Diagnostic accuracy of frozen section diagnosis of the adnexal mass: a metaanalysis

One of the most promising applications of telepathology (pathology at a distance by electronic transmission of images in pathology) is frozen section diagnosis, especially because by means of this tool operations requiring an intraoperative histopathological diagnosis are feasible at hospitals without a pathologist on‐site. For the introduction of this diagnostic tool into pathologist's daily practice the evidence of its diagnostic accuracy comparable to that of the conventional frozen section diagnosis is crucial.For this purpose the literature on the diagnostic accuracy of telepathological frozen section diagnosis was reviewed. In a metaanalysis these studies and reports, in which a total of more than 1290 cases had been examined, showed a slightly lower overall diagnostic accuracy (of the telepathological frozen section diagnosis) of about 0.91 than the conventional frozen section diagnosis with an average accuracy of about 0.98 found in an analysis of several studies (on frozen section diagnosis of different organs). This difference is at least predominantly caused by a higher rate of deferred and false negative frozen section diagnoses in the telepathological method, while the specificity of both methods, each more than 0.99 was not significantly different.In conclusion, the introduction of a telepathological frozen section diagnosis for hospitals without an acceptable access to a pathologist is justifiable already at the current state of the technological development especially when considering the advantages (time saving, reduction in costs) compared to the alternative of surgical interventions without access to an intraoperative diagnosis.

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The impact of size of the adnexal mass on the accuracy of frozen section diagnosis

Gynecologic Oncology ◽

10.1016/j.ygyno.2005.06.027 ◽

2005 ◽

Vol 99 (2) ◽

pp. 362-366 ◽

Cited By ~ 18

Author(s):

Peggy M.A.J. Geomini ◽

Laura D. Zuurendonk ◽

Gérard L. Bremer ◽

Jan de Graaff ◽

Roy F.P.M. Kruitwagen ◽

...

Keyword(s):

Adnexal Mass ◽

Frozen Section ◽

Frozen Section Diagnosis ◽

The Impact

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Diagnostic accuracy value of intraoperative frozen section for ovarian neoplasms

10.21203/rs.3.rs-19106/v1 ◽

2020 ◽

Author(s):

Farinaz Shahmoradi ◽

Maliheh Arab

Keyword(s):

Diagnostic Accuracy ◽

Medical Records ◽

Ovarian Neoplasms ◽

Frozen Section ◽

Final Diagnosis ◽

Intraoperative Frozen Section ◽

Frozen Section Diagnosis ◽

Accuracy Study ◽

Extent Of Surgery ◽

Histopathology Examination

Abstract Background Accuracy of intraoperative frozen section diagnosis is extremely important in the evaluation of ovarian tumors so that suitable surgical procedures can be chosen. Methods This retrospective diagnostic accuracy study was conducted in the Department of Obstetrics and Gynecology, Emam Hossein Hospital. The case records of patients with ovarian mass who underwent surgery and intraoperatively frozen section assessments between September 2006 and December 2014 were analyzed. Demographic and clinical data, operative details, frozen section and final histopathology Examination (HPE) were reviewed from the medical records. Results one hundred and ninety three patients with ovarian masses undergoing surgery and frozen section were included. The frozen section diagnoses were benign in 155 (80.31%), borderline in 10 (5.18%), and malignant in 28 (14.51%), whereas the final diagnosis was benign in 154 (79.80%), borderline in 9 (4.66%), and malignant in 30 (15.54%). The overall accuracy of intra-operative frozen section diagnosis was 98.9%. The sensitivity for frozen section diagnosis was 100% for benign, 89% for borderline and 93.3% for malignant category, whereas the specificity was 97%, 99%, and 100%, respectively. There were 3 cases with discordance between the frozen section diagnoses and the final diagnoses, all of which were under diagnosed by frozen section. Conclusion Frozen section was found to be accurate and useful in the intraoperative assessment of patients with ovarian neoplasm. The results may help to determine the type and extent of surgery.

