BACKGROUND： Unexpected gallbladder cancer may present with acute cholecystitis-like manifestat/ons. Some authors rec- ommended that frozen section analysis should be performed during laparoscopic cholecystectomy for ...BACKGROUND： Unexpected gallbladder cancer may present with acute cholecystitis-like manifestat/ons. Some authors rec- ommended that frozen section analysis should be performed during laparoscopic cholecystectomy for all cases of acute cholecystitis. Others advocate selective use of frozen section analysis based on gross examination of the specimen by the surgeon. The aim of the present study was to evaluate whether surgeons could effectively identify suspected gallbladder with macroscopic examination alone. If not, is routine frozen sec- tion analysis worth advocating？展开更多
OBJECTIVE To summarize a common pathogenefic condition, the pathologic characteristics shown in frozen section and our experience utilizing 2 different common thyroid diseases （TD）. diagnostic methods in cases of ME...OBJECTIVE To summarize a common pathogenefic condition, the pathologic characteristics shown in frozen section and our experience utilizing 2 different common thyroid diseases （TD）. diagnostic methods in cases of METHODS Data from 638 cases with frozen sections from thyroid tissue were retrospectively analyzed. The intraoperative frozen sections of the patients and postoperative diagnostic results of routine paraffin sections were compared. RESULTS In the 683 patients, the gender ratio of females to males was 2.64 ： 1, and the ratio between the patients with nodular goiter （NG） and the patients with thyroid adenoma was 1.5 ： 1. The oldest age group of patients with thyroid cancer （TC） ranged from 40 to 49 years. Frozen section pathologic examination has been employed more and more in the diagnosis of thyroid diseases, and the detection rate of TC has increased year by year, i.e., the rate increased to 6.45%, 7.58%, 14.55% and 16.57%, respectively, in 2005, 2006, 2007 and 2008. Thyroid papillary carcinoma （TPC） was the most commonly seen malignant tumor of the thyroid （MTT）, which accounted for approximately 94.8% of MTTs and 11.44% of the total TDs. Micropapillary carcinoma accounted for 27.4% of TPC, and multifocal carcinomas accounted for 15.58% of TCs. Many of the TCs （19.48%） were complicated by benign diseases such as adenoma, NG and thyroiditis. The coincidence rate of diagnoses made by frozen section and paraffin embedding for thyroid disease was 98.59%. Calcification was rather common in NG and TPC, and there were significant differences in psammoma bodies （PMB） between the calcifications of TPC and NG （P 〈 0.01）. CONCLUSION TPC ranks first in the incidence of MTTs and accounts for 94.8% of all MTTs. About 1/4 of TPCs are micropapillary carcinoma, while 1/5 are accompanied by benign disease, such as adenorna, NG and thyroiditis. PMB are of importance and of significance in the diagnosis of TPC.展开更多
We investigated the relationship between positive surgical margin(PSM)-related factors and biochemical recurrence(BCR)and the ability of intraoperative frozen sections to predict significant PSM in patients with prost...We investigated the relationship between positive surgical margin(PSM)-related factors and biochemical recurrence(BCR)and the ability of intraoperative frozen sections to predict significant PSM in patients with prostate cancer.The study included 271 patients who underwent robot-assisted laparoscopic prostatectomy with bilateral nerve sparing and maximal urethral preservation.Intraoperative frozen sections of the periurethra,dorsal vein,and bladder neck were analyzed.The ability of PSM-related factors to predict BCR and significant PSM was assessed by logistic regression.Of 271 patients,108(39.9%)had PSM and 163(60.1%)had negative margins.Pathologic Gleason score^8(18.9%vs 7.5%,P=0.015)and T stage≥T3a(51.9%vs 24.6%,P<0.001)were significantly more frequent in the PSM group.Multivariate analysis showed that Gleason pattern≥4(vs<4;hazard ratio:4.386;P=0.0004)was the only significant predictor of BCR in the PSM cohort.Periurethral frozen sections had a sensitivity of 83.3%and a specificity of 84.2%in detecting PSM with Gleason pattern≥4.Multivariate analysis showed that membranous urethra length(odds ratio[OR]:0.79,P=0.0376)and extracapsular extension of the apex(OR:4.58,P=0.0226)on magnetic resonance imaging(MRI)and positive periurethral tissue(OR:17.85,P<0.0001)were associated with PSM of the apex.PSM with Gleason pattern≥4 is significantly predictive of BCR.Intraoperative frozen sections of periurethral tissue can independently predict PSM,whereas sections of the bladder neck and dorsal vein could not.Pathologic examination of these samples may help predict significant PSM in patients undergoing robot-assisted laparoscopic prostatectomy with preservation of functional outcomes.展开更多
Objective:To analyze the diagnostic value of frozen section pathology in the diagnosis of breast cancer.Methods:A total of 50 patients with breast tumors treated between July 2021 and February 2023 were randomly selec...Objective:To analyze the diagnostic value of frozen section pathology in the diagnosis of breast cancer.Methods:A total of 50 patients with breast tumors treated between July 2021 and February 2023 were randomly selected as samples.Both paraffin section and frozen section diagnoses were conducted.The paraffin section results served as the gold standard for evaluating the value of frozen section examination.Results:Among the frozen section diagnoses,48 cases(96.00%)were confirmed,1 case was misdiagnosed(2.00%),and 1 case was delayed(2.00%).Among the confirmed patients,45 cases(90.00%)were entirely consistent,and 3 cases(6.00%)were basically consistent.The diagnostic rate of the frozen section was 96.00%,compared with 100.00%for the paraffin section(P>0.05).The diagnostic time of the frozen section(35.25±2.11 min)was significantly shorter than that for the paraffin section(6911.36±58.36 min;P<0.05).Conclusion:Frozen section diagnosis is rapid and demonstrates relatively high diagnostic accuracy.It can guide doctors in determining whether to pursue breast-conserving treatment and aid in selecting appropriate surgical methods.This is beneficial for preventing unnecessary medical interventions and reducing the need for secondary surgeries in breast cancer patients.展开更多
Objective: to explore the clinical value of frozen section in the diagnosis of pathological tumors. Methods: 162 tumor specimens collected during the operation in the Department of pathology of our hospital from June ...Objective: to explore the clinical value of frozen section in the diagnosis of pathological tumors. Methods: 162 tumor specimens collected during the operation in the Department of pathology of our hospital from June 2018 to may 2020 were selected as the research objects. These samples were randomly divided into reference group and experimental group, of which 83 samples were in the reference group and 79 samples were in the experimental group.T he patients in the reference group were diagnosed and treated by routine paraffin section, and the patients in the experimental group were diagnosed by frozen section. The diagnostic coincidence rate and detection quality of the two groups were compared. Results: the diagnostic coincidence rates of the two groups were compared. 