Use Of Intraoperative Frozen Section Research Articles

Does the use of intraoperative frozen section of bone marrow from the cut end of the mandible help assess the adequacy of bone margins following mandibulectomy for oral cancer?

The adequacy of the cut end of the mandible following a segmental mandibulectomy done for oral cancer intraoperatively is at times assessed using a frozen section (FS)of the bone marrow (BM)at the cut ends. The study aimed to assess its utility to guide the intraoperative decision on the adequacy of bony margins. All patients with oral squamous cell carcinoma (OSCC)who underwent segmental mandibulectomy from January 2012 to December 2021 at our institute and for whom intraoperative FS of BM was utilized were included. We analyzed the sensitivity, specificity, and positive and negative predictive value (PPV,NPV) of this in predicting positive bone margins. A total of 457 patients were included in the study. The majority of the cases were per premium cases (n = 372, 81.4%). The median age of the cohort was 52 years (range: 22-80 years). Most patients had T4 disease (n = 406, 88.8%). On FS, BM was positive in only 18 patients (3.9%) for whom the bone margin was revised. BM biopsy report in the final histopathology was positive in 12 patients (2.2%). The sensitivity, specificity PPV, and NPV were 52.3%, 98.65%, 64.7%, and 97.7% respectively. No factors predicting BM positivity on FS could be identified in this cohort. The BM FS was positive in only a small percentage of patients, and it helped in reducing the bone margin positivity rate from 3.9% to 2.2% only. Hence the intraoperative BM FS seems to have limited utility as seen from our study.

Use of intraoperative frozen section for primary diagnosis to determine optimum surgical strategy in suspected gallbladder malignancy

Background: Preoperative diagnosis of gallbladder cancer (GBC) remains a challenge. Unwarranted extensive surgery for benign disease is associated with increased morbidity and hospital stay; whereas undertreatment for GBC may lead to need for additional revision surgery, prolongation of treatment and delay in initiation of systemic therapy. We aimed to evaluate the routine use of intraoperative frozen section for primary histological diagnosis of suspected gallbladder malignancy and its impact on surgical strategy.

Utility and limitations of intraoperative frozen section diagnosis to determine optimal surgical strategy in suspected gallbladder malignancy

BackgroundPreoperative diagnosis of gallbladder cancer (GBC) remains a challenge. Unwarranted extensive surgery for benign disease and undertreatment for GBC pose challenges. We aimed to analyze the utility, diagnostic accuracy, and limitations of intraoperative frozen section (FS), for primary diagnosis of suspected gallbladder malignancy. MethodsPatients with suspected GBC underwent a cystic-plate cholecystectomy and FS for primary diagnosis. The procedure was considered adequate if FS suggested a benign pathology. A radical cholecystectomy was performed if FS favoured GBC, or in patients with high intra-operative suspicion of malignancy. All FS records were compared with final histopathology. ResultsFS guided the surgical strategy in 491 of 575 resections (85.4%). FS had a sensitivity of 88.3%, specificity of 99.6%, a positive predictive value of 99.4% and a negative predictive value of 92.7%. The diagnostic accuracy of FS was 95.1%. With routine use of intraoperative FS, only 10 out of 491 patients (2%) required a revised surgical strategy. ConclusionsFor radiologically suspected GBC it is prudent to confirm the histological diagnosis by use of intraoperative FS before undertaking radical resections. This study emphasizes the safety and accuracy of FS as an adjunct for directing optimal surgical strategy in suspected GBC.

Use of Intraoperative Frozen Section to Assess Final Tumor Margin Status in Patients Undergoing Surgery for Oral Cavity Squamous Cell Carcinoma

