The Frozen Section Yesterday and Today: Pediatric Solid Tumors—Crucial Issues

2001 ◽  
Vol 4 (3) ◽  
pp. 252-266 ◽  
Author(s):  
John E. Fisher ◽  
Peter C. Burger ◽  
Elizabeth J. Perlman ◽  
Paul S. Dickman ◽  
David M. Parham ◽  
...  
Keyword(s):  
Solid Tumors ◽  
Current Practice ◽  
Frozen Section ◽  
Frozen Sections ◽  
Pediatric Pathology ◽  
Historical Perspectives ◽  
Pediatric Solid Tumors ◽  
Wide Range ◽  
Frozen Section Diagnosis ◽  
Pediatric Oncology Group

This article is the offshoot of a Pediatric Oncology Group (POG) seminar presented at the Adams Mark Hotel, Denver, Colorado, Friday, May 21, 1999, titled “The Frozen Section in Pediatric Solid Tumors—Crucial Issues.” There were eight presenters who spoke on a wide range of topics that included historical perspectives of the frozen section and discussion of the following systems: brain, renal, germ cell, bone, soft tissue, and lymph nodes. To complement these presentations, a pediatric surgeon explained his concern and philosophy regarding the use of frozen sections, and a lawyer tackled the issues and risks in rendering a frozen section diagnosis. We think that this review covers all the important aspects of the frozen section in our current practice of pediatric pathology.

scholarly journals Experience with a Dynamic Inexpensive Video-Conferencing System for Frozen Section Telepathology

2000 ◽  
Vol 21 (3-4) ◽  
pp. 169-175 ◽  
Author(s):  
J. P. A. Baak ◽  
P. J. van Diest ◽  
G. A. Meijer
Keyword(s):  
Image Quality ◽  
Frozen Section ◽  
Video Conferencing ◽  
Final Diagnosis ◽  
Complete Agreement ◽  
Frozen Sections ◽  
Predictive Values ◽  
Video Conferencing System ◽  
Frozen Section Diagnosis ◽  
Conferencing System

Aim: To evaluate the feasibility of an inexpensive, generally applicable video‐conferencing system for frozen section telepathology (TP).Methods: A commercially widely available PC‐based dynamic video‐conferencing system (PictureTel LIVE, model PCS 100) has been evaluated, using two, four and six ISDN channels (128–384 kilobits per second (kbs)) bandwidths. 129 frozen sections have been analyzed which were classified by TP as benign, uncertain (the remark probably benign, or probably malignant was allowed), malignant, or not acceptable image quality. The TP results were compared with the original frozen section diagnosis and final paraffin diagnosis.Results: Only 384 kbs (3 ISDN‐2 lines) resulted in acceptable speed and quality of microscope images, and synchronous image/speech transfer. In one of the frozen section cases (0.7%), TP image quality was classified as not acceptable, leaving 128 frozen sections for the analysis. Five of these cases were uncertain by TP, and also deferred by frozen section procedure (FS). One more benign and three malignant FS cases were classified as uncertain by TP. Three additional cases were uncertain by FS, but benign according to TP (in agreement with the final diagnosis). In one case, FS diagnosis was uncertain but TP was malignant (in agreement with the final diagnosis). Thus, test efficiency (i.e., cases with complete agreement) was 120/128 (93.8%, Kappa = 0.88) between FS and TP. Sensitivity was 93.5%, specificity 98.6%, positive and negative predictive values were 97.7% and 96.0%. Between TP and final diagnosis agreement was even higher. More importantly, there was not a single discrepancy as to benign‐malignant. Moreover, there was a clear learning effect: 5 of the 8 FS/TP discrepancies occurred in the first 42 cases (5/42=11.9%), the remaining 3 in the following 86 cases (3/86=3.5%).Discussion: The results are encouraging. However, TP evaluation is time‐consuming (5–15 min for one case instead of 2–4 min although speed went up with more experience) and is more tiring. The system has the following technical drawbacks: no possibility to point at objects or areas of interest in the life image at the other end, resolution (rarely) may become suboptimal (blocky), storage of images evaluated (which is essential for legal reasons) is not easy and no direct control of a remote motorized microscope. Yet, all users were positive about the system both for telepathology and personal contact by video‐conferencing. Conclusion: With a relatively simple videoconferencing system, accurate dynamic telepathology frozen section diagnosis can be obtained without false positive or negative results, although a limited number of uncertain cases will have to be accepted.

