Comparison between imprint cytology and frozen sections in intraoperative consultation of ovarian tumours

Background: The ovaries frequently are the site for various primary tumors. Correct intraoperative diagnosis is crucial. The application of imprint cytology is very useful where frozen section facility is not available. The present study is a comparison of imprint cytology and frozen section during intraoperative consultation for various types of benign and malignant ovarian neoplasms in different age groups.Methods: Seventy-six cases of ovarian tumors were examined using both imprint cytology and frozen section and evaluated, taking histopathological report as gold standard. The histopathological diagnoses consisted of benign (54), borderline (9), and malignant (13). The malignant tumors consisted of various types including serous carcinoma, mucinous carcinoma, endometrioid carcinoma, clear cell carcinoma and carcinoid.Results: All 54 benign cases were accurately diagnosed as benign by imprint cytology. With frozen section 53 cases were correctly diagnosed as benign but one case was over diagnosed as borderline. Among 13 malignant cases 11 (84.6%) were correctly diagnosed with both techniques. Borderline tumors were not able to be diagnosed with imprint smear, 3 out of 9 cases were correctly diagnosed with frozen section.Conclusion: When compared with frozen section, imprint cytology is a simple, inexpensive and useful diagnostic tool in intraoperative diagnosis of benign and malignant ovarian tumors. Imprint smear is not useful in borderline tumors where only frozen section is useful. Imprint cytology can be used as an adjunct to frozen section for better diagnosis.

Accuracy of intraoperative consultation for ovarian tumours: Experience in an Indonesian teaching hospital

@#Background: Ovarian tumours are a very heterogeneous group of tumours, consisted of non-neoplastic and neoplastic lesions. Preoperative diagnoses in most conditions are inconclusive due to similar clinical, radiological and laboratory findings. Intraoperative consultation is crucial because it can provide rapid diagnosis leading to a suitable surgical management for the patients. Objective: To obtain profile, accuracy and concordance rates of ovarian intraoperative consultation in Dr. Soetomo Hospital Surabaya, a teaching hospital in Indonesia. Materials and Methods: Observational retrospective study, using data from archives of intraoperative consultation reports in Dr. Soetomo General Hospital Surabaya within 2012-2016 period. There were 734 cases of ovarian intraoperative consultations, all then proceed to permanent sections. Accuracy, sensitivity, and specificity rates were calculated. Results: Overall accuracy was 89.5%. Sensitivity for benign, borderline and malignant cases were 98.49%, 71.19% and 84.01%, respectively. Specificity were 90.32%, 95.11% and 98.72%, respectively. Conclusion: Intraoperative consultation for ovarian tumours has a reliable diagnostic value in benign and malignant lesion, but lower value in borderline tumours.

Intraoperative consultation for ovarian tumors / 영남의대학술지

The primary function of intraoperative frozen consultation is to provide an as accurate and prompt diagnosis as possible during surgery and to guide the surgeon in further management. However, the evaluation of frozen section (FS) is sometimes difficult because of suboptimal tissue quality and frozen artifacts compared with routinely processed tissue section. The pathologist responsible for the FS diagnosis requires experience and good judgment. Ovarian tumors are a heterogeneous group of tumors including primary surface epithelial tumors, germ cell tumors and sex cord-stromal tumors, secondary tumors, and other groups of tumors of uncertain histogenesis or nonspecific stroma. Intraoperative FS is a very important and reliable tool that guides the surgical management of ovarian tumors. In this review, the diagnostic key points for the pathologist and the implication of the FS diagnosis on the operator’s decisions are discussed.

Intraoperative frozen section sentinel lymph node assessment in breast cancer: A tertiary institution experience

@#Introduction: Intraoperative frozen section lymph node assessment helps to predict axillary lymph node metastasis in breast cancer. However, the accuracy of this frozen section analysis may vary among institutions. This study describes our institution’s experience in intraoperative analysis of sentinel lymph node and aims to determine the accuracy, sensitivity and specificity of our assessment. Materials and Methods: We retrospectively analysed the histopathological material and data from 82 breast cancer patients diagnosed over a period of four years who underwent intraoperative frozen section evaluation of sentinel lymph nodes. Results: Frozen section analysis detected metastasis in 13 out of 82 cases and definitive pathological examination on the paraffin section confirmed these positive findings. There was no false positive case (specificity of 100%). The true positive cases comprised seven macrometastases, five micrometastases and one isolated tumour cells. Sampling error was noted in two cases in which the malignant cells were only present in the deeper final paraffin sections (false negative rate of 13.3%). The test sensitivity was 86.7% and the accuracy rate was 97.5%. These findings are comparable to other published data. Conclusion: Intraoperative frozen section analysis is a safe and reliable method for assessment of sentinel lymph node. Knowledge on limitation of frozen section analysis with diligent evaluation of frozen section specimen will be beneficial in reducing interpretation error.

