Permanent Sections Research Articles

Reducing the Use of Frozen Section for Sentinel Node Biopsy in Breast Carcinoma: Feasibility and Outcome.

Sentinel lymph node biopsy (SLNB) is a standard practice for staging the axilla in breast cancer. Initially, intraoperative frozen section (FS) examination was used but was time-consuming and often provided false-negative results. Delayed permanent section (PS) analysis is currently performed; FS-SLNB is maintained for selected high-risk cases. The aim of this study was to evaluate the feasibility of this approach. All patients with breast cancer with clinically negative lymph nodes undergoing SLNB at our institution from 2004 to 2020 were analyzed, comparing operative time, re-operation rate and clinical outcome in terms of regional lymphatic recurrence-free and overall survival by type of SLNB (FS vs. PS). FS-SLNB comprised 100% of the procedures in 2004 and 18.2% at the end of the study period. The use of PS-SLNB instead of FS-SLNB was associated with a significantly reduced rate of axillary dissection (AD): 4.4% vs. 27.2, respectively (p<0.001). There was no significant difference in re-operation rate for AD: 3.9% vs. 6.9%, respectively (p=0.20). The use of PS-SLNB significantly reduced the operative time (mean=51 minutes) (p<0.001). After a mean follow-up of 70.9 months (range=16-180 months) there were no differences in regional lymphatic recurrence free or overall survival. The reduced use of FS-SLNB resulted in a significantly lower rate of AD, and significant operative time and costs savings, without any increase in the reoperation rate and lymphatic recurrences. Therefore, this approach is feasible, safe and beneficial, both for patients and healthcare services.

Intraoperative confocal laser endomicroscopy: prospective in vivo feasibility study of a clinical-grade system for brain tumors.

The authors evaluated the feasibility of using the first clinical-grade confocal laser endomicroscopy (CLE) system using fluorescein sodium for intraoperative in vivo imaging of brain tumors. A CLE system cleared by the FDA was used in 30 prospectively enrolled patients with 31 brain tumors (13 gliomas, 5 meningiomas, 6 other primary tumors, 3 metastases, and 4 reactive brain tissue). A neuropathologist classified CLE images as interpretable or noninterpretable. Images were compared with corresponding frozen and permanent histology sections, with image correlation to biopsy location using neuronavigation. The specificities and sensitivities of CLE images and frozen sections were calculated using permanent histological sections as the standard for comparison. A recently developed surgical telepathology software platform was used in 11 cases to provide real-time intraoperative consultation with a neuropathologist. Overall, 10,713 CLE images from 335 regions of interest were acquired. The mean duration of the use of the CLE system was 7 minutes (range 3-18 minutes). Interpretable CLE images were obtained in all cases. The first interpretable image was acquired within a mean of 6 (SD 10) images and within the first 5 (SD 13) seconds of imaging; 4896 images (46%) were interpretable. Interpretable image acquisition was positively correlated with study progression, number of cases per surgeon, cumulative length of CLE time, and CLE time per case (p ≤ 0.01). The diagnostic accuracy, sensitivity, and specificity of CLE compared with frozen sections were 94%, 94%, and 100%, respectively, and the diagnostic accuracy, sensitivity, and specificity of CLE compared with permanent histological sections were 92%, 90%, and 94%, respectively. No difference was observed between lesion types for the time to first interpretable image (p = 0.35). Deeply located lesions were associated with a higher percentage of interpretable images than superficial lesions (p = 0.02). The study met the primary end points, confirming the safety and feasibility and acquisition of noninvasive digital biopsies in all cases. The study met the secondary end points for the duration of CLE use necessary to obtain interpretable images. A neuropathologist could interpret the CLE images in 29 (97%) of 30 cases. The clinical-grade CLE system allows in vivo, intraoperative, high-resolution cellular visualization of tissue microstructure and identification of lesional tissue patterns in real time, without the need for tissue preparation.

Clinicopathologic Features and Frozen Diagnostic Pitfalls of Bronchiolar Adenoma/Ciliated Muconodular Papillary Tumors (BA/CMPTs).

