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.

The accuracy of telediagnosis of frozen sections is inferior to that of conventional diagnosis of frozen sections and paraffin-embedded sections

2003 ◽  
Vol 9 (3) ◽  
pp. 130-134 ◽  
Author(s):  
Patrizia L Moser ◽  
Ingo H Lorenz ◽  
Peter Sögner ◽  
Sylvia Stadlmann ◽  
Gregor Mikuz ◽  
...  
Keyword(s):  
False Positive ◽  
Frozen Section ◽  
False Negative ◽  
Acceptable Level ◽  
Successful Implementation ◽  
Frozen Sections ◽  
Remote Diagnosis ◽  
Frozen Section Diagnosis ◽  
Manual Examination

The accuracy of telepathology diagnosis and conventional diagnosis of frozen sections was compared, using the diagnosis established on paraffin-embedded tissue as a reference. Out of a total of 270 cases, remote frozen-section diagnosis was correct in 227 cases (84.1%) and incorrect in 23 cases (8.5%). The latter comprised 12 false positive diagnoses of malignancy (4.4%) and 11 false negative diagnoses (4.1%). A diagnosis was not possible in 20 cases (7.4%). In contrast, the conventional frozen-section diagnosis was correct in 269 cases (99.6%) and incorrect in 1 case (0.4%), the latter being a false negative diagnosis. The average time needed to make a remote diagnosis was 14.2 min (SD 9). Manual examination was not found to be essential for remote frozen-section diagnosis. Overall slide quality was rated as 'satisfactory' to 'fair' by the six pathologists concerned. An improvement in the quality of slides is necessary to guarantee an acceptable level of accuracy of remote frozen-section diagnosis; a shortening of the time needed for diagnosis is a further requirement for the successful implementation of a routine telepathology frozen-section service.

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.

scholarly journals Challenges of Frozen Section in Thoracic Pathology: Lepidic Lesions, Limited Resections, and Margins

2016 ◽  
Vol 141 (7) ◽  
pp. 932-939 ◽  
Author(s):  
Alain C. Borczuk
Keyword(s):  
False Positive ◽  
Frozen Section ◽  
False Negative ◽  
Data Sources ◽  
Lung Pathology ◽  
Margin Assessment ◽  
Clinical Recommendation ◽  
Frozen Section Diagnosis ◽  
Peripheral Lung ◽  
Pubmed Search

Context.— The use of frozen section in thoracic pathology includes assessment of peripheral lung lesions with lepidic pattern, with greater emphasis on evaluating lung-sparing resections and margin assessment. Objective.— To review pitfalls of frozen section in thoracic pathology; in this setting, reduction of false-positive and false-negative diagnosis in lesion identification and margin assessment is critical. Data Sources.— PubMed search of frozen section lung pathology yielded specific references related to the use of frozen section in the identification of lepidic lesions and the clinical recommendation for margin distance. Conclusions.— Frozen section diagnosis is overall accurate in assessment of lepidic lesions. Pitfalls include rare benign mimickers and more common reactive lesions. Standard approaches to gross assessment and margin measurement require further research with increasing use of lung-sparing resections.

scholarly journals False-Negative Frozen Section of Sentinel Nodes in Early Breast Cancer Patients

2021 ◽  
Author(s):  
Zhu-Jun Loh ◽  
Kuo-Ting Lee ◽  
Ya-Ping Chen ◽  
Yao-Lung Kuo ◽  
Wei-Pang Chung ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Frozen Section ◽  
False Negative ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Frozen Sections ◽  
Sentinel Nodes ◽  
Tumor Emboli

Abstract Background: Sentinel lymph node biopsy (SLNB) is the standard approach of the axillary region for early breast cancer patients with clinically negative nodes. The present study investigated patients with false-negative sentinel nodes of intraoperative frozen section (FNSNs) in real-world data.Methods: A case–control study with a 1:3 ratio was conducted. FNSN was diagnosed when sentinel nodes (SNs) are negative in frozen sections but positive for metastasis in formalin-fixed paraffin-embedded (FFPE) sections. The control was defined as having no metastasis of SNs in both frozen and FFPE sections.Results: A total of 20 FNSN cases and 60 matched controls were enrolled from 333 SLNB patients between April 1, 2005, and November 31, 2009. The demographics and intrinsic subtypes of breast cancer were similar between FNSN and controls. The FNSN patients had larger tumor sizes in preoperative mammography (P = 0.033) and more lymphatic tumor emboli in core biopsy (P < 0.001). Four FNSN patients had metastasis in the non-relevant SNs. Another 16 FNSN patients had benign lymphoid hyperplasia of SNs in frozen sections and metastasis in the same SNs from the FFPE sections. Micrometastasis was detected in seven of 16 patients, and metastases in non-relevant SNs were recognized in two patients. All FNSN patients received a second operation with axillary lymph node dissection (ALND). After a median follow-up of 143 months, no FNSN patients developed recurrence of breast cancer. The disease-free survival, disease-specific survival, and overall survival in FNSN were not inferior to the controls.Conclusions: The patients with a larger tumor size and more lymphatic tumor emboli have a higher incidence of FNSN. However, outcomes of FNSN patients after completing ALND were noninferior to those without metastasis in SNs. ALND provides a correct diagnosis of patients with metastasis in non-sentinel axillary lymph nodes.