83 samples in the reference group were pathologically diagnosed by conventional paraffin section technology, including 49 benign tumors, 19 malignant tumors and 15 borderline tumors. A total of 71 tumors were detected, and the actual diagnostic coincidence rate was 85.54% (71 / 83). Among 79 samples in the experimental group, frozen section technology was used for diagnosis, There were 47 cases of benign tumors, 20 cases of malignant tumors and 12 cases of borderline tumors. A total of 77 cases of tumors were detected. The actual diagnostic coincidence rate was 97.47% (77 / 79). In the comparative diagnostic coincidence rate, it was found that there were significant differences between the groups and the P value was (P = 0.0387). Therefore, the statistical significance obviously had tenable conditions;The score of cell morphology and structure in the contrast test group (75 ± 8) was 16.0, while the score of cell morphology and structure in the contrast test group (61 ± 8) was (1.0), and the score of cell morphology and structure in the contrast test group was (1 ± 8). In the comparison of various test quality scoring indexes, it was found that there were significant differences between the groups, and the P values were (P < 0.05) and the statistical significance was established. Conclusion: the application of frozen section technology in the pathological diagnosis process of tumor has a good effect. It can diagnose the nature of tumor quickly and accurately, and provide strong support for follow-up treatment. It is worth popularizing.展开更多
Intraductal papillary mucinous neoplasms(IPMN) of the pancreas include a spectrum of dysplasia ranging from minimal mucinous hyperplasia to invasive carcinoma and are extensive tumors that often spread along the ducta...Intraductal papillary mucinous neoplasms(IPMN) of the pancreas include a spectrum of dysplasia ranging from minimal mucinous hyperplasia to invasive carcinoma and are extensive tumors that often spread along the ductal tree.Several studies have demonstrated that preoperative imaging is not accurate enough to adapt the extent of pancreatectomy and have suggested routinely using frozen sectioning(FS) to evaluate the completeness of resection and also to check if ductal dilatation is active or passive,in order to avoid an excessive pancreatic resection.Separate main duct and branch duct analysis is needed due to the difference in the natural history of the disease.FS accuracy averages 95%.Eroded epithelium on the main duct,severe ductal inflammation mimicking dysplasia and reactive epithelial changes secondary to obstruction can lead to inappropriate FS results.FS results change the planned extent of resection in up to 30% of cases.The optimal cut-off leading to extend pancreatectomy is not consensual and our standard option is to extend pancreatec-tomy if FS reveals:(1) at least IPMN adenoma on the main duct;or(2) at least borderline IPMN on branch ducts;or(3) invasive carcinoma.However,the decision to extend resection must be taken after a multidisciplinary discussion since it does not exclusively depend on the FS result but also on age,general condition and expected prognosis after resection.The main limitation of using FS is the existence of discontinuous("skip") lesions which account for approximately 10% of IPMN in surgical series and can lead to reoperation in up to 8% of cases.展开更多
AIM To evaluate the usefulness of frozen section diagnosis(FSD) of bile duct margins during surgery for extrahepatic cholangiocarcinoma(CCA). METHODS We retrospectively analyzed 74 consecutive patients who underwent s...AIM To evaluate the usefulness of frozen section diagnosis(FSD) of bile duct margins during surgery for extrahepatic cholangiocarcinoma(CCA). METHODS We retrospectively analyzed 74 consecutive patients who underwent surgery for extrahepatic CCA from 2012 to 2017, during which FSD of bile duct margins was performed. They consisted of 40 distant and 34 perihilar CCAs(45 and 55 bile duct margins, respectively). The diagnosis was classified into three categories: negative, borderline(biliary intraepithelial neoplasia-1 and 2, and indefinite for neoplasia), or positive. FSD in the epithelial layer, subepithelial layer, and total layer was compared with corresponding permanent section diagnosis(PSD) postoperatively.Then, association between FSD and local recurrence was analyzed with special reference to borderline.RESULTS Analysis of 100 duct margins revealed that concordance rate between FSD and PSD was 68.0% in the total layer, 69.0% in the epithelial layer, and 98.0% in the subepithelial layer. The extent of remaining biliary epithelium was comparable between FSD and PSD, and more than half of the margins lost > 50% of the entire epithelium, suggesting low quality of the samples. In FSD, the rate of negative margins decreased and that of borderline and positive margins increased according to the extent of the remaining epithelium. Diagnostic discordance between FSD and PSD was observed in 31 epithelial layers and two subepithelial layers. Alteration from borderline to negative was the most frequent(20 of the 31 epithelial layers). Patients with positive margin in the total and epithelial layers by FSD demonstrated a significantly worse local recurrence-free survival(RFS) compared with patients with borderline and negative margins, which revealed comparable local RFS. Patients with borderline and negative margins in the epithelial layer by PSD also revealed comparable local RFS. These results suggested that epithelial borderline might be regarded substantially as negative. When classifying the status of the epithelial layer either as negative or positive, concordance rates between FSD and PSD in the total, epithelial, and subepithelial layers were 95.0%, 93.0%, and 98.0%, respectively.CONCLUSION During intraoperative assessment of bile duct margin, borderline in the epithelial layer can be substantially regarded as negative, under which condition FSD is comparable to PSD.展开更多
Objective: The aim of this work is to compare between intraoperative frozen section and scrape smear cytology in the diagnosis of ovarian neoplasm. Method: This study was performed between March 2011 and March 2012, o...Objective: The aim of this work is to compare between intraoperative frozen section and scrape smear cytology in the diagnosis of ovarian neoplasm. Method: This study was performed between March 2011 and March 2012, on 50 patients presented with ovarian mass. Gross examination of the tumor removed was done by inspection and palpation. The specimen was then cut with a sharp knife into two halves. The area was scraped with a sharp scalpel or the end of a glass slide, depending upon the type of tissue. A semifluid drop thus obtained was spread over a glass slide. One to four slides per case were taken from different representative areas. The slides were labelled and immediately put into 95% ethyl alcohol and stained with hematoxylin-eosin. The specimens were then fixed in formalin. Paraffin blocks of the sections were processed in the routine way and sections were stained with hematoxylin and eosin (H and E). Assessment of the overall accuracy of the intraoperative diagnosis was classified as concordant or discordant. Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of benign ovarian masses were 100%, 95.2%, 96.7%, 100% and 98% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of border line ovarian masses were 100%, 93.4%, 25%, 100% and 94% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of malignant ovarian masses were 80%, 100%, 100%, 88.2% and 92% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of benign ovarian masses were 100%, 100%, 100%, 100% and 100% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of borderline ovarian masses were 100%, 95.9%, 33.3%, 100% and 96% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of malignant ovarian masses were 90%, 100%, 100%, 93.8% and 96% respectively. Conclusion: Frozen section is more accurate than smear preparations in the intraoperative assessment of ovarian tumors in this study. However, the cytology preparations were helpful in supporting the histological diagnoses, and in some cases, provided additional useful information. Thus, cytology has a complementary role to frozen section in the intraoperative assessment of ovarian lesions. At the centers where the facilities of frozen section are not available, intraoperative scrape cytology is a useful tool for intraoperative diagnosis of tumor.展开更多