To describe the histologic features of bronchiolar adenoma/ciliated muconodular papillary tumors (BA/CMPTs) and analyze the pitfalls in diagnosis from frozen sections. A total of 208 frozen and permanent sections of BA/CMPTs from Shanghai Chest Hospital from July 2018 to July 2021 were retrospectively analyzed. The median age of BA/CMPT patients was 65 years (15 to 79y), and women accounted for 61.62% (122/198). The median size of BA/CMPTs was 0.6cm (range 0.2 to 2cm), of which 88.94% were small (≤1cm, 185/208). In terms of location, the right lower lobe accounted for 44.23% (92/208), and the left lower lobe accounted for 33.65% (70/208). In 10 patients with 2 independent BA/CMPTs, 5 lesions were located in the left lower lobe and 4 in the right lower lobe. A total of 86.06% of the CT images of BA/CMPT showed solid/subsolid nodules (179/208). Among 208 tumors, 68.75% were distal type (143/208), and 31.25% were proximal type (65/208). The qualitative error rate of frozen sections was 21.33% (32/150), of which the distal type accounted for 75% (24/32); most of them were misdiagnosed as invasive adenocarcinoma during frozen diagnosis. The frozen diagnosis of BA/CMPTs might result in misdiagnosis as invasive adenocarcinoma. A careful search for characteristics of BA/CMPT, such as bilayer epithelial cells with basal cells and a lack of cellular atypia and invasive growth patterns, may be helpful for frozen diagnosis.

Permanent section margin concordance after Mohs micrographic surgery with immunohistochemistry for invasive melanoma and melanoma in situ: A retrospective dual-center analysis

Mohs Micrographic Surgery (MMS) for melanoma practices vary among dermatologic surgeons. The implementation of immunohistochemical staining in MMS for melanoma mitigates challenges associated with slide interpretation, however the reliability of Melanoma antigen recognized by T cells 1 (MART-1), the preferred immunostain for melanoma, has yet to be compared to permanent section pathology. To assess concordance rates of MART-1 frozen sections and permanent section pathologic interpretation of melanoma treated with MMS. A dual center retrospective analysis was conducted to collect concordance and demographic data. Chi square tests were performed for group comparisons of categorical variables. Of the 379 permanent sections sent, 367 were concordant with frozen section pathology for an overall concordance rate of 96.8%. Cases were stratified into indeterminately concordant and indisputably concordant. 22 (6%) of cases were indeterminately concordant whereas 345 (94.0%) of cases were indisputably concordant. The concordance rate is derived from a comparison of adjacent tissue margins, an inevitable consequence of utilizing two techniques. To the author's knowledge, this study represents the largest investigation examining concordance rates of MART-1 frozen sections in Mohs for melanoma. High concordance disputes the ongoing need for additional permanent margins when using MART-1 in routine cases.

A Critical Appraisal of Intraoperative Frozen Section Analysis of Ovarian Tumors: A 3-Year Review of Accuracy and Clinicopathological Correlation at a Tertiary Care Center.

Intraoperative frozen section (IFS) plays a pivotal role in arriving at a diagnosis and guiding toward appropriate surgical management as there is a lack of effective ovarian cancer screening methods. Considering histopathology as the gold standard, the current study was conducted to examine the accuracy of frozen section in ovarian tumors. A prospective analysis was conducted on 52 cases of IFS of ovarian masses over 3 years (April 2018 to March 2021). Frozen section and permanent paraffin section reports were compared, and overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. The role of various clinicopathological parameters in predicting ovarian malignancy was also evaluated. The study group included 42 benign, 3 borderline, and 7 malignant tumors, with surface epithelial tumors being the most frequent. Discordance between IFS and histopathological diagnosis was observed in two cases. We observed a high sensitivity (90%), specificity (97%), PPV (90%), NPV (97%), and accuracy (94%) for frozen section of ovarian tumors. CA-125 (P = 0.007) and menopausal status (P = 0.05) emerged as significant for predicting malignancy statistically. Intraoperative frozen represents that section envisages pathologic examination in a time-bound manner and promotes fruitful communication between clinicians and pathologists, so that appropriate information is shared to curtail errors. Despite the small sample size, this study reiterates that frozen section serves as an effective diagnostic tool for intraoperative evaluation of ovarian masses when utilized judiciously by pathologists and surgeons as the advantages surpass the limitations.

