Evaluation of the Effectiveness of our Intraoperative Pathology Consultations in a Five-Year Period: A Total of 2.179 Cases

Yıl 2021, Cilt: 2 Sayı: 2, 98 - 104, 15.09.2021

Remzi Arslan , Onur Ceylan , Keziban Esin

Öz

ABSTRACT
OBJECTIVE: Intraoperative consultations (IOCs) or frozen section (FS), which meet the urgent need for diagnosis during an operation, are widely used for the management of surgical operations. Inquiries that are most frequently made in IOCs include the presence/absence of a mass, malignant-benign differentiation of the mass and lesion continuity at the surgical margin. IOC is the most urgent and difficult area of pathology. Accurate diagnosis rates and sensitivity and specificity values are important clinical quality indicators. We aimed to evaluate the IOC data of our clinic in light of the literature.
MATERIAL AND METHOD:The reports of IOCs requested from the Department of Pathology of Ataturk University Faculty of Medicine between 2016 and 2020 and paraffin section (PS) reports of these tissues were retrospectively analyzed. The reports of the same tissues were compared. The results were classified according to age, gender, organ distribution, reasons for IOC request, disagreement between the IOC and PS diagnoses. Data obtained were discussed in light of the literature.
RESULTS:A total of 2,179 cases, 70.03% female and 29.97% male, were included in the study. The primary reason for the IOC request (71,2%) was differentiation between masses and malignant-benign lesions. In 94.81% of the cases, diagnoses made during IOCs were confirmed by the PS examination, 3.62% were deferred, and disagreement was observed between IOC and PS examination in 2.5% of cases. In our study, the sensitivity was 95.7%, specificity 99.3%, positive predictive value 99.1%, and negative predictive value 97.2%.
CONCLUSION: IOC remains an important diagnostic method in guiding the surgical operation. The high agreement between IOC and PS diagnoses is an important quality indicator. However, it is inevitable to avoid certain technical and interpretation mistakes due to the nature of the process. in our study, high accuracy, sensitivity and specificity values were observed in accordance with the literature.
Keywords: Intraoperative Consultation, Frozen Section, Sensitivity, Specificity, Accuracy

Anahtar Kelimeler

Intraoperative Consultation, Frozen Section, Sensitivity, Specificity, Accuracy

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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Kaynakça