Objective: The aim of the work is to evaluate the accuracy of intraoperative frozen section in the diagnosis of ovarian neoplasms in Zagazig University. Design: A prospective cross sectional cohort study. Method: This...Objective: The aim of the work is to evaluate the accuracy of intraoperative frozen section in the diagnosis of ovarian neoplasms in Zagazig University. Design: A prospective cross sectional cohort study. Method: This study was performed between March 2011 and March 2012, on 50 patients presented with ovarian mass. Gross examination of the tumor removed was done by inspection and palpation. The specimen was then cut with a sharp knife into two halves. The most appropriate area thought to be representative of lesion was chosen. The number of sections frozen was depended on the type and size of the tumor. Seven to eight μm sections were obtained and stained with hematoxylin-eosin. The specimens were then fixed in formalin. Paraffin blocks of the sections were processed in the routine way and sections were stained with hematoxylin and eosin (H and E). The diagnosis obtained by intraoperative frozen section based on cellularity and cell morphology was compared with final histopathological diagnosis in terms of diagnostic sensitivity, to differentiate between benign and malignant lesions. Assessment of the overall accuracy of the intraoperative diagnosis was classified as concordant or discordant. Results: There was no statisticaly significant differencre in the studied patients as regard the clinical data, macroscopic and intraoperative picture, while there was statisticaly significat association as regard the laterality of the ovarian masses. The validity of frozen section in the diagnosis of benign tumour was 100% with 100% accuracy, specificity, positive predictive value, negative predictive value, while sensitivity & negative prediction for borderline tumour and specificity & positive prediction of malignant tumour were 100%, specifecity for borderline tumours was 95% while the positive predictive value was 33.3% with 96% accuracy for both malignant and borderline tumours. Conclusion: Intraoperative frozen section is accurate for rapid diagnosis of ovarian tumors. It can help surgeons avoid under-treatment or overtreatment of patients. Our study was designed prospectively using a small number of patients. The door is open to larger studies using a larger number of patients to be performed in order to substantiate our results.展开更多
Purpose: To evaluate the accuracy and limits of a frozen section analysis in our department in order to develop a quality control. Materials and methods: all frozen sections reported at our department between 1st Janu...Purpose: To evaluate the accuracy and limits of a frozen section analysis in our department in order to develop a quality control. Materials and methods: all frozen sections reported at our department between 1st January 2010 and 31st December 2010, have been retrospectively evaluated. The frozen section results were compared to permanent paraffin section results. Results: Frozen sections and final diagnosis agreed in 95% and disagreed in 5% (13 cases), 6.6% of the cases were deferred (17 cases). The most common pathological processes encountered were presence/typing of neoplasm (85.4%) and assessment of surgical margins (7.3%). Conclusion: The accuracy of frozen sections diagnosis at our department can be interpreted as comparable with the most international quality control series and is valuable to assist surgeons in their decision.展开更多
Objectives: To evaluate breast lumpectomy margins by frozen section in breast conservation surgery. Methods: A retrospective study of frozen section of lumpectomy margins of one hundred ten patients was done at King A...Objectives: To evaluate breast lumpectomy margins by frozen section in breast conservation surgery. Methods: A retrospective study of frozen section of lumpectomy margins of one hundred ten patients was done at King Abdulaziz University Hospital from June 2007 to June 2013. All patients underwent lumpectomy + Sentinel lymph node biopsy. Patient records were studied for location of mass in breast, size of mass, site of breast, pre or postmenopausal, frozen section margins, new frozen section margins, permanent margins, reoperation. Complications like skin necrosis, numbness, and wound infection were studied. Result: Majority were Saudis (64.5%). Left breast was involved in 60%. Upper outer quadrant was involved in majority (51.9%). Size of mass was less than 1 cm in 14.8% cases, 1 - 2.9 cm in 43.5%, 3 - 4 cm in 13%, more than 4 cm in 10.2%. Lumpectomy plus sentinel lymph node biopsy was done in 96.4% and lumpectomy and axillary lymph node dissection was done in 1.8% cases. Gross margins were positive in 17.3% and frozen margins were positive in 28.2%. New margin on frozen section were positive in 3.6% and negative in 79.1%. Permanent section histology showed positive margins in 5.5% and negative in 94.5% cases. Re-operation was done in 7.3%. Lympho-vascular margins were positive in 20.9%. Skin necrosis was found in 2.2%, numbness was found in 4.4%, wound infection was in 2.2%. Conclusion: Lumpectomy margins with frozen section reduce re-operation and recurrence.展开更多
Background: Frozen section (FS) has a valuable role in the diagnosis of ovarian tumors. It is considered a pivotal point in guiding the surgical therapy, particularly in premenopausal women. In postmenopausal women, i...Background: Frozen section (FS) has a valuable role in the diagnosis of ovarian tumors. It is considered a pivotal point in guiding the surgical therapy, particularly in premenopausal women. In postmenopausal women, it may be required as well to avoid unnecessary surgical staging in benign ovarian tumors. Aim: This study aims to evaluate the accuracy of intraoperative frozen section in ovarian neoplasms in postmenopausal women. Materials and Methods: A retrospective analysis was done for intraoperative FS for suspected ovarian neoplasms. The study was conducted in Oncology Center, Mansoura University from March 2008 to December 2014. The frozen and paraffin section reports were compared, and overall accuracy, sensitivity, specificity, positive and negative predictive values were determined. Results: The study included 105 patients and the overall accuracy of FS in determining malignancy was 81.7%. The sensitivity for malignant tumors was 75.32% with specificity of 100%. For benign tumors, the sensitivity and specificity were 100% and 93%, respectively. Borderline tumors had the lowest sensitivity of 100% with specificity of 95.19%. Conclusion: The present study concurs that frozen section is an accurate test for diagnosis of benign and malignant tumors in postmenopausal women thus determining the extent of surgery done for them. On the other hand, accuracy rates for borderline tumors are low.展开更多