Role of Frozen Sections in Diagnosing Female Genital Tract Lesions: A Tertiary Centre Study in Chennai, India

Introduction: Female Genital Tract (FGT) malignancies are common with ovarian cancers having high incidence and mortality. The asymptomatic character, difficult location and lack of effective screening methods make Intraoperative Frozen Section (IFS) an effective diagnostic test to guide the surgical decisions. Aim: To assess the performance of IFS, describe the associated demographic, clinicopathological factors and identify the errors leading to discordance when compared with Permanent Section (PS). Materials and Methods: A retrospective study of all the consecutive IFS consultations related to FGT lesions received in the Pathology Department between January 2013 to June 2022 was conducted between July 2022 to September 2022 at ESIC Medical College and Hospital, Chennai, Tamil Nadu, India. Cases with IFS deferred until PS section were excluded. The FS and PS reports, demographic, clinicopathological data, Risk of Malignancy Index (RMI), imaging and biochemical records were retrieved. In-depth descriptive analysis of clinicopathological parameters as frequency and percentage, frequency distribution of PS diagnosis, concordant and discordant categorisation, reasons for the discordance were described and the diagnostic accuracy of Frozen Section (FS) tool was calculated. Mean, Frequency (n) and percentage (%) analysis was done for the complete collected data. Results: Out of the total 35 FGT related IFS consultations received, 32 (91.43%) was for Ovarian Tumours (OT), which included 26 surface epithelial tumours, three sex cord stromal tumours, two germ cell tumours, one Krukenberg tumour. Two cases were deferred due to extensive haemorrhage and infarction. Confirmation of the diagnosis was the most common indication. The mean size of the OT (n=32) was 13 cm and ranged from 2 to 31 cm. RMI was low (&lt;25) in 14 (44%, n=32), intermediate (25-250) in 10 (31%, n=32) and high (&gt;250) in 8 (25%, n=32) of OT. The diagnostic accuracy of FS of all the FGT cases (n=35) was 85.71% (n=35 FGT cases) with an error rate of 14.29% was observed. Five OT cases had discordant FS diagnosis, 3 cases due to sampling error and mis-interpretation error in the remaining 2 cases. Artefacts like poor morphology due to tissue freezing, nucleomegaly, poor sectioning and section folding were observed in the discordant cases. Conclusions: Correct use of IFS along with careful preoperative work-up will help the surgeon intraoperatively. A good rapport among clinicians, pathologists and laboratory personnel will aid to improve the diagnostic accuracy. Periodic assessment of IFS tool is necessary as a quality check.

Arduino and Ultrasonic Sensor Based Smart Dustbin for Efficient Waste Management

Designing an effective and hygienic waste management system utilising an Arduino-based Smart Dustbin is the goal of this project. The trash can is divided into two sections: a permanent section that houses all the electrical parts and a detachable cover with a moveable flap. Two ultrasonic sensors, a servo motor, a breadboard, a buzzer, and an LED light are all parts of the system. When an item is detected by the first ultrasonic sensor, the servo motor is activated, lifting the flap for contactless trash removal. When the threshold is surpassed, the second sensor, which checks the garbage level, turns on the LED light to indicate that the bin is not yet ready for use. The motor is dormant and a buzzer alerts the user to empty the bin if they try to dispose of garbage during this period. By limiting the spread of bacteria and odours and ensuring that the trashcan is constantly accessible, the system provides an effective and environmentally responsible solution. It is simple to copy and apply in different settings to enhance waste management procedures. It is simple to empty the trash since the lid can be removed without harming the electrical components.

