Patterns of Major Frozen Section Interpretation Error: An In-Depth Analysis From a Complex Academic Surgical Pathology Practice

Abstract

Objectives To establish baseline error rates due to misinterpretation and to identify scenarios in which major errors were most common and potentially preventable. Methods Our database was queried over a 3-year period for major discrepancies due to misinterpretation. These were stratified by histomorphologic setting, service, availability/type of prior material, and years of experience and subspecialization of the interpreting pathologist. Results The overall discordance rate between frozen section (FS) and final diagnoses was 2.9% (199/6,910). Seventy-two errors were due to interpretation, of which 34 (47.2%) were major. Major error rates were highest on the gastrointestinal and thoracic services. Of major discrepancies, 82.4% were rendered in subdisciplines outside those of the FS pathologist. Pathologists with fewer than 10 years’ experience made more errors than those with more experience (55.9% vs 23.5%, P = .006). Major error rates were greater for cases without previous material compared to those with a prior glass slide (47.1% vs 17.6%, P = .009). Common histomorphologic scenarios in which disagreements were made involved discriminating mesothelial cells from carcinoma (20.6%) and accurately recognizing squamous carcinoma/severe dysplasia (17.6%). Conclusions To improve performance and decrease future misdiagnoses, monitoring discordances should be a continuous component of surgical pathology quality assurance programs.

Diagnostic efficacy of intraoperative histopathological examination of lesions with unknown diagnosis suspicious for malignancy

“…Furthermore, unfavorable factors such as impaired cytoarchitecture, the formation of ice crystals and the complete collapse of alveolar spaces during cryosection in pulmonary nodules can complicate the diagnostic accuracy of the FS examination approach [ 6 , 15 ]. Especially in the evaluation of gastrointestinal and thoracic pathologies, the error rate of FS is higher than other patient groups [ 16 ]. This can lead to a delay in the diagnosis of some patients, meaning that second surgical procedures may be required under general anesthesia after a final diagnosis has been established based on an examination of permanent sections cut from paraffin-embedded blocks [ 15 ].…”