Methods of assessing final margin status in patients undergoing surgery for oral cavity squamous cell carcinoma, such as intraoperative frozen section histopathology (IFSH) taken from the tumor bed, may have limitations in accuracy. To evaluate the accuracy and implications of using IFSH samples to assess tumor bed margins in patients undergoing surgery for oral cavity squamous cell carcinoma (SCC). This cross-sectional study included 1257 patients who underwent surgery for oral cavity SCC between January 1, 2000, and December 31, 2015, at an academic cancer center. A total of 4821 IFSH samples were examined from 1104 patients (87.8%) who had at least 1 IFSH sample. Institutional practice is to harvest margins for IFSH from the tumor bed. Statistical analysis was performed from August 1, 2021, to April 4, 2022. Sensitivity and specificity were calculated for IFSH samples of margins compared with the permanent pathology samples of the same tissue and for IFSH compared with the final tumor specimen histopathology (FTSH). Results were classified using a binary method, with histopathologic reports interpreted as either negative (including negative or atypia or dysplasia) or positive (including carcinoma in situ, suspicious, or positive). A total of 1257 patients met the inclusion criteria, including 709 men (56.4%), with a median age of 62 years (IQR, 52-73 years); 1104 patients (627 men [56.8%]; median age, 62 years [IQR, 52-72 years]) had IFHS samples. For IFSH relative to permanent sections of the IFSH tissue, sensitivity and specificity of IFSH were high (sensitivity, 76.5% [95% CI, 67.5%-85.5%]; specificity, 99.9% [95% CI, 99.8%-100%]), with discordant results in 24 of 4821 total specimens (0.5%). Final specimen margins were positive in 11.7% of patients (147 of 1257). Compared with FTSH, the sensitivity of IFSH for defining margin status was 10.8% (95% CI, 5.8%-15.8%), and the specificity was 99.1% (95% CI, 98.8%-99.4%). The rate of discordance was 4.0% (171 of 4284 specimens) between IFSH and FTSH. The findings of this cross-sectional study suggest that IFSH is accurate compared with permanent pathologic characteristics of the same tissue, but less reliable at assessing final margin status on the tumor specimen. Despite a high specificity, the sensitivity of IFSH compared with FTSH is low, which may be associated with the inherent inability of tumor bed IFSH margin analysis to accurately account for the 3-dimensional association of tumor margins with the periphery of the specimen and the overall low rate of positive final tumor margins. Although tumor bed IFSH is widely used in the management of oral cavity cancer, this study suggests that there are limitations of this modality in assessing the final surgical margin status.

Utility of frozen section in pediatric and adolescent malignant ovarian nonseminomatous germ cell tumors: A report from the children's oncology group

PurposeIn adult women, most malignant ovarian tumors are epithelial in origin. The use of intra-operative frozen section to distinguish between benign and malignant histology is reliable in guiding operative decision-making to determine the extent of surgical staging required. Pediatric and adolescent patients with ovarian masses have a much different spectrum of pathology with most tumors arising from germ cell precursors. This review was undertaken to assess the concordance between the intra-operative frozen section and the final diagnosis as an aid to guide extent of surgical staging in a group of pediatric and adolescent patients with malignant ovarian germ cell tumors. MethodsRecords of patients aged 0 to 20 years with malignant ovarian germ cell tumors enrolled on Children's Oncology Group study AGCT0132 were reviewed. Pathology reports from patients who had both intra-operative frozen section diagnosis and final paraffin section diagnosis were compared using descriptive statistics. By inclusion criteria for the study, all patients had a final diagnosis of malignancy with required yolk sac tumor, choriocarcinoma or embryonal carcinoma histology. Available central review of pathology final paraffin section slides were compared with final institution pathology reports. ResultsOf 131 eligible patients with ovarian germ cell tumors, 60 (45.8%) had both intra-operative frozen section and final paraffin section diagnoses available. Intra-operative frozen section diagnoses were classified as: incorrect diagnosis of benign tumor (13.3%), confirmation of malignancy (61.7%), immature teratoma (16.7%), germ cell tumor not otherwise specified (5%) and no diagnosis provided (3.3%). Intra-operative frozen section was incorrect in 23 of 60 (38.3%) patients evaluated. Central pathology review was concordant with the final institution pathology diagnosis in 76.3% of patients. Central pathology review identified additional germ cell tumor components in 23.7% of patients. ConclusionsIn pediatric and adolescent patients with a confirmed final diagnosis of ovarian germ cell malignancy, intra-operative frozen section diagnosis is not reliable to inform the extent of surgical staging required. Central review by an expert germ cell tumor pathologist provides important additional information to guide therapy.