Accuracy of Frozen Section Diagnosis of the Salivary Gland

1987 ◽  
Vol 96 (4) ◽  
pp. 325-330 ◽  
Author(s):  
Douglas R. Gnepp ◽  
Willa Rae Rader ◽  
Stewart F. Cramer ◽  
Linda L. Cook ◽  
James Sciubba
Keyword(s):  
Salivary Gland ◽  
Malignant Tumor ◽  
Benign Tumor ◽  
Malignant Tumors ◽  
Frozen Section ◽  
Frozen Sections ◽  
Acinic Cell ◽  
Frozen Section Examination ◽  
Permanent Section ◽  
Frozen Section Diagnosis

Three hundred and one salivary gland lesions (162 benign, 72 malignant, and 67 benign non-neoplastic) of 677 cases were evaluated by use of intraoperative frozen sections by 66 pathologists. In seven patients, the diagnosis was deferred for permanent sections. In four cases (1.3%), the diagnosis at permanent section changed from one category of benign tumor to another, and in five cases (1.7%), from one category of malignant tumor to another. In four tumors, a frozen section diagnosis of benign was changed to malignant on permanent sectioning; all four involved acinic cell carcinomas. Only two tumors were incorrectly diagnosed as malignant. We conclude that diagnoses of most salivary gland lesions based on frozen section examination are reliable and accurate. However, the literature does indicate that caution should be exercised when malignant tumors are dealt with.

scholarly journals Comparison of Different Telepathology Solutions for Primary Frozen Section Diagnostic

2000 ◽  
Vol 21 (3-4) ◽  
pp. 161-167 ◽  
Author(s):  
P. Hufnagl ◽  
G. Bayer ◽  
P. Oberbarnscheidt ◽  
K. Wehrstedt ◽  
H. Guski ◽  
...  
Keyword(s):  
Retrospective Study ◽  
False Positive ◽  
Frozen Section ◽  
False Negative ◽  
Frozen Sections ◽  
Frozen Section Diagnosis

In a retrospective study on a set of 125 cases we compared the following three telepathology solutions for primary frozen section diagnosis: ATM‐TP (connection via ATM), TPS 1.0 (connection via LAN) and TELEMIC (connection via Internet), which represent different concepts of telepathological procedures.A set of 125 routine frozen sections (breast) was selected from the Charité cases of the year 1999. Four experienced pathologists diagnosed retrospectively all of these cases.Using the ATM‐TP and TPS systems and 53 of them with the TELEMIC system. Using the ATM‐TP we recorded no false positive (0%), 4 false negative (3.2%) and 4 deferred (3.2%) cases. Using the TPS we recorded no false positive (0%), 4 false negative (3.2%) and 4 deferred (3.2%) cases. Using the TELEMIC we recorded in 53 cases no false positive (0%), no false negative (0%) and 16 deferred (30.2%) cases.The average time of 2.2 minutes per case using ATM‐TP is also short enough for routine frozen section diagnostic. This is also true for the TPS system with 7.2 minutes per case.

scholarly journals A cross-sectional study of the distribution of pediatric solid tumors at an Indian tertiary cancer centre

2019 ◽  
Vol 6 (6) ◽  
pp. 2522
Author(s):  
Monali Madhukar Patole
Keyword(s):  
Soft Tissue ◽  
Germ Cell ◽  
Solid Tumors ◽  
Germ Cell Tumors ◽  
Soft Tissue Sarcomas ◽  
Renal Tumors ◽  
Cancer Center ◽  
Female Ratio ◽  
Pediatric Solid Tumors ◽  
Wide Range

Background: Pediatric solid tumors include a heterogeneous group of tumors, and the burden of these tumors, especially from resource-challenged countries, is not well described. The aim of this study was to describe the distribution of solid tumors in children in an Indian tertiary cancer center.Methods: All patients under 12 years of age with histologically confirmed tumors presenting at a tertiary cancer center from January 2014 to January 2019 were identified from the hospital database. Patients with lymphomas, bone, and central nervous tumors were excluded. The demographic profile including age, sex distribution, and the treatment received were recorded for all patients. Results: The mean age of the eligible 153 patients was 5.7 years with majority (57.3%) in the 0-5 years age group. The male-to-female ratio was 1.6:1 with a male predominance in all tumors except germ cell tumors. Renal tumors were the most common tumors followed by neuroblastoma and soft tissue sarcoma, whereas germ cell and gonadal tumors formed only 8.49% of all tumors.Conclusions: Extracranial and extraosseous pediatric solid tumors include a wide range of tumors with a predilection for male sex and children below 4 years of age. Wilms tumors, neuroblastoma, and soft tissue sarcomas tumors are the most common tumors.