Diagnostic accuracy of intra-operative frozen section at tertiary care center

Introduction: Frozen section is a valuable technique for immediate diagnosis in intraoperative management of patients. It helps the surgeon in the surgical management of the patient by helping in the intraoperative diagnosis of tumors, margins and lymph node assessment, and organ identification. Accuracy and limitation of frozen sections vary according to different anatomical sites. Study objective was to evaluate the diagnostic accuracy of frozen sections. Aims: Aim of this study was to analyze the frozen section results and compare it with final paraffin sections and evaluate the diagnostic accuracy. Material and methods: A retrospective study of 201 specimens of intra operative FS were carried out in histopathology section of B.J. Medical College, Ahmedabad. The diagnoses given on frozen section were compared with the final diagnosis given on permanent paraffin sections. The results were categorized into concordant and discordant. Results: The diagnostic accuracy of frozen section was found to be 86.6%. Discordant rate is 13.4%. Most common frozen section analysis was primary diagnosis or typing of neoplasms (97.5%). Discordant rate or false negative diagnosis was because of technical and interpretative error. Conclusion: Frozen section is a rapid diagnostic process which helps surgeons to choose best therapeutic approach. It confirms various benign and malignant lesions. When unexpected disease process is found and require a definite diagnosis and to take a definite decision on extent of surgery frozen section is very much helpful. However one needs to be aware of its limitations. By avoiding its limitation diagnostic accuracy can be improved.

A Case of Malignant Lymphoma with Superior Orbital Fissure Syndrome

The superior orbital fissure syndrome (SOFS) is caused by impaired functions of the cranial nerves (III, IV, V1, VI) that enter the orbit through the superior orbital fissure. SOFS associated with malignant lymphoma is rare.We present the case of an 88-year-old female patient who presented with left-sided ptosis and total ophthalmoplegia, with pain in the left eye. Examination revealed small tumors in the left lower eyelid and a nodule in the left leg. CT of the orbits and the nasal sinus area showed mass lesions in the ethmoid sinuses of both sides and the left sphenoid sinus. We suspected infection or autoimmune disorder and performed endoscopic sinus surgery for the purpose of histopathologic diagnosis and treatment.Both frozen-section and permanent section diagnosis of the resected specimen revealed features consistent with malignant lymphoma (diffuse large B-cell lymphoma (DLBCL)). Biopsy of the skin nodule in the left leg performed at the same time also revealed features consistent with the diagnosis of DLBCL.Although the standard treatment for DLBCL is combination chemotherapy (R-CHOP), this patient and her family decided against aggressive chemotherapy in favor of best supportive care, in view of her age and performance status.A large variety of disease processes are known to underlie the etiopathogenesis of SOFS, such as infections and autoimmune diseases. When the onset of symptoms is slow, a neoplastic cause should be considered.The greater the degree of disease progression, the higher the risk of vision loss from optic neuropathy. Therefore, the condition should be diagnosed early and treated promptly to avoid blindness.

Russian Window East: Museum Research and Exhibition Projects (1996—2023)

The ongoing political and economic transformations have resurfaced the perpetual Russian inquiry into its civilizational identity. Against this backdrop, it's impossible not to take note of several noteworthy exhibition and publication initiatives pertaining to Russia's eastern policy throughout the ages. For nearly 30 years, the biggest Russian museums have carried out quite important exhibition projects in various cities, including St. Petersburg, Moscow, Kazan, Washington D. C., Lisbon, London, Amsterdam and Groningen, among others. These exhibitions trace the significant stages of cultural exchange between Russia and the East. The collections of Russian museums are an important indicator of the importance of the East in the formation of the Russian state and the development of Russian culture. The article opens a new permanent section of the journal called In angello cum libello (“In a corner with a book” = “Alone with a book”). This is an abbreviated form of a motto often attributed to Thomas à Kempis (1380—1471), author of a number of treatises on monastic life. The full saying is a mixture of Latin and Dutch: “In omnibus requiem quaesivi, sed non inveni, nisi in hoexkens ende boexkens” (“I have sought peace everywhere, but I have not found it except in nooks and in books”).