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Intramedullary spinal cord ependymoma and astrocytoma: intraoperative frozen-section diagnosis, extent of resection, and outcomes

Journal of Neurosurgery Spine ◽

10.3171/2018.7.spine18230 ◽

2019 ◽

Vol 30 (1) ◽

pp. 133-139 ◽

Cited By ~ 5

Author(s):

Hiroki Hongo ◽

Keisuke Takai ◽

Takashi Komori ◽

Makoto Taniguchi

Keyword(s):

Spinal Cord ◽

Diagnostic Accuracy ◽

Frozen Section ◽

Progression Free Survival ◽

Final Diagnosis ◽

Gross Total Resection ◽

Frozen Sections ◽

Total Resection ◽

Intramedullary Spinal Cord ◽

Frozen Section Diagnosis

OBJECTIVEThe intraoperative differentiation of ependymomas from astrocytomas is important because neurosurgical strategies differ between these two tumor groups. Previous studies have reported that the diagnostic accuracy of intraoperative frozen sections of intracranial central nervous system (CNS) tumors is higher than 83%–97%, whereas that for spinal intramedullary tumors remains unknown. Herein, authors tested the hypothesis that intraoperative frozen-section diagnosis is the gold standard for a differential diagnosis of intramedullary spinal cord tumors.METHODSThe clinical characteristics, intraoperative histological diagnosis from frozen sections, extent of tumor resection, progression-free survival (PFS), and overall survival (OS) of 49 cases of intramedullary spinal cord ependymomas (n = 32) and astrocytomas (n = 17) were retrospectively evaluated.RESULTSThe frozen-section diagnosis and final diagnosis with permanent sections agreed in 23 (72%) of 32 cases of ependymoma. Of the 9 cases of ependymoma in which the frozen-section diagnosis disagreed with the final diagnosis, 4 were incorrectly diagnosed as astrocytoma and the other 5 cases had a nonspecific diagnosis, such as glioma. Nonetheless, gross-total resection was achieved in 6 of these 9 cases given the presence of a dissection plane. The frozen-section diagnosis and final diagnosis agreed in 12 (71%) of 17 cases of astrocytoma. Of the 5 cases of astrocytoma in which the frozen-section diagnosis disagreed with the final diagnosis, 1 was incorrectly diagnosed as ependymoma and the other 4 had a nonspecific diagnosis. Gross-total resection was achieved in only 1 of these 5 cases.A relationship between the size of tumor specimens and the diagnostic accuracy of frozen sections was not observed. Ependymal rosettes and perivascular pseudorosettes were observed in 30% and 57% of ependymomas, respectively, but were absent in astrocytomas.Progression-free survival and OS were both significantly longer in cases of ependymoma than in cases of astrocytoma (p < 0.001). Gross-total resection was achieved in 69% of ependymomas and was associated with longer PFS (p = 0.041). In the astrocytoma group, gross-total resection was achieved in only 12% and there was no relationship between extent of resection and OS. Tumor grades tended to correlate with OS in astrocytomas (p = 0.079).CONCLUSIONSThe diagnostic accuracy of intraoperative frozen sections was lower for intramedullary spinal cord ependymomas and astrocytomas in the present study than that for intracranial CNS tumors reported on in the literature. Surgical strategies need to be selected based on multiple factors, such as clinical characteristics, preoperative imaging, frozen-section diagnosis, and intraoperative findings of the tumor plane.

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Twenty Challenging Minutes to Take the Right Decision

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol04-i03/601 ◽

2019 ◽

Vol 4 (03) ◽

Author(s):