Intraoperative assessment of parathyroid pathology in sporadic primary hyperparathyroidism: an institutional experience

Intraoperative consultation for assessment of parathyroid tissue is a controversial area of endocrine pathology. This assessment often follows historical institutional and individual surgical practitioner practices rather than documented utility data and adjuvant intraoperative testing data, including intraoperative parathyroid hormone level testing by clinical pathologists and the use of Oil Red O vital stain on frozen tissue sections by anatomic pathologists, as a means of conferring etiology of parathyroid disease. The American Association of Endocrine Surgeons (AAES), in 2016, proposed guidelines for the management of primary hyperparathyroidism, including recommendations for intraoperative consultation, recommending against the use of intraoperative frozen section to determine parathyroid functional status but in support for its use for parathyroid identification. In this series, we review a one-year, retrospective cohort of consecutive parathyroid surgeries at Massachusetts General Hospital, including over 200 cases meeting inclusion criteria for which primary hyperparathyroidism was the indication for surgery, discussing outcomes, compliance with AAES guidelines, and overall utility of intraoperative consultation and adjuvant testing.

The Use of Intraoperative Frozen Sections in Guiding the Extent of Pancreatic Resections for Intraductal Papillary Mucinous Neoplasms: A Single Institution Experience and Review of the Literature.

The utility of frozen section evaluation of the pancreatic parenchymal resection margin(s) in the surgical management of intraductal papillary mucinous neoplasm (IPMN) remains controversial. We investigated the frequency of its use in IPMN resections and its impact on achievement of negative final parenchymal margin(s). Sixty-two IPMN resections (11 with invasive carcinoma) performed over a 12-year period were studied. Frozen sections of the parenchymal margin(s) were performed on 44 of the 62 resections (71%), 30 (68%) of which had 10 positive and 22 indefinite margins on frozen section. Additional margin resections were performed in 14 of these 30 cases (47%), boosting the complete resection rate from 14% (2 of 14) on the initial margin(s) to 71% (10 of 14) on the final margin(s) (P = 0.002). Overall, negative final parenchymal margin(s) were achieved more frequently when evaluation of the initial margin(s) by frozen section was performed (35 of 44; 80%) than when it was not (11 of 18; 61%) (P = 0.13). In the intraoperative management of IPMN, frozen sections are highly reliable for margin evaluation and are useful for guiding the extent of pancreatic resection.

Utility of Intraoperative Frozen Section of the Inguinofemoral Sentinel Lymph Node in Vulvar Cancer: A Retrospective Cohort

Objective: Sentinel lymph node dissection (SLND) spares most patients diagnosed with clinically early-stage vulvar cancer from undergoing complete inguinofemoral lymphadenectomy (IFLND). We sought to evaluate the intraoperative examination of frozen sentinel lymph node (SLN) sections to assess the need for IFLND. Methods: We identified patients with vulvar cancer treated at a tertiary referral center between January 2006 and December 2019 who either underwent SLND or met the eligibility criteria to receive SLND. All patients were restaged according to the International Federation of Gynaecology and Obstetrics (FIGO) 2009 guidelines. The records of each patient were reviewed for disease characteristics, follow-up status, patient demographics, SLN eligibility, and surgical and pathologic variables. Results: Of 142 eligible patients, 76 underwent SLND (53.5%) for a total of 118 groins assessed. We found no statistically significant differences in characteristics between the cohorts that received or lacked SLN examination. The SLN was detected in 90.8% (95% Confidence Interval (CI): 81.9%–96.2%) of patients. SLNs of 52 patients were sent for frozen section, and the results were used to direct further surgical intervention. The results of the frozen section pathology and the final pathology report exhibited a high degree of correlation per patient (100%) and per groin (98.7%). The 1 incorrect groin was negative on frozen but positive on final pathology and therefore no patients received an incorrect complete groin dissection. We observed no statistically significant differences in recurrence-free survival or overall survival rates between those patients who received or did not receive SLND. Conclusions: The use of intraoperative frozen section is appropriate for assessing node status at time of initial surgery. The use of this method decreases the incidence of reoperation by identifying those patients who warrant immediate IFLND.

Use of Intraoperative Frozen Section in the Surgical Management of Patients with Nonmelanoma Skin Cancer.