Prevalence and Risk Factors for Hypoparathyroidism Following Total Thyroidectomy in Taif City.

Background Postoperative hypoparathyroidism has been investigated in health records and surgical cohorts, but the results have been highly variable and imprecise. It is not clear how often endocrinologists encounter this hormone deficit in clinical practice. Thus, the aim of this study is to determine the incidence of permanent hypoparathyroidism and the factors associated with it in a group of post-thyroidectomy patients followed at three tertiary care institutions in Taif city. Materials and Methods A retrospective cohort analysis was done to examine patients who had a total thyroidectomy in the city of Taif between January 1, 2015, and December 31, 2019. Patients were eligible for the study if they received total thyroidectomy, were above the age of 18 years, had surgical and pathological data available, and had been monitored in the same institution for at least a year after their thyroidectomy. Patients who did not return for follow-up care following surgery were excluded from the study. Results The incidence of hypoparathyroidism was 10.3%, and females had a higher prevalence (12.1%) than males (3.2%). In patients with two and three parathyroid glands, hypoparathyroidism was found to be more prevalent (33.3% and 25.5%) in permanent histological sections. There was no single independent risk factor for hypoparathyroidism according to a logistic regression model. Conclusion The incidence rate of hypoparathyroidism following total thyroidectomy was about 10.3%. There were no independent risk factors identified for hypoparathyroidism after total thyroidectomy. Permanent hypoparathyroidism severely affects the quality of life, and research should be done to prevent its incidence after thyroidectomy.

New digital confocal laser microscopy may boost real-time evaluation of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) from solid pancreatic lesions: Data from an international multicenter study

Pancreatic cancer is an aggressive malignancy and a leading cause of cancer death worldwide; its lethality is partly linked to the difficulty of early diagnosis. Modern devices for endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) were recently developed to improve targeting and sampling of small lesions, but innovative technologies for microscopic assessment are still lacking. Exvivo fluorescence confocal laser microscopy (FCM) is a new digital tool for real-time microscopic assessment of fresh unfixed biological specimens, avoiding conventional histological slide preparation and potentially being highly appealing for EUS-FNB specimens. This study evaluated the possible role of FCM for immediate evaluation of pancreatic specimens from EUS-FNB. It involved comparison of the interobserver agreement between the new method and standard histological analysis during international multicenter sharing of digital images. Digital images from 25 cases of EUS-FNB obtained with real-time FCM technology and 25 paired digital whole-slide images from permanent conventional paraffin sections were observed by 10 pathologists from different Institutions in Europe, Japan, and the United States, in a blinded manner. The study evaluated 500 observations regarding adequacy, morphological clues, diagnostic categories, and final diagnosis. Statistical analysis showed substantial equivalence in the interobserver agreement among pathologists using the two techniques. There was also good inter-test agreement in determining sample adequacy and when assigning a diagnostic category. Among morphological features, nuclear enlargement was the most reproducible clue, with very good inter-test agreement. Findings in this study are from international multicenter digital sharing and are published here for the first time. Considering the advantages of FCM digital diagnostics in terms of reduced time and unaltered sample maintenance, the exvivo confocal laser microscopy may effectively improve traditional EUS-FNB diagnostics, with significant implications for planning modern diagnostic workflow for pancreatic tumors. This study was not supported by any funding source.

Dissecting Diagnostic Discrepancies between Intraoperative and Permanent Head and Neck Pathology Sections at a Large University Medical Center

