oral paper at apcon 2012 comparative study of frozen section diagnoses with histopathology.dr.arpan
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COMPARATIVE STUDY OF FROZEN SECTION DIAGNOSES
WITH HISTOPATHOLOGY
Dr. Arpan Mehta (3rd yr, MD Path)
Dr. F.J.Goswami (Tutor)
Dr. R.K.Bulani (Assist. Professor)
Dr. H.P.Shrilakshmi (Asso. Professor)
Dr. S.C.Patel (Professor and Head)
Baroda Medical College
OUTLINE
•BACKGROUND
•METHOD
•RESULT
•DISCUSSION
•CONCLUSION
BACKGROUND
History:
•1891 : William H. Welch from John Hopkins Hospital
•1920s : Technique became popular and was used for intra-operative consultation in everyday practice.
•1950s : Preparation of frozen section was made easier by development of the modern cryostat, a
cabinet cooled to -20 to -30 °C and enclosing a microtome blade.
Indications:
1. To establish the presence and nature of a lesion
2. To determine the adequacy of surgical margins
3. To establish whether the tissue obtained contains diagnosable material.
BACKGROUND
Advantages:
1. Rapid2. Demonstration of fats, lipids, etc
Disadvantages:
3. Costly4. Not as satisfactory as paraffin sections5. Stressful
BACKGROUND
Basic Steps:
1. Proper Communication with the Surgeons2. Gross Tissue Examination3. Cryostat
• Temperature• Blade sharpness and angle
4. Staining5. Interpreting the frozen section6. Counterparts of frozen are processed for paraffin to
check our accuracy
METHOD
Cases taken from : S.S.G. Hospital, Baroda
Instrument used : Cryostat (Leica CM 1850)
Period of Study : July 2007 – June 2012
No. of cases : 117
METHOD
Departments:•Surgery
Breast Nervous systemGIT Thyroid and ParathryroidUB and Male GT Pancreas Hepatobiliary Sys SkinLN Soft tissue
•Obs & Gynaec Orthopedics• Ovary and FT• Uterus and Cervix
•ENT• General • Salivary gland
METHOD
FROZEN SECTION•Cut on Cryostat•Evaluated in Rapid Hematoxylin and Eosin (H&E) stain
PERMANENT SECTION (Paraffin)•Specimens fixed in 10% formalin, grossed, adequate representative sections taken according to the standards and processed.•Evaluated in Hematoxylin and Eosin (H&E) stain
METHOD
Number of Cases studied : 117
Number of Cases correlated : 108Deferred diagnosis : 02
No. of Cases not correlated : 9False Positives : 01False Negatives : 08
RESULTS
Frozen section diagnosis in 117 cases
Accuracy (%)False positives (%)False negatives (%)Deffered (%)
90.60%00.85%06.84%1.71%
RESULTS
Organs submitted for frozen sections & the distribution of malignancies diagnosed in paraffin
section
Organ Submitted No. of Cases
No. of malignancies
Breast 29 16
Nervous system 2 0
GIT 14 6
Thyroid gland and Parathyroid 6 0
Ovary and FT 24 9
UB and Male Genital Tract 5 5
Organs submitted for frozen sections & the distribution of malignancies diagnosed in paraffin
section
Organ Submitted No. of CasesNo. of
malignancies
Pancreas 1 0
ENT 11 8
Hepatobiliary 2 2
Skin 3 3
Lymph Node 8 3
Uterus and Cervix 7 3
Bone 1 0
Salivary gland 2 1
Soft tissue 2 1
RESULTSOrgan No. of
casesFalse
positivesFalse
negatives Accuracy
Nervous system 2 0 0 100.00
Thyroid gland & Parathyroid 6 0 0 100.00
UB and MGT 5 0 0 100.00