Background Intraoperative frozen section (IFS) is often utilised in the surgical treatment of nonmelanocytic skin cancer (NMSC) in sensitive facial regions when Mohs micrographic surgery (MMS) is not available. Objective To compare the outcome of NMSC patients with excision performed with and without IFS. Materials and Methods A retrospective, single-centre study was performed on all patients who had undergone resection of NMSC with and without IFS control at the National University Hospital (NUH) from 2010 to 2015. Results 116 patients were recruited, of which 86 had IFS and 30 did not. The complete excision rate of patients with IFS was higher at 87.2% (p=0.0194), need for secondary operation was lower at 1.2% (p=0.005), and need for postsurgery radiotherapy or chemotherapy was lower at 1.2% (p=0.001). The average duration of surgery in patients who underwent IFS was 95.4 minutes compared to 70.1 minutes in cases which did not undergo IFS. Conclusion Our study showed an increased complete excision rate and reduced need for secondary surgeries and adjuvant therapy in patients with IFS. However, a longer operative duration was required. Use of IFS may be useful in patients with NMSC lesions in sensitive regions requiring complex reconstruction after tumour excision.

Indocyanine Green-Guided Pediatric Tumor Resection: Approach, Utility, and Challenges.

Incomplete tumor resection increases the risk of local recurrence. However, the standard of care approach to distinguishing tumor tissue is less than optimal, as it depends on a conglomeration of preoperative imaging and visual and tactile indicators in real time. This approach is associated with a significant risk of inadequate resection; therefore, a novel approach that delineates the accurate intraoperative definition of pediatric tumors is urgently needed. To date, there is no reliable method for the intraoperative assessment of tumor extent and real-time differentiation between tumor- involved tissues and tumor-free tissues. Use of intraoperative frozen sections is challenging, time consuming, and covers a small surface area. Increased vascular permeability and impaired lymphatic drainage in the tumor microenvironment leads to an enhanced permeability and retention effect of small molecules. ICG is a fluorescent dye that when administered intravenously accumulates passively in the tumor because of EPR, thereby providing some tumor contrast for intraoperative real-time tumor recognition. Preclinical and clinical studies suggest that the tumor-to-background fluorescence ratio is optimized when imaging is obtained 24 h after dye injection, and many studies suggest using a high dose of ICG to optimize dye retention in the tumor tissue. However, in childhood cancers, little is known about the ideal dosing, applications, and challenges of ICG-guided tumor resection. This retrospective study examines the feasibility of ICG-guided tumor resection in common childhood solid tumors such as neuroblastoma, sarcomas, hepatic tumors, pulmonary metastases, and other rare tumors. Pediatric dosing and challenges related to the optimization of tumor-to-background ratio are also examined.

PD58-09 SURGICAL EXPERIENCE AND ONCOLOGIC QUALITY IN ROBOTIC ASSISTED LAPAROSCOPIC PROSTATECTOMY: ARE THEY ALWAYS LINKED?

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment (PD58)1 Sep 2021PD58-09 SURGICAL EXPERIENCE AND ONCOLOGIC QUALITY IN ROBOTIC ASSISTED LAPAROSCOPIC PROSTATECTOMY: ARE THEY ALWAYS LINKED? Turki Altaylouni, Pimrapat Gebert, Sefer Elezkurtaj, Florian Rossner, Bernhard Ralla, Jonas Busch, Thorsten Schlomm, and Bertrand Guillonneau Turki AltaylouniTurki Altaylouni More articles by this author , Pimrapat GebertPimrapat Gebert More articles by this author , Sefer ElezkurtajSefer Elezkurtaj More articles by this author , Florian RossnerFlorian Rossner More articles by this author , Bernhard RallaBernhard Ralla More articles by this author , Jonas BuschJonas Busch More articles by this author , Thorsten SchlommThorsten Schlomm More articles by this author , and Bertrand GuillonneauBertrand Guillonneau More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002092.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous studies reported that surgical outcomes improve with surgeons’ experience and surgeons’ generation. We assessed this statement in our tertiary university care center regarding pathologic outcomes after Robot-Assisted Laparoscopic Prostatectomy (RALP). METHODS: The study cohort included 1348 prostate cancer patients treated with RALP between February, 2010 and April, 2020. The 1st and 2nd surgeons’ generation of Surgeons included 3 surgeons each and have operated on 662 and 676 patients respectively. The two groups of patients were comparable regarding prostate specific antigen (PSA) and clinical stage by using Mann-Whitney U test and Chi-square test, respectively. We created learning curves for positive surgical margin (PSM) rate, pelvic lymph node dissection (PLND) probability and number of LN removed after adjusting for pre-operative PSA, pTNM stage, Gleason grade and the use of intra-operative frozen section (Neurosafe strategy). We also compared results between the 1st and 2nd generation of surgeons in regression models. RESULTS: Regarding PSM rate, learning curves after adjustment were flat at around 20% and didn’t show any improvement with experience. The comparison between, learning curves for PSM demonstrated no differences between the 2 generations of surgeons’ generation (p=0.794). Regarding PLND indications, a statistical significant improvement of PLND performed was found according to the surgeon’s experience for the 1rst generation. The 2nd generation had a learning curve that remained flat with experience at a high level (92.3%) and overall significant better than the first generation (p<0.001). Identically, numbers of LN removed showed a significant increase with experience in both generations but the overall the 1rst generation only while the second generation had a flat learning curve with a mean median number of LN removed significantly higher in the 2nd generation compared to the 1st generation (12 versus 10 for the 1rst generation, p<0.001) . CONCLUSIONS: In our study about experience of surgeons with robot-assisted radical prostatectomy, surgeons demonstrated improvement with experience regarding the indication for PLND and the number of nodes removed. Regarding PSM, surgeons demonstrated no improvement over time and through generation. Experience alone is not an intrinsic quality factor. Other factors might play a role for oncological improvement aside from experience only. Improvement in quality insurance concept should be implemented as a possible factor. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1020-e1020 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Turki Altaylouni More articles by this author Pimrapat Gebert More articles by this author Sefer Elezkurtaj More articles by this author Florian Rossner More articles by this author Bernhard Ralla More articles by this author Jonas Busch More articles by this author Thorsten Schlomm More articles by this author Bertrand Guillonneau More articles by this author Expand All Advertisement Loading ...