Introduction: Nowadays the more accepted surgical option for treating early breast cancer is breast conserving surgery. The main challenge in this type of surgery is to get free safety margins without need of second s...Introduction: Nowadays the more accepted surgical option for treating early breast cancer is breast conserving surgery. The main challenge in this type of surgery is to get free safety margins without need of second surgical operation, so many breast surgeons have started to depend on intraoperative frozen sections to ensure free safety margins. Aim of work: To assess our policy that we prefer to depend on intraoperative frozen section analysis to get free safety margin in breast conserving surgery from the 1st surgery, and its oncologic outcome. Patients and Methods: This is a retrospective study conducted in Oncology Center—Mansoura University (OCMU), where the data of 219 patients with breast cancer, who were managed by breast conserving surgery with intraoperative frozen section analysis of the safety margins, was analyzed. Results: The intraoperative frozen section analysis of safety margin was negative from the start in 183 (83.6%) patients, while it was positive in 36 patients (16.4%). Intraoperative decision of margin re-excision was applied for 29 patients (13.2%) in order to reach negative margin, modified radical mastectomy was offered for 4 patients (1.8%), while nipple sparing mastectomy with immediate breast reconstruction using latissimus dorsi flap was offered for 3 patients (1.4%). The postoperative paraffin results were typical with intraoperative frozen section analysis results in 216 patients (98.6%) and different results were obtained in only 3 patients (1.4%) who were managed by modified radical mastectomy in a second operation. Only 4 patients had local recurrence (1.8%) during the period of follow-up duration which was ranged from 1 to 86 months with mean ± SD (22.3 ± 14.1). Conclusion: The intraoperative frozen section analysis of safety margins in breast conserving surgery has very high-rate typical results with the paraffin section analysis and it is very helpful in decreasing the rate of second surgical operation in cases of infiltrated margins. It should be used routinely in all cases of breast conserving surgery.展开更多
Objective: To evaluate the reliability and accuracy of frozen section (FS) compared with final pathology and to determine whether they should be obligatory in every patient with atypical endometrial hyperplasia (AEH)....Objective: To evaluate the reliability and accuracy of frozen section (FS) compared with final pathology and to determine whether they should be obligatory in every patient with atypical endometrial hyperplasia (AEH). Methods: We retrospectively assessed the medical records of 192 patients whose endometrial biopsy results were endometrial hyperplasia and underwent hysterectomy at our center. Results: Twenty-two (11.4%) of the 192 patients in our study had concurrent endometrial carcinoma (EC). Of these, 21 (95.5%) were EC and 1 (4.5%) was non-endome- trioid. Of the 140 patients with AEH, 20 (14.3%) had concurrent EC. Overall, 157 patients had FS. Two (1%) patients’ EC was higher than grade 1B and needed lymphadenectomy. The positive and negative predictive value, specifity and sensitivity of FS were found to be 77.8%, 95.7%, 97% and 70%, respectively. Conclusion: Patients who have AEH without high-risk comorbidities do not have to be referred to oncology centers and can undergo hysterectomy in community hospitals without FS.展开更多
Background Although cytological methods for breast oncology have been used in recent decades, intra-operative frozen section has been playing a vital role in making therapeutic decisions. We analyzed a large series of...Background Although cytological methods for breast oncology have been used in recent decades, intra-operative frozen section has been playing a vital role in making therapeutic decisions. We analyzed a large series of frozen section diagnoses for Chinese cases of breast lesion within the last 15 years. The experience was expected to increase the diagnostic accuracy of cases with breast lesions. Methods The data from consecutive 13243 cases of breast lesions diagnosed with intra-operative frozen sections between 1988 to 2002 were compared with paraffin sections in a case by case manner. The causes of false negative and positive diagnoses as well as delayed diagnoses were analyzed. Results One hundred and seventeen cases （0.9%） were falsely diagnosed, with one false positive case and 116 false negative cases. The diagnosis of 47 cases （0.4%） was delayed. The proportion of several lesions had the features of the patients＇ ages. Six types （false invasion, peri-papUloma, adenoma of nipple duct, florid adenosis, sclerosing adenosis, and granulose cell tumor） of lesions may lead to false positive, and four types （morphological changes responding chemotherapy, well differentiated papillary carcinoma, invasive Iobular carcinoma, and tubular carcinoma） to a false negative. Gross and microscopic findings may be inconsistent in two types of lesions （radial scar and florid adenosis） microscopic and clinical findings in three types （ganulomatous mastitis mammary, duct ectasia, and fat necrosis）, and three types （abundant fat or sclerous tissues; borderline lesions and changes of post-chemotherapy） were likely wrongly classified. Conclusions Intra-operative frozen section can accurately identify breast lesions in many instances, leading to fewer errors on account of more diaanostic experience and understandina of diaanostic limitations.展开更多
Background Invasive cancer of the cervix is considered a preventable disease because it has a long pre-invasive state, cervical cytology screening programs are currently available, and treatment of pre-invasive lesion...Background Invasive cancer of the cervix is considered a preventable disease because it has a long pre-invasive state, cervical cytology screening programs are currently available, and treatment of pre-invasive lesions is effective. We tested the accuracy of frozen section examination （FSE） of cone specimens to identify the endocervical margin and rule out invasion in patients with high-grade cervical intraepithelial neoplasia （CIN）. Methods For 320 consecutive patients with a preoperative biopsy result of CIN stage 2/3, cold-knife conization （CKC） was performed followed by FSE. The results from analyses of permanent paraffin sections （PS） were compared with the FSE findings. Results The accuracy of FSE was 87% （278/320）. For all of the seven patients with an invasive squamous cell carcinoma of the cervix identified by FSE, the diagnosis was confirmed by PS analysis. For one patient, the FSE result was cervicitis, whereas PS ananlysis showed microinvasive carcinoma. Appropriate surgery was performed for all patients based on the FSE and biopsy results. The FSE and PS results were not significantly different （P=-0.000）. Definitive examination of margin status using PS was concordant with FSE findings in all cases. Conclusions FSE is a rapid and reliable method for evaluating CKC specimens. It can identify frank invasion, permit adequate treatment in a one-stage procedure, and reliably detect clear resection margins. Since discrepancies do exist and may result in inappropriate treatment, further research is required to decrease these discrepancies and avoid missing even one case.展开更多