Dr. Priyanka P Shetty ◽

Dr. Ramadas Naik ◽

Dr Vineeth G. Nair ◽

Dr Shubha Sudhakar ◽

Dr Ali Abdul Latheef

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Frozen Section ◽

Turnaround Time ◽

Frozen Sections ◽

Formalin Fixed Paraffin ◽

Frozen Section Diagnosis ◽

Formalin Fixed Paraffin Embedded ◽

The Right ◽

Sensitivity Specificity

Background: The diagnostic accuracy of frozen section is an important source of information and a high risk procedure in surgical pathology. This is an important tool, not only in the management of surgical patients but also has a pivotal role in institution’s quality assurance in histopathology. Aims and objectives: To analyze indications, efficacy, accuracy, limitations, deferrals and turnaround time for all frozen sections in correlation with histopathology. Materials and methods: A retrospective analysis of all the frozen samples was done in correlation with permanent sections from June 2016 till July 2017. The diagnostic accuracy, sensitivity, specificity, turnaround time, deferrals and limitations were analysed. Results: A total of 45 specimens for frozen sections were sent to the department of Pathology during the time period. Out of these, 97.8% (n=44) were accepted and 2.2% (n=1) were deferred. Of the remaining 44 specimens, 1 (2.3%) was discordant and 43 (97.7%) were concordant to permanent diagnoses. Specimens were primarily from the ovary, breast and lymph nodes. The overall sensitivity, specificity, positive predictive value and negative predictive value of the frozen section compared to formalin fixed paraffin embedded sections (as gold standard) were 97.7%, 100%, 100% and 100% respectively. The average turn-around time for frozen section diagnosis was 23 minutes. Conclusion: Frozen section diagnosis is an efficient, rapid, reliable and highly accurate tool in surgical diagnosis and management. The multidisciplinary approach helped avoiding limitations ensuring optimal patient care.

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Systematic Review of the Use of Telepathology During Intraoperative Consultation

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz155 ◽

2019 ◽

Vol 153 (2) ◽

pp. 198-209 ◽

Cited By ~ 4

Author(s):

Robin L Dietz ◽

Douglas J Hartman ◽

Liron Pantanowitz

Keyword(s):

Systematic Review ◽

Publication Bias ◽

Frozen Section ◽

Strong Support ◽

Risk Of Bias ◽

Low Risk ◽

Reference Standard ◽

Weighted Mean ◽

Frozen Section Diagnosis ◽

Conventional Microscopy

Abstract Objective To compare studies that used telepathology systems vs conventional microscopy for intraoperative consultation (frozen-section) diagnosis. Methods A total of 56 telepathology studies with 13,996 cases in aggregate were identified through database searches. Results The concordance of telepathology with the reference standard was generally excellent, with a weighted mean of 96.9%. In comparison, we identified seven studies using conventional intraoperative consultation that showed a weighted mean concordance of 98.3%. Evaluation of the risk of bias showed that most of these studies were low risk. Conclusions Despite limitations such as variation in reporting and publication bias, this systematic review provides strong support for the safety of using telepathology for intraoperative consultations.

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Abstract number 19: Frozen section diagnostic accuracy of endometrial adenocarcinoma at low risk for nodal metastasis at a single academic medical center

Gynecologic Oncology ◽

10.1016/j.ygyno.2014.04.037 ◽

2014 ◽

Vol 134 (2) ◽

pp. 436-437

Author(s):

J. Te Paske ◽

W. Baker ◽

C. Paquette ◽

L. Duska

Keyword(s):

Diagnostic Accuracy ◽

Frozen Section ◽

Medical Center ◽

Endometrial Adenocarcinoma ◽

Academic Medical Center ◽

Nodal Metastasis ◽

Low Risk ◽

Academic Medical

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Intraosseous Epidermoid Inclusion Cyst in a Great Toe

Archives of Pathology & Laboratory Medicine ◽

10.5858/2003-127-e298-ieicia ◽

2003 ◽

Vol 127 (7) ◽

pp. e298-e300 ◽

Cited By ~ 1

Author(s):

Beverly Y. Wang ◽

Jesse Eisler ◽

Dempsey Springfield ◽

Michael J. Klein

Keyword(s):

Frozen Section ◽

Inclusion Cyst ◽

Great Toe ◽

Imaging Studies ◽

Benign Lesions ◽

Work Related ◽

Frozen Section Diagnosis ◽

History Of ◽

Radiolucent Lesion ◽

Epidermoid Inclusion Cyst

Abstract Epidermoid inclusion cysts are benign lesions that occasionally occur in the distal phalanges of the fingers but are less frequently identified and underreported in the toes. We describe a 55-year-old man with a history of work-related trauma followed by painful expansion of his right great toe, resulting in great anxiety. Imaging studies revealed a radiolucent lesion in the distal phalanx of his right hallux. Clinical differential diagnoses included the possibility of an intramedullary inclusion cyst and other various radiolucent lesions. During surgery, a cystic lesion that contained creamy material was discovered. Frozen section diagnosis of the lesion was an intraosseous epidermoid inclusion cyst. The lesion was removed and the patient recovered uneventfully. Although it has been reported that an unduly large number of phalangeal cysts have been treated by amputation, the judicious use of intraoperative frozen sections can prevent this scenario.

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