A Quantitative and Qualitative Assessment of Frozen Section Diagnosis Accuracy and Deferral Rate Across Organ Systems

Abstract

Objectives Monitoring of frozen section diagnostic performance provides an important quality improvement measure. Methods Surgical specimens involving a frozen section diagnosis over a 3-year period were retrospectively reviewed. Glass slides were reviewed on cases with discordance. Discordance and deferral rates were calculated. Results Of 3,675 frozen section diagnoses included, 96 (2.7%) were discordant with the final diagnosis. Additionally, 114 frozen section diagnoses (3.1%) were deferred. The organ-specific discordance rates were lowest in breast and genitourinary specimens and highest for pancreas, lymph node, and gynecologic specimens. Deferral rates were highest in musculoskeletal, breast, and hepatobiliary cases and lowest in thyroid, parathyroid, and neuropathology cases. Discordance was explained by block-sampling error (45%), specimen-sampling error (27%), or interpretation error (27%). Discordant frozen section diagnoses from gynecologic specimens were responsible for 81% of specimen-sampling errors; frozen section diagnoses of lymph nodes, head and neck, and pancreas were responsible for 54% of interpretation errors; 51% of block-sampling errors involved lymph node evaluation for metastatic carcinoma. Conclusions Careful gross evaluation and microscopic examination of multiple levels should minimize specimen-sampling error and block-sampling error, respectively. Periodic review of accuracy and deferral rates may help reduce errors and improve the overall performance of this essential procedure.

Rapid Immunohistochemistry Based on Ultrasonic Thermal Steam Heating for Improvement of Intraoperative Diagnosis

“…With the advancement of imaging, endoscopy, and molecular detection technology, tumors are often detected at an early stage, 14–16 Biomarkers for early detection must not only identify precancerous lesions but also distinguish those at high risk of progression to carcinoma 16 . Surgery is often performed at an early stage of the tumor, where pathologic specimens are small and exhibit atypical histology 1 . In contrast, metastatic disease remains largely incurable and the main cause of cancer-related deaths 17 .…”

“…However, the accuracy rate of diagnosis in FSs is lower than in final paraffin-embedded sections, as paraffin sections offer higher quality and allow for additional auxiliary examinations, such as immunohistochemistry (IHC), special staining, and molecular methods, to aid in the diagnosis 1,6,7 …”

“…I ntraoperative frozen section (FS)-based histologic diagnosis plays an important role in the surgical management of patients. FS diagnosis can help direct surgeons on how to proceed with surgical management in many conditions, 1,2 including differentiating between primary central nervous system lymphoma and glioblastoma multiforme, intraoperative assessment of surgical margins, assessing surgical margins, and evaluating lymph nodes for metastatic disease, [3][4][5] and so on.…”

Diagnostic value of intraoperative fine‐needle aspiration cytologic diagnosis versus frozen section‐based histopathologic diagnosis in thoracic malignancies: A single institution's experience

“…3 Frozen section based histologic assessment has been shown to be an accurate method in the diagnosis of pulmonary masses and lymph nodes. 4,5 While a few studies 6,7 have assessed the value of intraoperative FNA as an independent diagnostic procedure, to our knowledge, a direct comparative study of intraoperative FNA and FS based diagnosis in thoracic malignancies within the same clinical practice has not been previously performed. In this study, we compare intraoperative FNA to FS in terms of diagnostic performance, independent of other variables that may partially or completely govern the decision as to which method should be utilized (e.g., tumor resectability, tumor site, patient's fitness for surgery, availability of expertise and resources, etc.…”

“…Reservations regarding FNA accuracy and perceptions that FNA is inferior to FS‐based diagnosis have been documented 3 . Frozen section based histologic assessment has been shown to be an accurate method in the diagnosis of pulmonary masses and lymph nodes 4,5 . While a few studies 6,7 have assessed the value of intraoperative FNA as an independent diagnostic procedure, to our knowledge, a direct comparative study of intraoperative FNA and FS based diagnosis in thoracic malignancies within the same clinical practice has not been previously performed.…”