Aspectos histopatológicos de la evaluación del donante en trasplante hepático, una aproximación a la consulta intraoperatoria: An Approach to Intraoperative Consultation during Liver Transplantation / Histopathological Evaluation of Liver Donors

El éxito de un trasplante hepático en gran parte radica en la selección del candidato óptimo y del mejor órgano. En los últimos años se ha trabajado de forma importante hacia la elaboración de criterios de selección y de asignación basados en la evidencia. La evaluación histopatológica de las biopsias hepáticas desempeña un papel importante en el contexto del trasplante hepático, tanto en la evaluación pretrasplante de órganos considerados como marginales y en el diagnóstico y el tratamiento del paciente que ha recibido un trasplante. El uso de la biopsia intraoperatoria para evaluar órganos marginales en la evaluación pretrasplante es debatido por unos grupos y apoyado por otros. Por otra parte, los cambios morfológicos que ocurren en el postrasplante como el rechazo agudo celular y el rechazo crónico están muy bien reconocidos y la biopsia hepática sigue siendo considerada el patrón oro para el diagnóstico de estas condiciones, no así la biopsia del posible donante, sin embargo su precisión ha sido cuestionada debido en gran parte a la gran variabilidad y subjetividad, dadas principalmente por las dificultades diagnósticas que plantea esta patología y a la experiencia del patólogo (1). En esta revisión se discutirán los tópicos más importantes y frecuentes, así como algunos que pueden crear problemas de diagnóstico en patología del trasplante, se hará énfasis en las características patológicas y el diagnóstico diferencial. Los temas serán tratados en tres partes, esta primera entrega corresponde a los aspectos relevantes de la biopsia del donante.

The success of liver transplantation depends largely on the selection of the optimal donor and the best organ. In recent years significant work has been done to develop selection criteria and evidence-based organ assignments. Histopathological evaluation of liver biopsies plays an important role both in pretransplant evaluation of possibly marginal organs and in the diagnosis and treatment of patients who receive transplants. The use of intraoperative biopsies to evaluate organs found to be marginal in the pretransplant evaluation is opposed by some groups and supported by others. On the other hand, in contrast to the debate about the use of liver biopsies to evaluate donor organs, liver biopsies are still considered to be the “gold standard” for diagnosis of morphological changes such as acute rejection and chronic rejection that occur following transplantation. Nevertheless, the accuracy of biopsies has been questioned due to the variability and subjectivity of these evaluations which is caused primarily by the diagnostic difficulties posed by this disease and by the experience of the pathologist (1). The most important and frequent topics in this area will be discussed in this review. In addition, issues that can cause problems for diagnosing pathologies of the donor organ will be discussed. The article emphasizes pathological features and differential diagnosis. It is organized into three installments. This installment, the first, is about issues relevant aspects to biopsies of the donor organ.

Accuracy of intraoperative consultation in lesions of the salivary glands: analysis of 748 cases / Acurácia da consulta intraoperatória em lesões das glândulas salivares: análise de 748 casos

Introduction: Lesions of the salivary glands are uncommon, representing 2% to 6.5% of all neoplasms of head and neck, and because of the difference in treatment between them, an accurate diagnosis is essential. The cytological study by fine-needle aspiration (FNA) biopsy is a highly accurate method used to diagnose lesions of the salivary glands. Intraoperative consultation (IOC), in its turn, is a test that provides diagnosis during surgery, aiming to differentiate malignant from benign lesions and to enable the most appropriate surgical approach. Objective: To evaluate the accuracy of IOC in salivary gland lesions. Material and methods: A survey was conducted in the database of Instituto Nacional de Câncer (Inca) into IOC for diagnosis of salivary gland lesions from January 2001 to December 2012, and found 748 cases. Diagnosis made at IOC (IOCD) was compared with the gold standard histopathological diagnosis and classified into: 1) consenting; 2) discordant; and 3) indeterminate. From these data, sensitivity, specificity and accuracy were calculated. Results: Among the 748 IOCs, results were concordant in 656 cases (88%), discordant in 56 (7%), and indeterminate in 36 (5%). Sensitivity was 78%, specificity 99% and accuracy 92%. Conclusion: Our results indicate that IOC in salivary gland lesions is highly accurate and can contribute to the surgical approach. .

