: Failure Mode, Effects, and Criticality Analysis of the Biological Samples Transfer.

Introduction: The frozen section intra-operative consultation is a pathology procedure that provides real-time evaluations of tissue samples during surgery, enabling quick and informed decisions. In the pre-analytical phase, errors related to sample collection, transport, and identification are common, and tools like failure mode, effects, and criticality analysis help identify and prevent risks. This study aims to enhance patient safety and diagnostic quality by analyzing risks and optimizing sample management. Materials and Methods: The failure mode, effects, and criticality analysis was conducted by a multidisciplinary team to analyze the workflow of frozen section sample handling from collection in the operating theater to acceptance at the pathology lab. Six steps were identified, each assigned tasks and responsibilities, with risks assessed through the risk priority number, calculated from severity, occurrence, and detectability. Severity was classified based on the WHO framework, ranging from "No Harm" to "Death", to prioritize risks effectively. Results: The study identified 12 failure modes across 11 sub-processes, prioritized by risk. Key failures included missing patient identification, incorrect sample retrieval, missing labels, misdirected samples, and samples sent to the wrong lab. Discussion: Pre-analytical errors in pathology pose risks to diagnosis and patient care, with most errors occurring in this phase. A multidisciplinary team identified key issues, such as sample mislabeling and delays due to staff unavailability, and implemented corrective actions, including improved signage, staff re-training, and sample tracking systems. Monitoring and regular checks ensured ongoing adherence to protocols and reduced the risks of misidentification, transport delays, and procedural errors. Conclusions: The frozen section intra-operative consultation is vital in surgical pathology, with the pre-analytical phase posing significant risks due to potential errors in sample handling and labeling. Failure mode, effects, and criticality analysis has proven effective in identifying and prioritizing these failures, despite resource demands, by allowing corrective actions that enhance patient safety and healthcare quality.

Comparative Study on the Application Effects of Optimized Frozen Section Procedure in Oral Cancer Surgery.

Objective. To investigate the application effects of optimizing the frozen section procedure in oral cancer surgery. Methods. A total of 45 oral cancer patients undergoing surgery were selected as the control group, operated from January 2020 to May 2021, without optimization of the frozen section procedure. Another 45 oral cancer patients undergoing surgery were selected as the experimental group, operated from June 2021 to December 2022, with the optimized frozen section procedure. The differences in the excellent rate of sections, the preparation time, the frozen report time and the accuracy rate between the two groups were compared. Results. In terms of the excellent rate of sections, the optimized procedure group was (44/45) 97.8%, which was higher than the conventional group (40/45) 88.9%; the preparation time and frozen report time in the optimized procedure group were (9.2 ± 0.7) min, and (26.4 ± 2.2) min, respectively, both shorter than those in the conventional group were (12.3 ± 1.3) min, and (31.8 ± 2.7) min, (p < 0.05); the accuracy rate of the frozen report, the optimized procedure group was (43/45) 95.6%, which was higher than the conventional group (40/45) 88.9%. Conclusion. Optimizing the frozen section procedure in oral cancer surgery can achieve desirable results, conducive to improving slide quality, reducing preparation time, and overall frozen report time. It is worthy of promotion.

Optimizing surgical margins in oral cancer without frozen section: A single center retrospective study

PurposeFrozen section analysis has been a cornerstone in intraoperative pathological evaluation for oral cancer surgeries, aiding in achieving tumor-free margins. However, its utility and availability are subjects of ongoing debate and research. This study evaluates the efficacy of a guideline-based approach to surgical resection margins in the absence of frozen section analysis in a resource-constrained setting. Materials and methodsWe conducted a retrospective audit of 490 oral cavity cancer patients treated from December 2021 to December 2023 at our center, where frozen section analysis was not available. Surgical resections adhered to the guidelines of maintaining 1 cm mucosal soft tissue and base margins, and a 7 mm specimen-driven margin assessment intraoperatively. The outcomes measured were the rates of close (between 1 mm and 5 mm) and involved (less than or equal to 1 mm) margins in final histopathology reports (HPR). Results448 patients were included in our audit. On final HPR, a gross margin of 7 mm or more achieved intraoperatively translated into safe (more than 5 mm) margins in 410 patients (91.1 %). 25 (5.1 %) had at least one close margin, of which 11 were technical due to the desire to minimize functional morbidity. 15 (3.1 %) had involved margins, where R0 resection was not achieved due to anatomical constraints. An additional finding was the correlation of compromised margins with worst pattern of invasion (WPOI) 4&5 on Chi-square analysis (p = 0.021) and depth of invasion (DOI) more than 5 mm (OR 3.81, p = 0.010). ConclusionThis study indicates that a margin of 7 mm or more intraoperatively translates into safe margins on final HPR, and calls for a pragmatic and judicious use of FS in the interest of choosing wisely.