Objective: To evaluate the Weill Cornell Medical CoLlege (WCMC)/New York Presbyterian Hospital (NYPH) experience with intraoperative frozen (IOF) section in the management of thyroid nodules with a fine needle aspirat...Objective: To evaluate the Weill Cornell Medical CoLlege (WCMC)/New York Presbyterian Hospital (NYPH) experience with intraoperative frozen (IOF) section in the management of thyroid nodules with a fine needle aspiration (FNA) diagnosis of Bethesda Ⅱ-Ⅵ and to analyze the cost and pathology benefit it provides.Methods: The surgical and cytopathology files at WCMC/NYPH were searched within the time period of January 2008 to May 2013.A total of 435 thyroid specimens were identified for which both an FNA and subsequent IOF section was performed.The FNA was correlated with the locations of the resected nodule and the nodule frozen for intraoperative diagnosis.The results of the FNA were compared to the IOF section diagnosis and final diagnosis (FD).Results: Among 435 cases, the FNA diagnosis was Bethesda Ⅱ:149 cases, Bethesda Ⅲ:170 cases, Bethesda Ⅳ: 91 cases, Bethesda Ⅴ: 19 cases, and Bethesda Ⅵ: 6 cases.There were a total of 83 carcinomas identified on FD, which included 69 papillary thyroid carcinomas (PTCs), 12 follicular carcinomas, and 2 poorly differentiated carcinomas.The preoperative FNA diagnosis for these carcinomas was as follows: Bethesda Ⅱ, 11/149 (7.4％), Bethesda Ⅲ, 24/170 (14％), Bethesda Ⅳ, 26/91 (29％), Bethesda Ⅴ, 16/19 (84％), and Bethesda Ⅵ, 6/6 (100％).IOF section contributed to the diagnosis of malignancy in 16/429 (4％) cases: 1/149 (0.7％) Bethesda Ⅱ, 5/170 (3％) Bethesda Ⅲ, 2/91 (1.1％) Bethesda Ⅳ, and 8/19 (42％) Bethesda Ⅴ.The diagnosis of malignancy was confirmed in the 6 Bethesda Ⅵl cases by IOF section.There were no false positives on IOF section.IOF had a sensitivity and specificity of 26％ and 100％, respectively.Conclusion: The role of IOF section is limited in the evaluation of thyroid nodules.IOF section is most useful for nodules with an FNA diagnosis of Bethesda V lesions.The diagnosis of follicular variant of PTC remains difficult on frozen section.展开更多
基金supported by grants from the Science & Technology Support Project of Sichuan Province(2011FZ0009 and 2014SZ0002-10)
文摘BACKGROUND： Unexpected gallbladder cancer may present with acute cholecystitis-like manifestat/ons. Some authors rec- ommended that frozen section analysis should be performed during laparoscopic cholecystectomy for all cases of acute cholecystitis. Others advocate selective use of frozen section analysis based on gross examination of the specimen by the surgeon. The aim of the present study was to evaluate whether surgeons could effectively identify suspected gallbladder with macroscopic examination alone. If not, is routine frozen sec- tion analysis worth advocating？
文摘OBJECTIVE To summarize a common pathogenefic condition, the pathologic characteristics shown in frozen section and our experience utilizing 2 different common thyroid diseases （TD）. diagnostic methods in cases of METHODS Data from 638 cases with frozen sections from thyroid tissue were retrospectively analyzed. The intraoperative frozen sections of the patients and postoperative diagnostic results of routine paraffin sections were compared. RESULTS In the 683 patients, the gender ratio of females to males was 2.64 ： 1, and the ratio between the patients with nodular goiter （NG） and the patients with thyroid adenoma was 1.5 ： 1. The oldest age group of patients with thyroid cancer （TC） ranged from 40 to 49 years. Frozen section pathologic examination has been employed more and more in the diagnosis of thyroid diseases, and the detection rate of TC has increased year by year, i.e., the rate increased to 6.45%, 7.58%, 14.55% and 16.57%, respectively, in 2005, 2006, 2007 and 2008. Thyroid papillary carcinoma （TPC） was the most commonly seen malignant tumor of the thyroid （MTT）, which accounted for approximately 94.8% of MTTs and 11.44% of the total TDs. Micropapillary carcinoma accounted for 27.4% of TPC, and multifocal carcinomas accounted for 15.58% of TCs. Many of the TCs （19.48%） were complicated by benign diseases such as adenoma, NG and thyroiditis. The coincidence rate of diagnoses made by frozen section and paraffin embedding for thyroid disease was 98.59%. Calcification was rather common in NG and TPC, and there were significant differences in psammoma bodies （PMB） between the calcifications of TPC and NG （P 〈 0.01）. CONCLUSION TPC ranks first in the incidence of MTTs and accounts for 94.8% of all MTTs. About 1/4 of TPCs are micropapillary carcinoma, while 1/5 are accompanied by benign disease, such as adenorna, NG and thyroiditis. PMB are of importance and of significance in the diagnosis of TPC.
基金This research was supported by the Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Science,ICT&Future Planning(NRF-2019R1C1C1005170)Korea Health Technology R&D Project,the Korea Health Industry Development Institute(H16C2193).
文摘We investigated the relationship between positive surgical margin(PSM)-related factors and biochemical recurrence(BCR)and the ability of intraoperative frozen sections to predict significant PSM in patients with prostate cancer.The study included 271 patients who underwent robot-assisted laparoscopic prostatectomy with bilateral nerve sparing and maximal urethral preservation.Intraoperative frozen sections of the periurethra,dorsal vein,and bladder neck were analyzed.The ability of PSM-related factors to predict BCR and significant PSM was assessed by logistic regression.Of 271 patients,108(39.9%)had PSM and 163(60.1%)had negative margins.Pathologic Gleason score^8(18.9%vs 7.5%,P=0.015)and T stage≥T3a(51.9%vs 24.6%,P<0.001)were significantly more frequent in the PSM group.Multivariate analysis showed that Gleason pattern≥4(vs<4;hazard ratio:4.386;P=0.0004)was the only significant predictor of BCR in the PSM cohort.Periurethral frozen sections had a sensitivity of 83.3%and a specificity of 84.2%in detecting PSM with Gleason pattern≥4.Multivariate analysis showed that membranous urethra length(odds ratio[OR]:0.79,P=0.0376)and extracapsular extension of the apex(OR:4.58,P=0.0226)on magnetic resonance imaging(MRI)and positive periurethral tissue(OR:17.85,P<0.0001)were associated with PSM of the apex.PSM with Gleason pattern≥4 is significantly predictive of BCR.Intraoperative frozen sections of periurethral tissue can independently predict PSM,whereas sections of the bladder neck and dorsal vein could not.Pathologic examination of these samples may help predict significant PSM in patients undergoing robot-assisted laparoscopic prostatectomy with preservation of functional outcomes.
文摘Objective:To analyze the diagnostic value of frozen section pathology in the diagnosis of breast cancer.Methods:A total of 50 patients with breast tumors treated between July 2021 and February 2023 were randomly selected as samples.Both paraffin section and frozen section diagnoses were conducted.The paraffin section results served as the gold standard for evaluating the value of frozen section examination.Results:Among the frozen section diagnoses,48 cases(96.00%)were confirmed,1 case was misdiagnosed(2.00%),and 1 case was delayed(2.00%).Among the confirmed patients,45 cases(90.00%)were entirely consistent,and 3 cases(6.00%)were basically consistent.The diagnostic rate of the frozen section was 96.00%,compared with 100.00%for the paraffin section(P>0.05).The diagnostic time of the frozen section(35.25±2.11 min)was significantly shorter than that for the paraffin section(6911.36±58.36 min;P<0.05).Conclusion:Frozen section diagnosis is rapid and demonstrates relatively high diagnostic accuracy.It can guide doctors in determining whether to pursue breast-conserving treatment and aid in selecting appropriate surgical methods.This is beneficial for preventing unnecessary medical interventions and reducing the need for secondary surgeries in breast cancer patients.