scholarly journals CTNI-75. A PILOT CLINICAL TRIAL OF OROTECAN (VAL-413), A NOVEL ORAL DOSAGE FORMULATION OF IRINOTECAN: IMPLICATIONS FOR PEDIATRIC BRAIN TUMORS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii60-ii60
Author(s):  
Dennis Brown ◽  
Jeffrey Bacha ◽  
Lars Wagner ◽  
Markos Leggas ◽  
Sarath Kanekal ◽  
...  
Keyword(s):  
Solid Tumors ◽  
Pediatric Patients ◽  
Tumor Response ◽  
Pediatric Brain Tumors ◽  
Primary Objective ◽  
Oral Dosage ◽  
Treatment Regimens ◽  
Pediatric Solid Tumors ◽  
Wide Range ◽  
Recommended Phase Ii Dose

Abstract Tumors of the brain and of the central nervous system (CNS) are the most common solid tumors in children. Intravenous irinotecan hydrochloride (IRN-IV) is approved for the treatment of adult colorectal cancer. IRN-IV is also used off-label in a wide range of treatment regimens for recurrent adult and pediatric tumors including glioblastoma, pediatric glioma and medulloblastoma. Recently, commercially available IRN-IV has been administered orally (IRN-IVPO) in pediatric patients to reduce intravenous administration-related side effects, improve convenience and reduce clinic time and costs. Unfortunately, the poor palatability of this preparation leads to poor compliance, especially in pediatric patients. VAL-413 is novel formulation developed to improve tolerability of oral irinotecan. The current study (NCT04337177) evaluates the safety and pharmacokinetics of VAL-413 administered with temozolomide for treatment of recurrent pediatric solid tumors. METHODS: Up to 20 patients ≥ 1 to ≤ 30 years of age with recurrent pediatric solid tumors will be enrolled. The primary objective is to establish the recommended phase II dose of VAL-413 when given in combination with temozolomide. Secondary objectives include characterization of the pharmacokinetics of VAL-413 vs. IRN-IVPO, evaluating palatability of VAL-413, assessing the toxicity profile of VAL-413 in combination with temozolomide, and assessment of tumor response. Toxicity is evaluated based on CTCAEv5 and tumor response based on RECISTv1.1. An update on the progress of this trial will be presented.

Frozen Section Diagnosis of Pancreatic Lesions

2002 ◽  
Vol 126 (10) ◽  
pp. 1169-1173 ◽  
Author(s):  
Adina M. Cioc ◽  
E. Christopher Ellison ◽  
Daniela M. Proca ◽  
Joel G. Lucas ◽  
Wendy L. Frankel
Keyword(s):  
Frozen Section ◽  
Single Cells ◽  
Benign Lesion ◽  
False Negative ◽  
Resection Margins ◽  
Frozen Sections ◽  
Surgical Biopsy ◽  
Frozen Section Diagnosis ◽  
Metastatic Sites

Abstract Background.—The clinical and radiologic diagnosis of pancreatic cancer and the safety of pancreatic resections have improved. These improvements, together with the indication for resection in some cases of complicated chronic pancreatitis, have reduced the necessity for confirmed preoperative tissue diagnosis. We investigated the clinical use and accuracy of frozen section diagnosis for pancreatic lesions. Design.—We searched archival files for the years 1989–2000 for patients with pancreatic lesions who had received a diagnosis based on frozen section results. We compared the diagnosis of all frozen section slides with that of the permanent sections and reviewed the clinical follow-up notes. We evaluated histologic features useful in differentiating between malignant and benign pancreatic lesions. Results.—A total of 538 patients underwent surgical biopsy and/or resection for suspected pancreatic lesions. Frozen section was requested in 131 cases (284 frozen sections). Ninety cases had frozen section of the pancreatic lesions, 70 cases had frozen section of metastatic sites, and 29 cases had frozen section of surgical margins. Of the 90 cases in which frozen section of the pancreatic lesions was requested, malignancy was diagnosed in 44, a benign lesion was diagnosed in 37, and the diagnosis was atypical and deferred in 9. In total, 3 false-negative frozen sections and 1 false-positive frozen section were identified for respective rates of 1.2% and 0.3%. In all cases in which the frozen section diagnosis was deferred or was inconsistent with the operative impression, and the surgeon acted on his/her impression, the operative diagnoses were subsequently confirmed by additional permanent sections and/or clinical follow-up. The most useful histologic features for the diagnosis of pancreatic adenocarcinoma in frozen sections were variation in nuclear size of at least 4:1, disorganized duct distribution, incomplete duct lumen, and infiltrating single cells. Conclusions.—Frozen sections are useful in conjunction with the impression at surgery for the management of patients with pancreatic lesions. Frozen sections of resection margins were 100% accurate; frozen sections of pancreatic lesions or metastatic sites were accurate in 98.3% of cases. We found an acceptable rate of deferred frozen section (6.6%). The experienced surgeon's impression of malignancy is reliable in cases in which frozen section is deferred or has negative findings.