• Zarbo R, Hoffman G, Howanitz P. Interinstitutional comparison of frozen-section consultation. A College of American Pathologists Q-Probe study of 79,647 consultations in 297 North American institutions. Archives of pathology & laboratory medicine 1991;115(12):1187-94.
• Usubütün A. Küçükali T. Cerrahi patolojide ve jinekolojik onkolojide “frozen section” Ankara Patoloji Bülteni 1999;16:46-8.
• Dehner LP. Frozen section examination in surgical pathology: a retrospective study of one year experience, comprising 778 cases. Minn Med 1977;60:83-94.
• Saglam EA, Usubütün A, Ayhan A, Küçükali T. Mistakes prevent mistakes: experience from intraoperative consultation with frozen section. European Journal of Obstetrics and Gynecology and Reproductive Biology 2006;125(2):266-8.
• Howanitz PJ, Hoffman GG, Zarbo RJ. The accuracy of frozen-section diagnoses in 34 hospitals. Archives of pathology & laboratory medicine 1990;114(4):355-9.
• White VA, Trotter MJ. Intraoperative consultation/final diagnosis correlation: relationship to tissue type and pathologic process. Archives of pathology & laboratory medicine 2008;132(1):29-36.
• Ferreiro JA, Myers JL, Bostwick DG, editors. Accuracy of frozen section diagnosis in surgical pathology: review of a 1-year experience with 24,880 cases at Mayo Clinic Rochester. Mayo Clinic Proceedings; 1995: Elsevier.
• Kösem M, Oral H, İbiloğlu İ. Cerrahi Patolojide Frozen Kesitin Yeri. Van Tıp Dergisi 2003;10(4):113-7.
• Arora H, Solanki R, Gupta R. Evaluation of cryostat frozen section in the diagnosis of surgical biopsies. Indian journal of pathology & microbiology 1991;34(2):136-9.
• Hwang TS, Ham EK, Kim CW, Chi JG, Park SH. An evaluation of frozen section biopsy in 4434 cases. J Korean Med Sci. 1987;2(4):239-45
• Wen M-C, Chen J-T, Ho W. Frozen-section diagnosis in surgical pathology: a quality assurance study. The Kaohsiung journal of medical sciences 1997;13(9):534-9.
• Alabalık U, Yahya A, Keleş AN, Fıray U, Türkçü G, Yildiz Y, et al. Bir üniversite hastanesinde 5 yıllık intraoperatif patoloji konsültasyonlarının değerlendirilmesi. Dicle Tıp Dergisi 2013;40(2):207-11.
• Obiakor I, Maiman M, Mittal K, Awobuluyi M, DiMaio T, Demopoulos R. The accuracy of frozen section in the diagnosis of ovarian neoplasms. Gynecologic oncology 1991;43(1):61-3.
• DiNardo LJ, Lin J, Karageorge LS, Powers CN. Accuracy, utility, and cost of frozen section margins in head and neck cancer surgery. The Laryngoscope 2000;110(10):1773-6.
• Tofte K, Berger C, Torp SH, Solheim O. The diagnostic properties of frozen sections in suspected intracranial tumors: A study of 578 consecutive cases. Surgical neurology int. 2014;5:170
• Twaalfhoven F, Peters A, Trimbos J, Hermans J, Fleuren G. The accuracy of frozen section diagnosis of ovarian tumors. Gynecologic oncology 1991;41(3):189-92.
• Wang KG, Chen TC, Wang TY, Yang YC, Su TH. Accuracy of frozen section diagnosis in gynecology. Gynecologic oncology 1998;70(1):105-10.
• Gol M, Baloglu A, Yigit S, Dogan M, Aydin C, Yensel U. Accuracy of frozen section diagnosis in ovarian tumors: is there a change in the course of time? International Journal of Gynecologic Cancer 2003;13(5).
• İlker A, Aykut B, Muge H, Mehmet Ibrahim H, Bayar Ü, Sener G , Suna S. Accuracy of intra-operative frozen section in the diagnosis of ovarian tumours. J Pak Med Assoc 2011 Sep;61(9):856-8
• Holck S, Galatius H, Engel U, Wagner F, Hoffmann J. False-negative frozen section of sentinel lymph node biopsy for breast cancer. The Breast 2004;13(1):42-8.
• Geertsema D, Gobardhan P, Madsen E, Albregts M, Van Gorp J, de Hooge P, et al. Discordance of intraoperative frozen section analysis with definitive histology of sentinel lymph nodes in breast cancer surgery: complementary axillary lymph node dissection is irrelevant for subsequent systemic therapy. Annals of surgical oncology. 2010;17(10):2690-5
• Jensen AJ, Naik AM, Pommier RF, Vetto JT, Troxell ML. Factors influencing accuracy of axillary sentinel lymph node frozen section for breast cancer. The American journal of surgery 2010; 199(5):629-35
• Chan YH, Hung WK, Mak KL, Ying MW, Chan MC, Lui CY. Intra-operative assessment of axillary sentinel lymph nodes by frozen section—an observational study of 260 procedures. Asian journal of surgery 2011;34(2):81-5.
• Chao C, Wong SL, Ackermann D, Simpson D, Carter MB, Brown CM, et al. Utility of intraoperative frozen section analysis of sentinel lymph nodes in breast cancer. The American journal of surgery 2001;182(6):609-15.
• Weiser MR, Montgomery LL, Susnik B, Tan LK, Borgen PI, Cody HS. Is routine intraoperative frozen-section examination of sentinel lymph nodes in breast cancer worthwhile? Annals of surgical oncology 2000;7(9):651-5.
• Borman KR, Hume AT. Credibility and clinical utility of thyroid fine-needle aspiration biopsy in a teaching hospital. The American journal of surgery. 1995;170(6):638-42.
• Chen H, Nicol TL, Udelsman R. Follicular lesions of the thyroid. Does frozen section evaluation alter operative management? Annals of surgery. 1995;222(1):101.
• Yılmazbayhan ED. Toraks Patolojisinde Frozen İncelemesi. Toraks Cerrahisi Bülteni 2017; 10: 45-50.
• Liu S, Wang R, Zhang Y, Li Y, Cheng C, Pan Y, et al. Precise diagnosis of intraoperative frozen section is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma. Journal of clinical oncology 2016;34(4):307-13.