Sensitivity of frozen section examination of pelvic lymph nodes for metastatic prostate carcinoma

Abstract

Background. A Total Quality Improvement review of frozen section diagnoses yielded four sequential false‐negative frozen section diagnoses in lymph nodes in the evaluation of metastases from prostate carcinoma. Because these results appeared to differ from the department's overall frozen section experience, frozen section diagnoses of pelvic lymph nodes in patients with prostate carcinoma were reviewed to benchmark the department's performance. Methods. All 220 pelvic lymph node frozen section samples from 110 patients with prostate carcinoma from January, 1986 to July, 1993 at Bridgeport Hospital (BH) were reviewed, and the department's frozen section diagnostic efficiency was compared with: (1) all BH frozen section procedures performed during the same period; (2) pelvic lymph node frozen section analysis and (3) imaging techniques for prostate carcinoma from other institutions found in MEDLARS literature searches from 1973 to 1993. Results. Frozen section diagnostic efficiency for patients with prostate carcinoma from BH was 93.6% (sensitivity 63.2%, specificity 100%) compared with (1) 98% for all BH frozen section analyses (sensitivity 99%, specificity 98%); (2) 90.1% for MEDLARS search pelvic lymph node frozen section prostate carcinoma analyses (sensitivity 66.5%, specificity 100%); and (3) 88% for MEDLARS search magnetic resonance imaging (MRI) pelvic lymph node prostate carcinoma (sensitivity 41%, specificity 97%). Conclusions. Frozen section diagnosis of pelvic lymph nodes approaches the overall diagnostic efficiency of frozen section analysis and is more sensitive for the diagnosis of prostate carcinoma in pelvic lymph nodes than is MRI because more than half of the metastases are smaller than the 1.0‐cm resolution limit of the MRI. False‐negative frozen section diagnoses (67% sensitivity) occur because of errors in sampling microscopic metastases. Cancer 1995; 76: 661–8.

Frozen section evaluation of lymph nodes in Oral squamous cell carcinoma - A retrospective study

“…The phloxine methylene blue stain was used as it brings out nuclear details more clearly and hence 0% false negativity was observed. Davis reported efficiency of frozen section diagnosis in assessment of pelvic lymph nodes for metastasis, when compared with MRI (magnetic resonance imaging), CT (computed tomography), Lymphangiography, ISG (immunoscintigraphy) and LSG (lymphangioscintigraphy) (3). However the 100% efficiency of frozen sections observed in this study cannot be in any way superior to the MRI, CT, ISG and LSG.…”

Intraoperative Frozen Section in Uropathology: When and How?

“…The lymph nodes are macroscopically examined first and the suspicious cut surface is being sectioned for microscopic evaluation regardless of the primary malignancy (2). The specificity of frozen section diagnosis of the lymph nodes has been reported to be very high in many studies (10). However, the adipose tissue replacing the lymph node in older patients and the difficulty in freezing and sectioning adipose tissue must be considered in false negativity which has been reported to be as high as 33% in RPs (10).…”

Diagnosis of pelvic lymph node metastasis in prostate cancer using single optical fiber probe

“…In a large contemporary cohort study, Song et al discussed that FS analysis is highly sensitive for detection of large metastasis on pelvic lymph node but sensitivity was low for detection of micrometastasis (<5 mm) [28]. Davis et al reported that the mean intraoperative FS sensitivity of pelvic lymph nodes of prostate cancer patients of 67% is due to the microscopic size of metastasis and inadequate sampling of all nodes submitted, resulting in sampling errors and false-negative results [29]. More lymph nodes improve the quality of pathological assessment of the removed tissue and so operation time and pathology costs increase.…”