文摘Objective: to explore the clinical value of frozen section in the diagnosis of pathological tumors. Methods: 162 tumor specimens collected during the operation in the Department of pathology of our hospital from June 2018 to may 2020 were selected as the research objects. These samples were randomly divided into reference group and experimental group, of which 83 samples were in the reference group and 79 samples were in the experimental group.T he patients in the reference group were diagnosed and treated by routine paraffin section, and the patients in the experimental group were diagnosed by frozen section. The diagnostic coincidence rate and detection quality of the two groups were compared. Results: the diagnostic coincidence rates of the two groups were compared. 83 samples in the reference group were pathologically diagnosed by conventional paraffin section technology, including 49 benign tumors, 19 malignant tumors and 15 borderline tumors. A total of 71 tumors were detected, and the actual diagnostic coincidence rate was 85.54% (71 / 83). Among 79 samples in the experimental group, frozen section technology was used for diagnosis, There were 47 cases of benign tumors, 20 cases of malignant tumors and 12 cases of borderline tumors. A total of 77 cases of tumors were detected. The actual diagnostic coincidence rate was 97.47% (77 / 79). In the comparative diagnostic coincidence rate, it was found that there were significant differences between the groups and the P value was (P = 0.0387). Therefore, the statistical significance obviously had tenable conditions;The score of cell morphology and structure in the contrast test group (75 ± 8) was 16.0, while the score of cell morphology and structure in the contrast test group (61 ± 8) was (1.0), and the score of cell morphology and structure in the contrast test group was (1 ± 8). In the comparison of various test quality scoring indexes, it was found that there were significant differences between the groups, and the P values were (P < 0.05) and the statistical significance was established. Conclusion: the application of frozen section technology in the pathological diagnosis process of tumor has a good effect. It can diagnose the nature of tumor quickly and accurately, and provide strong support for follow-up treatment. It is worth popularizing.
文摘Intraductal papillary mucinous neoplasms(IPMN) of the pancreas include a spectrum of dysplasia ranging from minimal mucinous hyperplasia to invasive carcinoma and are extensive tumors that often spread along the ductal tree.Several studies have demonstrated that preoperative imaging is not accurate enough to adapt the extent of pancreatectomy and have suggested routinely using frozen sectioning(FS) to evaluate the completeness of resection and also to check if ductal dilatation is active or passive,in order to avoid an excessive pancreatic resection.Separate main duct and branch duct analysis is needed due to the difference in the natural history of the disease.FS accuracy averages 95%.Eroded epithelium on the main duct,severe ductal inflammation mimicking dysplasia and reactive epithelial changes secondary to obstruction can lead to inappropriate FS results.FS results change the planned extent of resection in up to 30% of cases.The optimal cut-off leading to extend pancreatectomy is not consensual and our standard option is to extend pancreatec-tomy if FS reveals:(1) at least IPMN adenoma on the main duct;or(2) at least borderline IPMN on branch ducts;or(3) invasive carcinoma.However,the decision to extend resection must be taken after a multidisciplinary discussion since it does not exclusively depend on the FS result but also on age,general condition and expected prognosis after resection.The main limitation of using FS is the existence of discontinuous("skip") lesions which account for approximately 10% of IPMN in surgical series and can lead to reoperation in up to 8% of cases.
基金JSPS KAKENHI(No.JP16K08695)from the Ministry of Education,Culture,Sports,Science and Technology of Japan
文摘AIM To evaluate the usefulness of frozen section diagnosis(FSD) of bile duct margins during surgery for extrahepatic cholangiocarcinoma(CCA). METHODS We retrospectively analyzed 74 consecutive patients who underwent surgery for extrahepatic CCA from 2012 to 2017, during which FSD of bile duct margins was performed. They consisted of 40 distant and 34 perihilar CCAs(45 and 55 bile duct margins, respectively). The diagnosis was classified into three categories: negative, borderline(biliary intraepithelial neoplasia-1 and 2, and indefinite for neoplasia), or positive. FSD in the epithelial layer, subepithelial layer, and total layer was compared with corresponding permanent section diagnosis(PSD) postoperatively.Then, association between FSD and local recurrence was analyzed with special reference to borderline.RESULTS Analysis of 100 duct margins revealed that concordance rate between FSD and PSD was 68.0% in the total layer, 69.0% in the epithelial layer, and 98.0% in the subepithelial layer. The extent of remaining biliary epithelium was comparable between FSD and PSD, and more than half of the margins lost > 50% of the entire epithelium, suggesting low quality of the samples. In FSD, the rate of negative margins decreased and that of borderline and positive margins increased according to the extent of the remaining epithelium. Diagnostic discordance between FSD and PSD was observed in 31 epithelial layers and two subepithelial layers. Alteration from borderline to negative was the most frequent(20 of the 31 epithelial layers). Patients with positive margin in the total and epithelial layers by FSD demonstrated a significantly worse local recurrence-free survival(RFS) compared with patients with borderline and negative margins, which revealed comparable local RFS. Patients with borderline and negative margins in the epithelial layer by PSD also revealed comparable local RFS. These results suggested that epithelial borderline might be regarded substantially as negative. When classifying the status of the epithelial layer either as negative or positive, concordance rates between FSD and PSD in the total, epithelial, and subepithelial layers were 95.0%, 93.0%, and 98.0%, respectively.CONCLUSION During intraoperative assessment of bile duct margin, borderline in the epithelial layer can be substantially regarded as negative, under which condition FSD is comparable to PSD.
文摘Objective: The aim of this work is to compare between intraoperative frozen section and scrape smear cytology in the diagnosis of ovarian neoplasm. Method: This study was performed between March 2011 and March 2012, on 50 patients presented with ovarian mass. Gross examination of the tumor removed was done by inspection and palpation. The specimen was then cut with a sharp knife into two halves. The area was scraped with a sharp scalpel or the end of a glass slide, depending upon the type of tissue. A semifluid drop thus obtained was spread over a glass slide. One to four slides per case were taken from different representative areas. The slides were labelled and immediately put into 95% ethyl alcohol and stained with hematoxylin-eosin. The specimens were then fixed in formalin. Paraffin blocks of the sections were processed in the routine way and sections were stained with hematoxylin and eosin (H and E). Assessment of the overall accuracy of the intraoperative diagnosis was classified as concordant or discordant. Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of benign ovarian masses were 100%, 95.2%, 96.7%, 100% and 98% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of border line ovarian masses were 100%, 93.4%, 25%, 100% and 94% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of malignant ovarian masses were 80%, 100%, 100%, 88.2% and 92% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of benign ovarian masses were 100%, 100%, 100%, 100% and 100% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of borderline ovarian masses were 100%, 95.9%, 33.3%, 100% and 96% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of malignant ovarian masses were 90%, 100%, 100%, 93.8% and 96% respectively. Conclusion: Frozen section is more accurate than smear preparations in the intraoperative assessment of ovarian tumors in this study. However, the cytology preparations were helpful in supporting the histological diagnoses, and in some cases, provided additional useful information. Thus, cytology has a complementary role to frozen section in the intraoperative assessment of ovarian lesions. At the centers where the facilities of frozen section are not available, intraoperative scrape cytology is a useful tool for intraoperative diagnosis of tumor.