Factors Affecting Total Operating Time in Patients Undergoing Mastectomy With and Without Reconstruction.

Operating room (OR) time varies significantly in patients undergoing mastectomy. We sought to determine factors influencing OR time such that more accurate predictions could be made. Records of patients undergoing mastectomy at our institution between January 2010 and June 2018 were reviewed. Operating Room time was defined as time from incision to dressing. Nonparametric analyses were performed to determine factors associated with OR time. A predictive model using linear regression was created on a training set and evaluated in a separate testing set. Our cohort included 1008 female patients who underwent either unilateral or bilateral mastectomy (BM), with or without reconstruction, and with or without concomitant axillary lymph node staging at our institution. The median OR time was 4.67hours (range; .70-16.35hours). To create a predictive model, we divided our cohort into a training set of 504 patients and a testing set of 504 patients. Across the training set, body mass index (BMI), BM, nonconventional mastectomies, intraoperative frozen sections, receipt of neoadjuvant chemotherapy, and reconstruction were associated with longer OR times on linear regression. A model generated from these findings on the training set was run on the testing set (Pearson correlation = .743 for predicted vs. actual OR times, P < .001). A number of preoperative factors such as BMI, unilateral vs. BM, type of mastectomy and reconstruction, use of intraoperative frozen sections, and receipt of neoadjuvant chemotherapy can influence OR times. Accurate predictions can be made using a simple model incorporating these factors.

Intraoperative assessment and reporting of radical prostatectomy specimens to guide nerve-sparing surgery in prostate cancer patients (NeuroSAFE).

AimsRadical prostatectomy for prostate cancer is frequently complicated by urinary incontinence and erectile dysfunction. Nerve‐sparing surgery reduces the risk of postoperative complications and can be optimised by the use of intraoperative frozen sections of the adjacent neurovascular structure (NeuroSAFE). The aims of this study were to evaluate the pathological outcomes of the NeuroSAFE technique and to develop a comprehensive algorithm for intraoperative clinical decision‐making.Methods and resultsBetween September 2018 and May 2019, 491 NeuroSAFE procedures were performed in 258 patients undergoing radical prostatectomy; 74 of 491 (15.1%) NeuroSAFE specimens had positive surgical margins. As compared with the corresponding paraffin sections, NeuroSAFE had a positive predictive value and negative predictive value of 85.1% and 95.4%, respectively. In 72.2% of secondary neurovascular bundle resections prompted by a NeuroSAFE positive surgical margin, no tumour was present. These cases more often had a positive surgical margin of ≤1 mm (48.7% versus 20.0%; P = 0.001) and only one positive slide (69.2% versus 33.3%; P = 0.008). None of the nine patients with Gleason pattern 3 at the surgical margin, a positive surgical margin length of ≤1 mm and one positive slide had tumour in the secondary resection.ConclusionsThis study provides a systematic reporting template for pathological intraoperative NeuroSAFE evaluation, supporting intraoperative clinical decision‐making and comparison between prostate cancer operation centres.