Abstract Introduction/Objective Accurate correlation between intraoperative frozen section (FS) and subsequent permanent section (PS) diagnoses is essential for quality patient care. Intraoperative FS is used for confirmation of diagnoses and margin status (MS) evaluation in head and neck (H&amp;N) pathology. Reported FS-PS discrepancy rates for H&amp;N cases range between 1.42% to 1.80%, mostly due to sampling and interpretation errors. We sought to review our experience with FS and concordant PS from H&amp;N pathology cases diagnosed at a high volume, university medical center. Methods/Case Report Correlation was performed between intraoperative FS and paraffin-embedded PS of H&amp;N surgical resections between January 2019 to December 2021. FS-PS discrepancies were classified due to “sampling” or “interpretation”. Recurrence rates based on a 2 year follow up period of 2019 cases was also recorded. Results (if a Case Study enter NA) 2337 H&amp;N cases yielded 11108 intraoperative FS diagnoses. FS-PS correlation identified 142 (1.27%) discrepancies. Of these, 85 (60%) were for MS control, comprised of 45 (53%) due to “sampling” and 40 (47%) to “interpretation”. FS slides generally represented a single top section taken from the tissue, with “sampling” discrepancies due to discordant diagnoses identified on a deeper cut of tissue on the PS slides. Common “interpretative” discrepancies included overlooking high-grade dysplasia. For patients diagnosed in 2019, we found that 6% of discrepant cases of locoregional disease over a 2 year follow up period were due to inadequate margin control. Conclusion Our institutional intraoperative FS-PS discrepancy rate for H&amp;N pathology cases is 1.27%, and within the national quality standards. Our FS-PS discrepancy rate for H&amp;N cases related to MS control were mostly due to “sampling". Intraoperative review of deeper cuts of FS tissue and in service instruction for pathologists regarding intraoperative reporting of high-grade dysplasia will be the subject of a prospective study for potential improvement of “sampling” and “interpretative” discrepancies, respectively. Future studies hope to minimize the cases of locoregional occurence due to inadequate margin status.

Langerhans’ Cell Histiocytosis Masquerading as Metastatic Melanoma on Frozen Section

Abstract Introduction/Objective Langerhans’ cell histiocytosis (LCH) involving the lungs usually presents as multiple interstitial, bilateral, peribronchiolar pulmonary nodules. As lungs are a common site of metastatic involvement LHC can masquerade as a metastatic lesion. The distinction can be challenging, especially on a frozen section. Methods/Case Report We present a case of a 35-year-old male with history of metastatic melanoma who presented with pulmonary nodules and underwent lung wedge resection. Frozen section was requested at the time of surgery. Grossly there was a 2.8 cm tan-grey irregular lesion abutting the pleura. Frozen section of a representative piece showed a discohesive lesion composed of large cells with prominent nuclei resembling melanocytes. The eosinophilic infiltrate in the frozen slide was extremely scant, and presence of anthracotic macrophages resembled the melanin pigment frequently seen with melanoma. CT imaging prior to the surgery had raised the differential of LCH and metastatic disease. The frozen section was favored to be negative for carcinoma and metastatic melanoma and final diagnosis was deferred to permanent sections. Permanent tissue sections showed classic features of LCH and positivity for CD1a confirming the diagnosis. Results (if a Case Study enter NA) NA Conclusion This case emphasizes the importance of multidisciplinary approach and knowledge of imaging impression during a frozen section.

63 (PB-063) Poster - Is sentinel lymph node biopsy without frozen section in early stage breast cancer sufficient in accordance with ACOSOG-Z0011? A retrospective review from King Chulalongkorn Memorial Hospital

Background: In 2021, there is an increased global trend for sending sentinel lymph node biopsy (SLNB) specimens for permanent section (PS) without intraoperative frozen sections (FS). ACOSOG Z0011 revealed that reoperation of axillary lymph node dissection (ALND) was not necessary in patients with 1 or 2 nodal metastases. Permanent section alone was thought to be sufficient for sentinel lymph node (SLN) diagnosis. This pilot study conducted in Thailand determines the re-operation rate for SLNB without FS.