Pancreas 1 0 0 100.00
Hepatobiliary 2 0 0 100.00
Skin 3 0 0 100.00Lymph Node 8 0 0 100.00
Ut and Cervix 7 0 0 100.00
Bone 1 0 0 100.00Soft tissue 2 0 0 100.00
RESULTS
Organ No. of cases
False positives
False negatives Accuracy
Breast 29 1 2 89.66
GIT 14 0 1 92.86
Ovary and FT 24 0 3 87.50
ENT 11 0 1 90.91
Salivary gland 2 0 1 50.00
False positive table
DISCUSSION
Site Frozen diagnosis Final diagnosis
Breast IDC Mammary Duct Ectasia
False negative tableSite Frozen diagnosis Final diagnosis
Breast Inflammatory lesion IDC
Breast Lobular hyperplasia with atypical cells IDC
Ileocecal mass margin Inflammatory lesion Non Hodgkin's lymphoma
Ovary Boderline Papillary Serous Neoplasm
Serous papillary cystadenocarcinoma
Ovary Boderline Epithelial tumor
Mucinous Cystadenocarcinoma
Ovary Papillary Serous Cystadenoma
Serous micropapillary carcinoma
Nasal Mass Inflammatory lesion Non Hodgkin's lymphoma
Submandibular gland Benign neoplasm Acinic cell carcinoma
Deferred DiagnosisDISCUSSION
Site Frozen diagnosis Final diagnosis
Ovary and FT
Cyst : Benign Ovarian CystNodule : Anisonucleosis, Hyperchromatic Nuclei
Clear cellCarcinomaof Ovary
Submandibular gland
? Inflammatory?MalignantWait for paraffin
Non specific sailadenitis
Breast
DISCUSSION
False Positive
FROZEN PARAFFIN SECTION
1 IDC Mammary Duct Ectasia
False Negative
FROZEN PARAFFIN SECTION
1 Inflammatory lesion IDC
2 Lobular hyperplasia with atypical cells
IDC
Ovary and FTFalse
NegativeFROZEN PARAFFIN SECTION
1 Boderline Papillary Serous Neoplasm
Serous papillary cystadenocarcinoma
2 Boderline Epithelial tumor
Mucinous Cystadenocarcinoma
3 Papillary Serous Cystadenoma
Serous micropapillary carcinoma
Deferred Diagnosis
FROZEN PARAFFIN SECTION
1 Benign Ovarian CystAnisonucleosis,
Hyperchromatic Nuclei
Clear cellCarcinomaof Ovary
Submandibular Gland
DISCUSSION
False Negative
FROZEN PARAFFIN SECTION
1 Benign Neoplasm Acinic cell carcinoma
Deferred Diagnosis
FROZEN PARAFFIN SECTION
1
? Inflammatory?MalignantWait for paraffin
Non specific sailadenitis
DISCUSSION
False Negative
FROZEN PARAFFIN SECTION
Ileocecal mass
marginInflammatory lesion Non Hodgkin's lymphoma
Nasal Mass Inflammatory lesion Non Hodgkin's lymphoma
False positive 1.5%
False negative 3.9%
Deferred 3.9%
Accuracy 94.6%
Accuracy 96.5%
CONCLUSION• Frozen section is very useful, fast and very accurate procedure.• Results are comparable with other studies
• Gross inspection, proper sampling by pathologist and good communication of intra-operative findings by the surgeon to the pathologist can avoid certain limitations and provide rapid, reliable and cost-effective information necessary for optimum patient care.
REFERENCES• Rosai and Ackerman’s Surgical Pathology
• Cellular Pathology Techniques: Culling’s
• Shrestha S, Lee M, Dhakal H, Pun C, Pradhan M, Basval et al. Comparative Study of Frozen Section Diagnoses with Histopathology. Postgraduate Medical Journal of NAMS. 2009; 9(2) • Howanitz P, Hoffman G, Zarbo R. The Accuracy of Frozen Section Diagnoses in 34 Hhospitals. Arch Pathol Lab Med. 1990; 114
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