Phase I trial of trimetrexate in pediatric solid tumors: A pediatric oncology group study

1993 ◽  
Vol 21 (4) ◽  
pp. 280-282 ◽  
Author(s):  
Alberto S. Pappo ◽  
Tribhawan Vats ◽  
Thomas E. Williams ◽  
Mark Bernstein ◽  
Barton A. Kamen
Keyword(s):  
Phase I ◽  
Solid Tumors ◽  
Pediatric Oncology ◽  
Phase I Trial ◽  
Oncology Group ◽  
Oncology Group Study ◽  
Pediatric Solid Tumors ◽  
Pediatric Oncology Group

Frozen Section Diagnosis and Indications in Ophthalmic Pathology

2005 ◽  
Vol 129 (12) ◽  
pp. 1626-1634 ◽  
Author(s):  
Patricia Chévez-Barrios
Keyword(s):  
Frozen Section ◽  
Temporal Artery ◽  
Molecular Techniques ◽  
Tissue Sampling ◽  
Frozen Sections ◽  
Childhood Malignancies ◽  
Tissue Handling ◽  
Ophthalmic Pathology ◽  
Frozen Section Diagnosis ◽  
Margin Control

Abstract Context.—Frozen sections for ophthalmic tissues require very precise indications. Objective.—To describe indications and procedures for frozen sections in ophthalmic pathology based on review of my experience and reports in the literature. Design.—Frozen sections received by the ophthalmic pathology service at The Methodist Hospital from 1996 to 2004 were reviewed. A review of the literature also was performed. Results.—Of the 277 specimens received, most were eyelid lesions (138, 49.8%), followed by orbital (106, 38.3%), temporal artery (17, 6.1%), optic nerve (9, 3.2%), and conjunctival (7, 2.5%) lesions. A review of appropriate indications for intraoperative diagnosis is presented and a description of tissue handling and procedures to obtain better results in ophthalmic pathologic lesion cases is discussed. Conclusions.—The most frequent indications for frozen sections in ophthalmic abnormalities are for margin control in eyelid and orbital lesions. At my institution, the second most frequent indications for ophthalmic frozen sections are the evaluation of adequacy of tissue sampling and triaging for flow cytometry and molecular techniques, especially in childhood malignancies.

scholarly journals Frozen Section Diagnosis of Ovarian Epithelial Tumors: Diagnostic Pearls and Pitfalls

2019 ◽  
Vol 143 (1) ◽  
pp. 47-64 ◽  
Author(s):  
Natalia Buza
Keyword(s):  
Frozen Section ◽  
Ovarian Tumors ◽  
Benign Tumors ◽  
Ovarian Carcinomas ◽  
Intraoperative Frozen Section ◽  
Epithelial Tumors ◽  
Ovarian Epithelial Tumors ◽  
Wide Range ◽  
Frozen Section Diagnosis ◽  
Section Evaluation

Context.— Epithelial tumors of the ovary are one of the most frequently encountered gynecologic specimens in the frozen section laboratory. The preoperative diagnostic workup of an ovarian mass is typically limited to imaging studies and serum markers, both of which suffer from low sensitivity and specificity. Therefore, intraoperative frozen section evaluation is crucial for determining the required extent of surgery, that is, cystectomy for benign tumors, oophorectomy or limited surgical staging for borderline tumors in younger patients to preserve fertility, or extensive staging procedure for ovarian carcinomas. Ovarian epithelial tumors may exhibit a wide range of morphologic patterns, which often overlap with each other and can mimic a variety of other ovarian nonepithelial neoplasms as well. A combination of careful gross examination, appropriate sampling and interpretation of morphologic findings, and familiarity with the clinical context is the key to the accurate frozen section diagnosis and successful intraoperative consultation. Objective.— To review the salient frozen section diagnostic features of ovarian epithelial tumors, with special emphasis on useful clinicopathologic and morphologic clues and potential diagnostic pitfalls. Data Sources.— Review of the literature and personal experience of the author. Conclusions.— Frozen section evaluation of ovarian tumors continues to pose a significant diagnostic challenge for practicing pathologists. This review article presents detailed discussions of the most common clinical scenarios and diagnostic problems encountered during intraoperative frozen section evaluation of mucinous, serous, endometrioid, and clear cell ovarian tumors.

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