文摘Objective: The aim of the work is to evaluate the accuracy of intraoperative frozen section in the diagnosis of ovarian neoplasms in Zagazig University. Design: A prospective cross sectional cohort study. Method: This study was performed between March 2011 and March 2012, on 50 patients presented with ovarian mass. Gross examination of the tumor removed was done by inspection and palpation. The specimen was then cut with a sharp knife into two halves. The most appropriate area thought to be representative of lesion was chosen. The number of sections frozen was depended on the type and size of the tumor. Seven to eight μm sections were obtained and stained with hematoxylin-eosin. The specimens were then fixed in formalin. Paraffin blocks of the sections were processed in the routine way and sections were stained with hematoxylin and eosin (H and E). The diagnosis obtained by intraoperative frozen section based on cellularity and cell morphology was compared with final histopathological diagnosis in terms of diagnostic sensitivity, to differentiate between benign and malignant lesions. Assessment of the overall accuracy of the intraoperative diagnosis was classified as concordant or discordant. Results: There was no statisticaly significant differencre in the studied patients as regard the clinical data, macroscopic and intraoperative picture, while there was statisticaly significat association as regard the laterality of the ovarian masses. The validity of frozen section in the diagnosis of benign tumour was 100% with 100% accuracy, specificity, positive predictive value, negative predictive value, while sensitivity & negative prediction for borderline tumour and specificity & positive prediction of malignant tumour were 100%, specifecity for borderline tumours was 95% while the positive predictive value was 33.3% with 96% accuracy for both malignant and borderline tumours. Conclusion: Intraoperative frozen section is accurate for rapid diagnosis of ovarian tumors. It can help surgeons avoid under-treatment or overtreatment of patients. Our study was designed prospectively using a small number of patients. The door is open to larger studies using a larger number of patients to be performed in order to substantiate our results.
文摘Purpose: To evaluate the accuracy and limits of a frozen section analysis in our department in order to develop a quality control. Materials and methods: all frozen sections reported at our department between 1st January 2010 and 31st December 2010, have been retrospectively evaluated. The frozen section results were compared to permanent paraffin section results. Results: Frozen sections and final diagnosis agreed in 95% and disagreed in 5% (13 cases), 6.6% of the cases were deferred (17 cases). The most common pathological processes encountered were presence/typing of neoplasm (85.4%) and assessment of surgical margins (7.3%). Conclusion: The accuracy of frozen sections diagnosis at our department can be interpreted as comparable with the most international quality control series and is valuable to assist surgeons in their decision.
文摘Objectives: To evaluate breast lumpectomy margins by frozen section in breast conservation surgery. Methods: A retrospective study of frozen section of lumpectomy margins of one hundred ten patients was done at King Abdulaziz University Hospital from June 2007 to June 2013. All patients underwent lumpectomy + Sentinel lymph node biopsy. Patient records were studied for location of mass in breast, size of mass, site of breast, pre or postmenopausal, frozen section margins, new frozen section margins, permanent margins, reoperation. Complications like skin necrosis, numbness, and wound infection were studied. Result: Majority were Saudis (64.5%). Left breast was involved in 60%. Upper outer quadrant was involved in majority (51.9%). Size of mass was less than 1 cm in 14.8% cases, 1 - 2.9 cm in 43.5%, 3 - 4 cm in 13%, more than 4 cm in 10.2%. Lumpectomy plus sentinel lymph node biopsy was done in 96.4% and lumpectomy and axillary lymph node dissection was done in 1.8% cases. Gross margins were positive in 17.3% and frozen margins were positive in 28.2%. New margin on frozen section were positive in 3.6% and negative in 79.1%. Permanent section histology showed positive margins in 5.5% and negative in 94.5% cases. Re-operation was done in 7.3%. Lympho-vascular margins were positive in 20.9%. Skin necrosis was found in 2.2%, numbness was found in 4.4%, wound infection was in 2.2%. Conclusion: Lumpectomy margins with frozen section reduce re-operation and recurrence.
文摘Background: Frozen section (FS) has a valuable role in the diagnosis of ovarian tumors. It is considered a pivotal point in guiding the surgical therapy, particularly in premenopausal women. In postmenopausal women, it may be required as well to avoid unnecessary surgical staging in benign ovarian tumors. Aim: This study aims to evaluate the accuracy of intraoperative frozen section in ovarian neoplasms in postmenopausal women. Materials and Methods: A retrospective analysis was done for intraoperative FS for suspected ovarian neoplasms. The study was conducted in Oncology Center, Mansoura University from March 2008 to December 2014. The frozen and paraffin section reports were compared, and overall accuracy, sensitivity, specificity, positive and negative predictive values were determined. Results: The study included 105 patients and the overall accuracy of FS in determining malignancy was 81.7%. The sensitivity for malignant tumors was 75.32% with specificity of 100%. For benign tumors, the sensitivity and specificity were 100% and 93%, respectively. Borderline tumors had the lowest sensitivity of 100% with specificity of 95.19%. Conclusion: The present study concurs that frozen section is an accurate test for diagnosis of benign and malignant tumors in postmenopausal women thus determining the extent of surgery done for them. On the other hand, accuracy rates for borderline tumors are low.
文摘Introduction: Nowadays the more accepted surgical option for treating early breast cancer is breast conserving surgery. The main challenge in this type of surgery is to get free safety margins without need of second surgical operation, so many breast surgeons have started to depend on intraoperative frozen sections to ensure free safety margins. Aim of work: To assess our policy that we prefer to depend on intraoperative frozen section analysis to get free safety margin in breast conserving surgery from the 1st surgery, and its oncologic outcome. Patients and Methods: This is a retrospective study conducted in Oncology Center—Mansoura University (OCMU), where the data of 219 patients with breast cancer, who were managed by breast conserving surgery with intraoperative frozen section analysis of the safety margins, was analyzed. Results: The intraoperative frozen section analysis of safety margin was negative from the start in 183 (83.6%) patients, while it was positive in 36 patients (16.4%). Intraoperative decision of margin re-excision was applied for 29 patients (13.2%) in order to reach negative margin, modified radical mastectomy was offered for 4 patients (1.8%), while nipple sparing mastectomy with immediate breast reconstruction using latissimus dorsi flap was offered for 3 patients (1.4%). The postoperative paraffin results were typical with intraoperative frozen section analysis results in 216 patients (98.6%) and different results were obtained in only 3 patients (1.4%) who were managed by modified radical mastectomy in a second operation. Only 4 patients had local recurrence (1.8%) during the period of follow-up duration which was ranged from 1 to 86 months with mean ± SD (22.3 ± 14.1). Conclusion: The intraoperative frozen section analysis of safety margins in breast conserving surgery has very high-rate typical results with the paraffin section analysis and it is very helpful in decreasing the rate of second surgical operation in cases of infiltrated margins. It should be used routinely in all cases of breast conserving surgery.