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.

scholarly journals Reliability of Telepathology for Frozen Section Service

2000 ◽  
Vol 21 (3-4) ◽  
pp. 213-222 ◽  
Author(s):  
Uwe Wellnitz ◽  
Bernd Binder ◽  
Peter Fritz ◽  
Godehard Friedel ◽  
Peter Schwarzmann
Keyword(s):  
Diagnostic Accuracy ◽  
Technological Development ◽  
Frozen Section ◽  
False Negative ◽  
Daily Practice ◽  
Histopathological Diagnosis ◽  
Time Saving ◽  
Surgical Interventions ◽  
Average Accuracy ◽  
Frozen Section Diagnosis

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.

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.

Parotid Tumors: Fine-Needle Aspiration and/or Frozen Section

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P42-P43
Author(s):  
Peter Zbaren ◽  
Heinz Loosli ◽  
Edouard Stauffer
Keyword(s):  
Sensitivity And Specificity ◽  
Fine Needle Aspiration ◽  
False Positive ◽  
Frozen Section ◽  
False Negative ◽  
Needle Aspiration ◽  
True Positive ◽  
True Negative ◽  
Fine Needle ◽  
Parotid Neoplasms

Objective Assess the difficulties of preoperative and intraoperative tumor typing of parotid neoplasms. Know the advantages and pitfalls of fine-needle-aspiration cytology (FNAC) and frozen section (FS) analysis in primary parotid neoplasms. Methods In 113 parotid neoplasms (70 malignancies and 43 benign tumors) preoperative FNAC as well as intraoperative FS analysis were performed. FNAC and FS findings were analyzed and compared with the final histopathologic diagnosis. Results The FNAC smear was non-diagnostic in 6 tumors. In 2 FS specimens, it was not possible to determine the tumor dignity. FNAC findings and FS findings were both available in 105 neoplasMS The FNAC findings were true positive for malignancy in 54, true negative in 36, false positive in 4, and false negative in 11 tumors. The accuracy, sensitivity, and specificity were 86%, 83%, and 90% respectively. The FS findings were true positive in 60, true negative in 38, false positive in 2, and false negative in 5 tumors. The accuracy, sensitivity, and specificity were 93%, 92% and 95% respectively. The exact histologic tumor typing by FNAC was correct, false or not mentioned in 58%, 20% and 22% true positive or true negative evaluated tumors, and by FS in 83%, 5% and 12% true positive or true negative evaluated tumors. Conclusions The current analysis showed a superiority of FS compared with FNAC regarding the diagnosis of malignancy and especially of tumor typing. FNAC alone is not prone in many cases to determine the surgical management of primary parotid carcinomas.

scholarly journals Is there a role of frozen section of sentinel lymph node in patients with early breast cancer for the management of axilla in India: a prospective study

2019 ◽  
Vol 6 (6) ◽  
pp. 2126
Author(s):  
Anshika Arora ◽  
Neena Chauhan ◽  
Sunil Saini ◽  
Nishish Vishwakarma ◽  
Tanvi Luthra
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Breast Cancer ◽  
False Positive ◽  
Frozen Section ◽  
False Negative ◽  
Lymph Node Biopsy ◽  
True Negative ◽  
Node Negative

Background: Evaluation of axilla using sentinel lymph node biopsy (SLNB) is the standard of care in node negative early breast cancer. Intra operative assessment of SLNB with frozen section (FS) often guides the surgeon regarding decision for level of axillary dissection. The aim of this study was to evaluate accuracy of FS of SLNB in these patients with histopathology examination (HPE) as the gold standard.Methods: This study was performed between July 2017 and November 2018. After gross evaluation of SLNB, nodes were cut in half and frozen; the other half was preserved for HPE. For FS, nodes were sectioned to 4 mm width and examined.Results: A total of 61 patients underwent SLNB, 55 patients undergoing intra-operative FS. The mean age was 53 years (range 30-84, ± 15.09 SD), primary tumor was clinically T1 in 23.6%, T2 in 76.4% patients. A median of four sentinel nodes were identified, mean size 13.84 mm. On FS SLNB was positive for metastasis in 14 (25.5%), on HPE in 16 (29.1%) patients. There were 13 true positive, 38 true negative, 3 false negative and 1 false positive result for FS. The sensitivity, specificity, positive and negative predictive value, false negative and false positive rates were 81.25%, 97.44%, 92.86%, 92.73%, 18.75% and 2.56% respectively in this study. The overall accuracy of FS of SLNB in early carcinoma breast was found to be 92.73%.Conclusions: An intra-operative FS of the SLN in node negative early breast cancer is a highly sensitive tool in axilla management.

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