PMON155 Intraoperative, confocal laser endomicroscopy in pituitary surgery

Abstract Introduction Fluorescence imaging, such as confocal laser endomicroscopy (CLE) is a fast modality of image acquisition, which offers the possibility of early intraoperatively diagnosis and may be used to improve surgical decision making. Objective Within a 3-month prospective trail we used the Zeiss CONVIVO CLE in transspehnoidal surgery for different sellar pathologies. CLE is a miniaturized portable, handheld, fiber optic-based, confocal laser scanning microscope used in conjunction with a 488-nm excitable fluorophore. During the trial period we investigated feasibility, diagnostic accuracy and usability in terms of differential diagnosis in transsphenoidal surgeries of various pituitary tumours (15 pituitary adenomas, 2 craniopharyngiomas, 1 sellar metastasis). Method: Patients were randomly selected. Inclusion criteria were a pituitary macroadenoma or a sellar mass lesion exceeding 10 mm in diameter. A transsphenoidal approach was used and fluorescin was injected upon opening the sellar floor. CLE was carried out immediately after dural opening and during tumour resection, whenever possible. Additionally, the microprobe was used ex vivo with the resected tumor material. Histopathologic features of CLE images and H&amp;E-stained permanent sections were assessed and compared postoperatively. Result: We were able to obtain CLE in-vivo images in all cases. Using the microscopic approach, no problems occurred regarding space for the microprobe. To obtain in-vivo images we had to rest the probe within a mount. Wiggling of the surgeon's hand, pulse synchronous movements of the mass and mild intraoperative venous bleeding led to inexact images. To overcome these problems, we used CLE as early as possible at the beginning of tumor resection to avoid bleeding interferences. Additionally we investigated resected tumor specimens ex-vivo within the OR. Since no bleeding and no interference with movements occurred image quality and acquisition time improved. Histopathologic features of CLE images and H&amp;E-stained permanent sections showed, that except for the sellar metastasis, a diagnosis could be made on the basis of the intraoperative CLE images, whereas the ex-vivo images were more precise. Conclusion CLE is a potential imaging modality for transnasal assessment of skull base and pituitary lesions. It may help to establish an early diagnosis, to identify pituitary microadenomas, especially in cushing´s disease and to distinguish the various sellar pathologies. CLE is a fascinating possibility to verify a suspected diagnoses already intraoperatively. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Intraoperative cytology when cryostat is not available. A 7-year experience in a Peruvian cancer center.

Intraoperative cytology (IC) is an alternative to frozen-section (FS) diagnosis. We present our experience with and the diagnostic value of IC during a 7-year period when FS was not available in a Peruvian Cancer Center. This 7-year retrospective single-arm review study includes IC procedures performed by three pathologists between 2012 and 2018. These IC reports were reviewed independently by one pathologist and were correlated with the histologic diagnoses, which were used as the gold standard. All IC preparations (imprint, scrape, and crush smears) were stained with hematoxylin and eosin. IC interpretations were categorized as: malignant, benign, atypical, and "deferred to permanent sections." Sensitivity, specificity, and positive and negative predictive values were calculated by use of standard methods. A total of 1814 IC cases prepared from various organs obtained from 887 patients were reviewed. Malignant, benign, atypical, and "deferred to permanent sections" IC diagnoses were 26.3%, 68.9%, 3.7%, and 1.9%, respectively. Atypical and deferred cases were excluded from the statistical analysis; thus 1712 cases were found to be eligible. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were 91.6%, 97.7%, 94.1%, 96.7%, and 96%, respectively. In experienced hands, IC is a rapid, cost-effective, and accurate alternative diagnostic modality for intraoperative diagnosis when FS is not available.

Role of intraoperative frozen section evaluation of sentinel lymph node in breast carcinoma

