Oral paper at apcon 2012 comparative study of frozen section diagnoses with histopathology.dr.arpan

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