CTNI-02. FLUORESCEIN-STAINED CONFOCAL LASER ENDOMICROSCOPY VERSUS CONVENTIONAL FROZEN SECTION FOR INTRAOPERATIVE HISTOPATHOLOGICAL ASSESSMENT OF INTRACRANIAL TUMORS

Abstract BACKGROUND The aim of this clinical trial was to compare Fluorescein-stained intraoperative confocal laser endomicroscopy (CLE) of intracranial lesions and evaluation by a neuropathologist with routine intraoperative frozen section (FS) assessment by Neuropathology. METHODS In this phase II non-inferiority, prospective, multicenter, non-randomized, off-label clinical trial (Eudra-CT: 2019-004512-58), patients above the age of 18 years with any intracranial lesion scheduled for elective resection were included. The diagnostic accuracies of both CLE and FS referenced with the final histopathological diagnosis were statistically compared in a non-inferiority analysis, representing the primary endpoint. Secondary endpoints included the safety of the technique and time expedited for CLE and FS. RESULTS 210 patients were included by 3 participating sites between November 2020 and June 2022. Most common entities were high grade gliomas (37.9%), metastases (24.1%), and meningiomas (22.7%), A total of 6 serious adverse events in 4 (2%) patients were recorded. For the primary endpoint, the diagnostic accuracy for CLE was inferior with.87 versus.91 for FS, resulting in a difference of.04 (95% confidence interval -.10;.02; p=.367). The median time expedited until intraoperative diagnosis was 3 minutes for CLE and 27 minutes for FS, with a mean difference of 27.5 minutes (standard deviation 14.5; p&amp;lt;.001). CONCLUSION CLE allowed for a safe and time-effective intraoperative histological diagnosis with a diagnostic accuracy of 87% across all intracranial entities included. The technique achieved histological assessments in real-time with a tenfold reduction of processing time compared to FS, which may invariably impact surgical strategy on the fly.

The utilization of cytology for intraoperative diagnosis of primary central nervous system lymphoma

To investigate the diagnostic value of intraoperative cytology and rapid immunocytochemistry in primary central nervous system lymphoma. 254 cases of lymphoma and 82 cases of non-lymphoma were collected from 2010 to 2023. Frozen section(FS) was using alone in 44 cases during 2010–2014, FS and intraoperative cytology(IC) were using in 251 cases during 2015 to 2022. Rapid immunocytochemical(RICC, CD20, GFAP) were using with FS + IC in 41 cases during 2021 to 2023. Method One: According to the results of archives, statistic the diagnostic accuracy of lymphoma during three time periods. Method Two: All cases were randomly renumbered, 4 neuropathologists compared the accuracy of independent histology and that of combining cytology. The archives showed the diagnostic accuracy of FS in PCNSL was 77.27%, FS + IC was 86.06%, FS + IC + RICC was 92.68%. The retrospective study demonstrated the diagnostic accuracy of FS was 79.76%, FS + IC was 87.33% and FS + IC + RICC was 92.68%. The positive predictive value, negative predictive value, sensitivity, specificity and accuracy of CD20 were 100%, 76.92%, 90.32%, 100% and 92.68%, respectively. The results of the paired χ2 test was no statistically significant difference (0.05 < P < 0.1) between FS + IC + RICC and immunohistochemical (IHC) diagnosis of paraffin sections. The integration of IC + RICC + FS diagnosis can significantly enhance the intraoperative diagnostic accuracy of PCNSL and rectify potential errors that may occurred when relying solely on FS diagnosis.

The role of gynecologic oncology providers in intraoperative consultations in obstetrics and gynecology department

The role of gynecologic oncology providers in intraoperative consultations in obstetrics and gynecology department