Background Breast carcinoma is the most common malignancy in women worldwide. Intraoperative frozen section of SLNs can detect metastatic disease, allowing immediate axillary dissection and avoiding the need for reoperation, at the same time it avoids unnecessary dissection of uninvolved LNs.Aim of the study 1. To evaluate the current role of frozen section in identifying patients who could benefit from it. 2. To verify the accuracy of intraoperative frozen section examination for SLNs. Materials and methods In this combined retrospective and prospective study, we reviewed the outcome for 33 female patients with breast cancer who underwent intraoperative SLN biopsy, at (Al-Shariqa laboratory) and (Ghazi Al-Hariri Hospital, Medical City) Baghdad, Iraq. and compared it with the permanent H&E sections, covering the period between Jan.2019 and Jan.2021Results: The patients age was ranging from 32 to 79 years with a mean of 50.7 years and the highest proportion was ≥ 40 years (90%). Only 10 patients (30.3%) of the total cases were diagnosed as having POSITIVE SLNs by intraoperative frozen section examination, while 23 patients (69.7%) had NEGATIVE SLNs. Nine of them (90%) were of ductal type, while only 1 case (10%) was of lobular type. all 10 cases (100%), the primary tumor size measured >2cm, (i.e: pT2). Validity of frozen section examination in comparison with permanent sections showed a sensitivity and specificity of 100%. Conclusions: Intraoperative frozen section evaluation of SLN biopsy is a reliable method, it offers a high sensitivity, specificity and diagnostic accuracy when compared with permanent section

Frozen Section Evaluation for Surgical Margins in Laryngeal Squamous Cell Carcinoma: Is it a Reliable Method for Partial and Total Laryngectomies?

In this study, we aimed to compare the accuracy of frozen section evaluation in partial and total laryngectomies performed to treat laryngeal squamous cell carcinoma . A retrospective study was conducted to evaluate the efficacy and accuracy of frozen section analysis for laryngeal squamous cell carcinoma of 65 patients, operated at a tertiary hospital. Two groups were recruited according to the surgical procedure. The sensitivity and specificity of frozen section diagnosis in laryngeal cancer were 20% and 99.73%, respectively. For partial laryngectomy, the sensitivity was 16.66% and specificity was 100%. For total laryngectomy, sensitivity was 22.2% and specificity 99.13%. Discordances between the initial frozen section diagnosis and the subsequent permanent section diagnosis were found in 13 (3.35%) pairs (3.37% partial laryngectomy and 3.33% total laryngectomy). Our study shows that the surgical method applied has no effect on discordances. However, sampling errors are likely to be more common in partial laryngectomy procedures. It should be kept in mind that the sensitivity of frozen section evaluation is low.

ORGANIZATION OF LEISURE ACTIVITIES FOR CHILDREN WITH SPECIAL EDUCATIONAL NEEDS IN EXTRACURRICULAR EDUCATIONAL INSTITUTIONS OF THE END OF THE XX - FIRST QUARTER OF THE XXI CENTURY

The article considers the organizational aspects of leisure activities for children with special educational needs in extracurricular educational institutions during the independence of Ukraine. Based on the analysis of legal documents, review of scientific works of this period, practical experience of activities in the field of extracurricular education, a vision of the content, forms and types of work with the younger generation is formulated. The content of the organization of leisure activities is revealed through a set of principles and functions. The most important principles of organization are the principles of consistency; systematicity; voluntariness; differentiation; availability and quality of leisure services; compliance of leisure services with local conditions; interest; unity of reaction and cognition; common activities; individualization; interdisciplinarity; practicality; visualizations, etc. The main functions of the organization of leisure activities are recreational and entertainment; cognitive and developmental; socially adaptive; communicative; information and educational; game; educational; value-oriented; creative, etc. The characteristics of the organizational structure of management and state regulation of the system of extracurricular educational institutions at different levels of government and taking into account industry characteristics and types of institutions are given. Some extracurricular educational institutions include education, culture and art, physical education and sports, tourism and local lore, health and recreation. It is revealed that the interaction of institutions and establishments of different levels of management of extracurricular education, pupils, parents, pedagogical collectives, separate teachers-organizers is carried out on the basis of partnership. The draft Law of Ukraine on Amendments to Some Laws of Ukraine of April 29, 2021, which proposes a corporate form of ownership, which provides for the conclusion of an agreement between several founders of different forms of ownership on the basis of public-private partnership. It was found that the corporate form of ownership will be able to increase funding for extracurricular educational institutions and improve their resources. It is concluded that the modern system of leisure work in extracurricular education includes extracurricular and extracurricular activities in educational institutions, palaces, centers, houses, libraries, stadiums, theaters, museums, which have permanent clubs, groups, sections, clubs, studios and others. creative associations.