DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20203042

Analysis of intraoperative frozen section consultations and audit of accuracy: a two year experience in a tertiary care multispeciality hospital in India

Vinay P. Maurya, Vandana Rana, Kanchan Kulhari, Prashant Kumar, Puneet Takkar, Nitu Singh

Abstract


Background: Diagnostic accuracy of intra-operative frozen section (FS) depends largely on quality of tissue sections backed by good clinical communication and experience of reporting pathologist. Periodic audit of this consultation in surgical pathology help in assessing the efficiency of procedure and addressing the pitfalls. In this study authors have analysed the spectrum, indications and assessed the accuracy of FS consultation in their institution.

Methods: A retrospective study of 212 consequent tissue specimens submitted for FS over two years in study centre was conducted. The FS and corresponding formalin fixed paraffin embedded (FFPE) tissue section with their final histopathological examination (HPE) reports were studied and analyzed. The results were classified in concordant, discordant and deferred categories. Accuracy rates and discordant frequencies were calculated and comparison with other similar studies was done. Reasons for inaccuracies were deduced.

Results: A total of 212 tissue specimens for FS were reported over two years in this study institute, six of which showed discordant results. Most common site of FS in this study centre was from central nervous system (CNS) lesions (28.77%). Indications for intra-operative consultation were mainly for establishment of tumor diagnosis (66.51%) and status of margins (29.25%). The accuracy rate was found to be 97.17% with error rate of 2.83%. On analysis of discordant cases; the reason for inaccuracy was mainly due to interpretation error (83.33%).

Conclusions: The audit of FS consultation established that accuracy rates of this study institution are comparable with most international quality control statistics for FS. The discordant cases were mostly false positive hence emphasising that a variable degree of reservation is required while interpreting and communicating the FS results. The closest possible diagnosis should be communicated on FS and definitive diagnosis should be deferred to HPE in case of doubt.


Keywords


Accuracy, Histopathology, Frozen section, Intra operative, Margin, Tumor

Full Text:

PDF

References


Jaafar H. Intra-operative frozen section consultation: concepts, applications and limitations. Malays J Med Sci. 2006;13(1):4-12.

Zarbo RJ, Hoffman GG, Howanitz PJ. Interinstitutional comparison of frozen-section consultation: a college of American Pathologists Q-probe study of 79,647 consultations in 297 North American institutions. Arch Pathol Lab Med. 1991;115:1187-94.

Agarwal P, Gupta S, Singh K, Sonkar AA, Rani P, Yadav S, et al. Intra-operative frozen sections: experience at a tertiary care centre. Asian Pac J Cancer Pre. 2016;17(12):5057-61.

Gephardt GN, Zarbo RJ. Inter institutional comparison of frozen section consultations: A College of American Pathologists Q-probes study of 90,538 cases in 461 institutions. Arch Pathol Lab Med. 1997;120:804-9.

Etienne M, Shamim A, Bishara M, Kurian A, Tauqir S, Ursani N, et al. Intraoperative pathology consultation: error, cause and impact. Can J Surg. 2013;56(3):E13-E18.

Raab SS, Tworek JA, Souers R, Zarbo RJ. The value of monitoring frozen section-permanent section correlation data over time. Arch Pathol Lab Med. 2006;130:337-42.

Novis DA, Zarbo RJ. Inter institutional comparison of frozen section turnaround time. A College of American Pathologists Q-Probes study of 32868 frozen sections in 700 hospitals. Arch Pathol Lab Med. 1997;121(6):559-67.

Selvakumar AS, Rajalakshmi V, Sundaram KM. Intraoperative frozen section consultation- an audit in a tertiary care hospital. Ind J Pathol Oncol. 2018;5(3):421-8.

Patil P, Shukla S, Bhake A, Hiwale K. Accuracy of frozen section analysis in correlation with surgical pathology diagnosis. Int J Res Med Sci. 2015;3:399-404.