Is the Use of Intraoperative Frozen Section During Pancreaticoduodenectomy Justified?

BackgroundIntraoperative frozen section (IFS) is routinely utilized by many surgeons during pancreaticoduodenectomy. However, its utility has not been rigorously studied. MethodsPatients who underwent pancreaticoduodenectomy between 2006 and 2015 were identified from institutional data. Measures of diagnostic accuracy of frozen section and multivariate logistic regression are reported. ResultsThe cohort included 1076 patients. Of resected specimens, 73.3% were malignant. IFS and final pathologic review (the gold standard) were discrepant for (1) pathologic diagnosis or (2) resection margin status in 5.3% and 3.3% of cases. The sensitivity, specificity, and accuracy of IFS for histologic determination of malignancy were 97.2%, 95.3%, and 96.7% respectively. For resection margins, they were 92.3%, 99.3%, and 96.8%, respectively. Positive bile duct and neck margins were revised intraoperatively 62% and 65% of the time, respectively; positive uncinate margins were never resected but led surgeons to avoid revision of a second positive margin in 13% of cases (4.2% of all PDA). Operative changes were rarely noted in the presence of benign disease (n = 11, 1.0%); conversion to total pancreatectomy based on positive margins was performed in just 13 cases (1.2%). Upon multivariable analysis, a positive neck margin proved to be the greatest predictor for a revised resection margin (AOR 16.9 [4.8–59.8]), whereas a positive uncinate margin or a diagnosis of chronic pancreatitis was protective against IFS-driven operative changes (AOR 0.25 [0.09–0.73]; AOR 0.16 [0.13–0.19]). ConclusionsIFS is highly accurate and guides reresection of margins. However, selective omission of IFS may be justified for cases where benign disease is suspected.

Correlation of Biomarkers and Frozen Section Diagnosis with Paraffin Histopathological Diagnosis in Suspected Ovarian Cancer

Introduction: Ovarian cancers pose diagnostic dilemma and is problematic for decision making for the gynecological oncologist as well as the pathologist. The use of intra-operative frozen section can aid significantly in decision making and assist in choosing the correct operative path once a mass lesion of ovaries is discovered. Materials and Methods: Over a two-year period, 50 cases of Suspected Ovarian cancers were examined by intra- operative frozen section as well as followed up with histopathology in paraffin sections. Results were categorized in two strata—benign and malignant. Results: A comparison between frozen-section diagnosis and findings on paraffin section showed that the sensitivity of frozen section in diagnosis of malignant lesions is 97.14%, with specificity 93.33%, positive predictive value 97.14% and negative predictive value 93.33%. Among 50 cases, one case was reported as false positive and one was reported as false negative. Conclusion: Intra-operative frozen section is a highly sensitive and specific modality for the diagnosis of malignant lesions of the ovary.

Surgery in Endometrial Cancer: An Audit of Quality Across Centers in India

Surgical management is the cornerstone in the treatment of endometrial cancer. However, there are many controversies involved in the management starting from what constitutes adequate staging to the type of adjuvant treatment. In India, surgeons from several specialties operate on patients with endometrial cancer and there is a lack of guideline-based practice which necessitates an audit on the quality of care offered to women with endometrial cancer. The study was a questionnaire-based study conducted at various conference venues. The study participants included general surgeons, gynecologists, surgical oncologists and gynecologic oncologists who operate on endometrial cancer. There is an extensive variation in the management of endometrial cancer among practitioners and lack of consensus regarding lymphadenectomy and its extent during surgery. Also, the use of intraoperative frozen section and comprehensive staging is more commonly seen among oncosurgeons when compared to other specialties.