文摘Objective: To evaluate the reliability and accuracy of frozen section (FS) compared with final pathology and to determine whether they should be obligatory in every patient with atypical endometrial hyperplasia (AEH). Methods: We retrospectively assessed the medical records of 192 patients whose endometrial biopsy results were endometrial hyperplasia and underwent hysterectomy at our center. Results: Twenty-two (11.4%) of the 192 patients in our study had concurrent endometrial carcinoma (EC). Of these, 21 (95.5%) were EC and 1 (4.5%) was non-endome- trioid. Of the 140 patients with AEH, 20 (14.3%) had concurrent EC. Overall, 157 patients had FS. Two (1%) patients’ EC was higher than grade 1B and needed lymphadenectomy. The positive and negative predictive value, specifity and sensitivity of FS were found to be 77.8%, 95.7%, 97% and 70%, respectively. Conclusion: Patients who have AEH without high-risk comorbidities do not have to be referred to oncology centers and can undergo hysterectomy in community hospitals without FS.
文摘Background Although cytological methods for breast oncology have been used in recent decades, intra-operative frozen section has been playing a vital role in making therapeutic decisions. We analyzed a large series of frozen section diagnoses for Chinese cases of breast lesion within the last 15 years. The experience was expected to increase the diagnostic accuracy of cases with breast lesions. Methods The data from consecutive 13243 cases of breast lesions diagnosed with intra-operative frozen sections between 1988 to 2002 were compared with paraffin sections in a case by case manner. The causes of false negative and positive diagnoses as well as delayed diagnoses were analyzed. Results One hundred and seventeen cases （0.9%） were falsely diagnosed, with one false positive case and 116 false negative cases. The diagnosis of 47 cases （0.4%） was delayed. The proportion of several lesions had the features of the patients＇ ages. Six types （false invasion, peri-papUloma, adenoma of nipple duct, florid adenosis, sclerosing adenosis, and granulose cell tumor） of lesions may lead to false positive, and four types （morphological changes responding chemotherapy, well differentiated papillary carcinoma, invasive Iobular carcinoma, and tubular carcinoma） to a false negative. Gross and microscopic findings may be inconsistent in two types of lesions （radial scar and florid adenosis） microscopic and clinical findings in three types （ganulomatous mastitis mammary, duct ectasia, and fat necrosis）, and three types （abundant fat or sclerous tissues; borderline lesions and changes of post-chemotherapy） were likely wrongly classified. Conclusions Intra-operative frozen section can accurately identify breast lesions in many instances, leading to fewer errors on account of more diaanostic experience and understandina of diaanostic limitations.
文摘Background Invasive cancer of the cervix is considered a preventable disease because it has a long pre-invasive state, cervical cytology screening programs are currently available, and treatment of pre-invasive lesions is effective. We tested the accuracy of frozen section examination （FSE） of cone specimens to identify the endocervical margin and rule out invasion in patients with high-grade cervical intraepithelial neoplasia （CIN）. Methods For 320 consecutive patients with a preoperative biopsy result of CIN stage 2/3, cold-knife conization （CKC） was performed followed by FSE. The results from analyses of permanent paraffin sections （PS） were compared with the FSE findings. Results The accuracy of FSE was 87% （278/320）. For all of the seven patients with an invasive squamous cell carcinoma of the cervix identified by FSE, the diagnosis was confirmed by PS analysis. For one patient, the FSE result was cervicitis, whereas PS ananlysis showed microinvasive carcinoma. Appropriate surgery was performed for all patients based on the FSE and biopsy results. The FSE and PS results were not significantly different （P=-0.000）. Definitive examination of margin status using PS was concordant with FSE findings in all cases. Conclusions FSE is a rapid and reliable method for evaluating CKC specimens. It can identify frank invasion, permit adequate treatment in a one-stage procedure, and reliably detect clear resection margins. Since discrepancies do exist and may result in inappropriate treatment, further research is required to decrease these discrepancies and avoid missing even one case.
文摘Objective: To evaluate the Weill Cornell Medical CoLlege (WCMC)/New York Presbyterian Hospital (NYPH) experience with intraoperative frozen (IOF) section in the management of thyroid nodules with a fine needle aspiration (FNA) diagnosis of Bethesda Ⅱ-Ⅵ and to analyze the cost and pathology benefit it provides.Methods: The surgical and cytopathology files at WCMC/NYPH were searched within the time period of January 2008 to May 2013.A total of 435 thyroid specimens were identified for which both an FNA and subsequent IOF section was performed.The FNA was correlated with the locations of the resected nodule and the nodule frozen for intraoperative diagnosis.The results of the FNA were compared to the IOF section diagnosis and final diagnosis (FD).Results: Among 435 cases, the FNA diagnosis was Bethesda Ⅱ:149 cases, Bethesda Ⅲ:170 cases, Bethesda Ⅳ: 91 cases, Bethesda Ⅴ: 19 cases, and Bethesda Ⅵ: 6 cases.There were a total of 83 carcinomas identified on FD, which included 69 papillary thyroid carcinomas (PTCs), 12 follicular carcinomas, and 2 poorly differentiated carcinomas.The preoperative FNA diagnosis for these carcinomas was as follows: Bethesda Ⅱ, 11/149 (7.4％), Bethesda Ⅲ, 24/170 (14％), Bethesda Ⅳ, 26/91 (29％), Bethesda Ⅴ, 16/19 (84％), and Bethesda Ⅵ, 6/6 (100％).IOF section contributed to the diagnosis of malignancy in 16/429 (4％) cases: 1/149 (0.7％) Bethesda Ⅱ, 5/170 (3％) Bethesda Ⅲ, 2/91 (1.1％) Bethesda Ⅳ, and 8/19 (42％) Bethesda Ⅴ.The diagnosis of malignancy was confirmed in the 6 Bethesda Ⅵl cases by IOF section.There were no false positives on IOF section.IOF had a sensitivity and specificity of 26％ and 100％, respectively.Conclusion: The role of IOF section is limited in the evaluation of thyroid nodules.IOF section is most useful for nodules with an FNA diagnosis of Bethesda V lesions.The diagnosis of follicular variant of PTC remains difficult on frozen section.