Chang JL, Tseng HH, Sheu LF, Lee WH, Tu YC. Diagnostic accuracy of frozen sections in surgical pathology-a retrospective analysis of 1084 frozen sections. J Med Sci. 1992;13(2):133-42.

Tofte K, Berger C, Torp SH, Solheim O. The diagnostic properties of frozen sections in suspected intracranial tumors: a study of 578 consecutive cases. Surg Neurol Int. 2014;5:170.

Geramizadeh B, Larijani TR, Owji SM, Attaran SY, Torabinejad S, Aslani FS, et al. Accuracy of intra-operative frozen section consultation in south of Iran during four years. IJPM. 2010;53(3):414-7.

Jorns JM, Visscher D, Sabel M, Breslin T, Healy P, Daignaut S, Myers JL, et al. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: One-year experience at an ambulatory surgical center. Am J Clin Pathol. 2012;138:657-69.

NCCN clinical practice guidelines in oncology TM. Breast version 4.2020. Margin status recommendations for both DCIS and breast cancer. Available at: http://www.nccn.org/Professional/ Physician_gls/pdf/nsd.pdf. Accessed on 27th May 2020.

Mishra S, Gupta M, Bharat V, Bansal R. Qualitative comparative study of frozen section with routine histological technique. National J Lab Med. 2016;2:44-50.

Nayanar SK, Krishnan A, Mrudula KI, Thavarool SB, Thiagarajan S. Frozen section evaluation in head and neck oncosurgery: an initial experience in a tertiary cancer center. Turk J Path. 2019;35(1):46-51.

DiNardo LJ, Lin J, Karageorge LS, Powers CN. Frozen section margins in head and neck cancer surgery. Laryngoscope. 2000;110:1773-6.

lvan S, Ramazanoglu R, Ulker Akyildiz E, Calay Z, Bese T, Oruc N. The accuracy of frozen section (intraoperative consultation) in the diagnosis of ovarian masses. Gynecol Oncol. 2005;97(2):395-9.

Maheshwari A, Gupta S, Kane S, Kulkarni Y, Goyal BK, Tongaonkar HB. Accuracy of intraoperative frozen section in the diagnosis of ovarian neoplasms: experience at a tertiary oncology center. WJSO. 2006;4:12.

Medeiros LR, Rosa DD, Edelweiss MI, Stein AT, Bozzetti MC, Zelmanowicz A, et al. Accuracy of frozen-section analysis in the diagnosis of ovarian tumors: a systematic quantitative review. In J Gynecol Oncol. 2005;15(2):192-202.

Ackerman LV, Ramirez GA. The indications for and limitations of frozen section diagnosis: a review of 1269 consecutive frozen sections. Br J Surg. 1959;46:336.

Moatasim A, Mujtaba S, Faridi N. Intraoperative frozen section analysis of sentinel lymph nodes in breast carcinoma patients in a tertiary hospital in Pakistan. Int J Surg. 2013;11(3):253-8.

Osamura RY, Hunt JL. Current practices in performing frozen sections for thyroid and parathyroid pathology. Virchows Arch. 2008;453:433-40.

Harrison BJ, Triponez F. Intraoperative adjuncts in surgery for primary hyperparathyroidism. Langenbecks Arch Surg. 2009;394:799-809.

Khoo JJ. An audit of intraoperative frozen section in Johor. Med J Malaysia. 2004;59(1):50-5.

Shrestha S, Lee MC, Dhakal H, Pun CB, Pradhan M, Shrestha S, et al. Comparative study of frozen section diagnoses with histopathology. Postgraduate Med J NAMS. 2009;3(2):1-5.

Roy S, Parwani AV, Dhir R, Yousem SA, Kelly SM, Pantanowitz L. Frozen section diagnosis Is there discordance between what pathologists say and what surgeons hear?. Am J Clin Pathol. 2013;140:363-9.

Farah-Klibi F, Neji O, Ferjaoui M, Zaouche A, Koubaa A, Sfar R, et al. Accuracy of frozen section diagnosis: an analysis of 1695 consecutive cases. Tunis Med. 2008;86(7):693-7.