Introdução: As lesões das glândulas salivares são incomuns, representando de 2% a 6,5% de todas as neoplasias da região da cabeça e do pescoço. Devido à diferença de tratamento entre elas, é fundamental um diagnóstico preciso. O estudo citológico por meio de punção aspirativa por agulha fina (PAAF) é um método com alta acurácia utilizado para o diagnóstico das lesões das glândulas salivares; já a consulta intraoperatória (CIO) é um exame que oferece o diagnóstico no decorrer da cirurgia, tendo como objetivo diferenciar as lesões malignas das benignas e possibilitar a conduta cirúrgica mais adequada. Objetivo: Avaliar a acurácia da CIO nas lesões das glândulas salivares realizadas em uma instituição. Material e métodos: Realizou-se uma pesquisa sobre as CIOs realizadas para diagnóstico nas lesões das glândulas salivares no Instituto Nacional de Câncer (Inca) no período de janeiro de 2001 a dezembro de 2012, sendo encontrados 748 casos. Os diagnósticos de CIO foram comparados com o diagnóstico histopatológico (DHP), considerado padrão-ouro, e classificados em: 1) concordantes, 2) discordantes e 3) indeterminados. A partir desses dados, foram calculadas sensibilidade, especificidade e acurácia. Resultados: Das 748 CIOs realizadas, os resultados foram concordantes em 656 casos (88%), discordantes em 56 (7%) e indeterminados em 36 (5%). A sensibilidade foi de 78%; a especificidade, de 99%; e a acurácia, de 92%. Conclusão: Nossos resultados indicam que a CIO em lesões das glândulas salivares tem alta acurácia, podendo contribuir para a conduta cirúrgica. .

Biopsia por congelación / Frozen sections biopsy

La biopsia por congelación es un método que se emplea en la consulta intraoperatoria ya que los resultados se obtienen rápidamente, permite la diferenciación entre una lesión benignao maligna, y el estudio de los márgenes quirúrgicos con una exactitud diagnóstica superior al 90%en la mayoría de los casos; sin embargo, la biopsia por congelación presenta algunas limitantes, entre ellas, la alteración de la citología y la arquitectura, los artefactos y su bajo desempeño en algunos procesos neoplásicos, por lo cual es un instrumento para el manejo de los pacientes sin reemplazar la biopsia convencional. El objetivo de este módulo es revisar la utilidad clínica y laslimitaciones de la biopsia por congelación en muestras de aparato genital femenino, riñón, vejiga,tracto gastrointestinal, peritoneo, hígado, vesícula biliar, páncreas y piel. Además, se describe brevemente la técnica y se compara con la de la biopsia convencional.

Frozen section biopsy is a method used for intraoperative consultation because resultsare rapidly obtained, enables the differentiation between a benign and malignant lesion and theanalysis of resection margins, helps with the diagnosis of some neoplasms with a diagnostic accuracyof 90%. Nevertheless, frozen biopsy has several limitations, such as cytological and architectural distortion, artifacts, and its low performance in some specific neoplasms, which explain whyfrozen section biopsy is a tool for patient care that does not replace the conventional biopsy. The aim of this module is to review the clinical utility and the disadvantages of frozen section biopsy inspecimens from the female genital tract, kidney, bladder, gastrointestinal tract, peritoneum, liver, gallbladder, pancreas and skin. Additionally, a brief description of the technique and differenceswith conventional biopsy are included.

Quality Assurance of Intraoperative Consultation Review Analysis of 2,392 frozen sections

A retrospective quality assurance study of intraoperative consultation (frozen section) was carried out to assess the accuracy and to determine the reasons of discordance. Of 14,977 surgical pathology cases accessioned over a 6-month period in Asan Medical Center, frozen sections were done on 1,270 (8.5%) patients and 2,392 frozen sections (1.88 frozen sections/case) were performed. Discordance was noted in 106 cases (4.4%) and diagnosis was deferred in 26 cases (1.1%). All deferred cases were reviewed with the result of 53.8% justified and 46.2% unjustified. The discordant cases were divided into three categories as to their clinical significances: category A (no affect on patient care) 61.3%, B (minimal affect) 9.4%, and C (major affect) 29.2%. Of 31 category C cases, 7 cases were false positive and 24 cases were false negative. Misinterpretation (70.8%) was the leading cause of discordance, followed by sampling error (15.1%), failure to identify lesion (8.5%), and technical problem (5.7%). More than one-third (35.8%) of all discordances were of central nervous system cases. Total central nervous system cases were 403 (16.8%) with a significantly higher disordance rate (9.8%) and deferral rate (2.5%) in comparison to the other cases with 3.4% discordance rate and 0.8% deferral rate. There were 43 colorectal cancer cases of intraoperative consultation for adequacy of resectional margins. The surgical margins were between 0.4 cm and 28 cm (mean: 6.7 cm) away from the tumor and there was no tumor-positive case. The study indicates surgical pathology should 1) promote interpretative skills in cases involving minute fragments of neurosurgical cases, 2) defer the diagnosis and ask for more tissue on inadequate or inappropriate specimens and 3) give only gross opinions without unnecessary frozen section procedures in the event of simple, clear-cut cases.