Frozen Section Assessment of Bronchial Margins during Lung Carcinoma Surgeries: Report of the Experience at a Single Institution

Introduction Many thoracic surgeons consider frozen section analysis of bronchial margins during lobectomies “obligatory” although routine frozen section analysis of the bronchial margin rarely yields positive results and infrequently changes intra-operative management in patients undergoing Non-Small Cell Lung Carcinoma (NSCLC) resection. Materials and methods 234 cases of lobectomies with carcinoma were reviewed at our institution to assess bronchial margin involvement, correlation between frozen section and final bronchial margin status, gross distance between tumor and margin, and tumor type. Results Tumor distance to margin varied in the 234 cases from grossly involved to 10 cm away. 5 cases out of 234 (approximately 2.1%) had a positive bronchial margin in the final report. 3 out of the 5 cases were poorly differentiated squamous cell carcinoma grossly abutting the bronchial margin, two cases were of poorly differentiated adenocarcinoma located grossly 0.5 cm away from the bronchial margin. 4 out of 5 cases were called positive intra-operatively. In none of the 4 out of the 5 positive cases did frozen section exam of the bronchial margins change the intra-operative management of the case. Conclusion Our study supports selective use of intra-operative frozen section of bronchial margins during lobectomies for carcinoma. On the basis of our findings, a distance of approximately 1 cm or less is suggested as a threshold for intra-operative microscopic examination of the bronchial margins. However, routine examination of the bronchial margins, regardless of the location of the tumor upon gross examination, and in the absence of empirical evidence supporting this practice, is only time consuming intra-operatively, wasteful of resources and has no therapeutic or prognostic value.

Importance of intra-operative frozen section in the laparoscopic approach to ovarian tumors

Introduction: Laparoscopic management of adnexal masses remains as one of the most frequently performed laparoscopic intervention. The use of intraoperative frozen section (IFS) is an important and helpful adjuvant in the operative management of suspicious adnexal masses. It is usually performed in order to define the adequate surgical plan: either by obtaining histological confirmation of suspected malignant or borderline primary ovarian tumours, or by ruling out malignancy in a suspicious adnexal mass.

Utility Of Frozen Section Versus IOPTH In Parathyroid Surgery

Introduction: Parathyroid surgeries are becoming less extensive procedures, with reduced hospital stay. The use of intraoperative frozen section help the surgeon in identifying the pathology, thereby determining the nature of surgery. Aim: To study the utility of frozen section in comparison to chemical frozen section in our set up Materials and Methods: Data was collected from records of department of Pathology during a period of 3 years. Only those cases were included in which the patient had undergone parathyroidectomy, with specimen being sent for frozen section and intra-operative parathyroid hormone (IOPTH) simultaneously. Results: Frozen section diagnosis was concordant in 11/15 (73%) cases. Significant percentage drop in IOPTH was seen in 13/15 (86%) cases. We found frozen section useful in identifying parathyroid when there were multiple neck swellings. Conclusion: The utility of frozen section in parathyroid surgery is diminishing and it is being replaced by better and more accurate biochemical assays.

Identification of Grossing Criteria for Intraoperative Evaluation by Frozen Section of Lung Cancer Resection Margins.

Because of a lack of official guidelines, systematic use of intraoperative frozen section for the evaluation of surgical margins in lung oncology constitutes standard practice in many pathology departments. This costly and time-consuming procedure seems unjustified as reported rates of positive margins remain low. We aimed to evaluate clinicopathologic criteria associated with positive margins and establish evidence-based recommendations regarding the use of frozen sections. This retrospective cohort included 1903 consecutive patients with a lung resection for malignant neoplasm between 2006 and 2015. Clinicopathologic data were retrieved from medical files. Univariate and multivariate analyses were used to identify variables associated with a positive margin. Receiver operating characteristic curves and a probability table of positive margins based on tumor-margin distance were created. Our results were confirmed in a validation cohort of 27 patients with positive margins. The rate of positive margins was 3.8%. A positive margin status changed the surgical management in 48.6% of patients. A short macroscopic tumor-margin distance was associated with a higher risk of positive bronchovascular and parenchymal margins in univariate and multivariate analyses. Selecting a 2.0 cm tumor-margin distance cut-off for performing a frozen section would result in a 55.3% reduction of intraoperative evaluations, with a risk of missing a positive margin of 0.61%. Overall, we showed that systematic use of frozen section for intraoperative evaluation of surgical margins is unnecessary. A better selection of patients with a higher risk of a positive margin can be achieved with tumor-margin distance as a simple gross evaluation parameter.