scholarly journals Frozen Section Diagnosis: Accuracy and Errors; with Emphasis on Reasons for Discordance

2021 ◽  
Vol 8 (2) ◽  
pp. A33-38
Author(s):  
Roopam Kishore Gidwani ◽  
Falguni Jay Goswami ◽  
Arpan Mehta ◽  
Nirali V Shah ◽  
Shobhana Ashok Prajapati ◽  
...  
Keyword(s):  
Sampling Error ◽  
Frozen Section ◽  
False Positive Rate ◽  
False Negative ◽  
False Negative Rate ◽  
Paraffin Section ◽  
Cost Effective ◽  
Final Diagnosis ◽  
Frozen Section Diagnosis ◽  
Final Histological Diagnosis

Background: Frozen section is a multistep process involving surgical resection, intraoperative preparation of slides and their microscopic examination.  It is important to   assess concordant, discordant and deferred diagnosis rates from intra-operative frozen section diagnosis with final diagnosis on paraffin section and to determine the reasons for discordance. An integral part of quality assurance in surgical pathology entails the correlation of intra-operative frozen section diagnosis with final diagnosis on permanent section.  Methods:  A retrospective analysis of 117 cases of frozen section biopsy was carried out which were reported in the Histopathology department between July 2007 to June 2012.  The correlation between the frozen section diagnosis with final histological diagnosis was performed in order to check the accuracy of the technique.  The number and type of discrepancies were compared, causes for the discrepancies were analyzed in order to decrease the avoidable errors and improve on the frozen section diagnoses.   Results:  The overall accuracy of frozen section diagnoses over 5years was 90.60% with false positive rate of 0.85%, false negative rate of 6.84% and 1.71% of deferred diagnosis. Sensitivity was 87.69% and Specificity was 98%.  The discrepancies were mainly due to the interpretation error, sampling error and technical artefacts. Conclusions:  Gross inspection, sampling by pathologist, frozen section complemented with cytological and histological review and cooperation between consultants can avoid certain limitations and provide rapid, reliable, cost effective information necessary for optimum patient care.

scholarly journals Distribution of pathologic smear results and histopathologic agreement in precancerous cervical lesions

2020 ◽  
pp. 1
Author(s):  
Eser Colak ◽  
Esra Zeynep Coskunoglu
Keyword(s):  
Pap Smear ◽  
False Positive Rate ◽  
False Negative ◽  
False Negative Rate ◽  
Young Patients ◽  
Cost Effective ◽  
High Grade ◽  
Cervical Lesions ◽  
Histopathological Correlation ◽  
Epithelial Lesions

<p><strong>OBJECTIVES:</strong> The accuracy of the Papanicolau smear test is very important in cervical cancer which is preventable cancer. In this study, we aimed to investigate the distribution of smear results and cyto-histopathological correlation and agreement in biopsies.</p><p><strong>STUDY DESIGN:</strong> A retrospective study was performed at the gynecology obstetrics and pathology department of Baskent University Konya Application and Research Hospital, over a 5-year period. The histopathology results of 89 patients who underwent colposcopic biopsy from 273 patients with pathologic Pap smear results were examined. The histopathologic results and pathologic Pap smear results were compared and the compatibility between them was examined.</p><p><strong>RESULTS:</strong> Data records were collected for 11,191 women. Overall, the prevalence of cytologic abnormalities was 2.43%. The cytohistopathologic correlation in epithelial lesions was 56% and was statistically significant. In glandular lesions, normal biopsy results were reported in 93% of AGC-NOS cytology results, whereas there was a 100% malignancy correlation with AGC-FN cytology results. In terms of detecting low and high-grade lesions, the false-negative rate was 12% and the false-positive rate was 17%.</p><p><strong>CONCLUSION:</strong> In conclusion, Pap smears can be less cost-effective and easily accessible method. While conservative treatment is appropriate in young patients because of possible regression even in high-grade lesions; in older patients, it should not be hesitated to get biopsy when a suspicious clinic is present.</p>

scholarly journals Borderline ovarian tumor frozen section diagnoses with features suspicious of invasive cancer: a retrospective study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Koen De Decker ◽  
Karina H. Jaroch ◽  
Joost Bart ◽  
Loes F. S. Kooreman ◽  
Roy F. P. M. Kruitwagen ◽  
...  
Keyword(s):  
Ovarian Tumor ◽  
Invasive Carcinoma ◽  
Frozen Section ◽  
Paraffin Section ◽  
Final Diagnosis ◽  
Borderline Ovarian Tumor ◽  
Histopathological Diagnosis ◽  
Frozen Section Diagnosis ◽  
Histologic Subtypes ◽  
Section Evaluation

Abstract Background A frozen section diagnosis of a borderline ovarian tumor with suspicious features of invasive carcinoma (“at least borderline” or synonymous descriptions) presents us with the dilemma of whether or not to perform a full ovarian cancer staging procedure. Quantification of this dilemma may help us with the issue of this clinical decision. The present study assessed and compared both the prevalence of straightforward borderline and “at least borderline” frozen section diagnoses and the proportion of these women with a final histopathological diagnosis of invasive carcinoma, with a special interest in histologic subtypes. Methods A retrospective cohort study was performed in three hospitals in The Netherlands. All women that underwent ovarian surgery with perioperative frozen section evaluation in one of these hospitals between January 2007 and July 2018 were identified and included in case of a borderline or “at least borderline” frozen section diagnosis and a borderline ovarian tumor or invasive carcinoma as a final diagnosis. Results A total of 223 women were included, of which 41 women (18.4%) were diagnosed with “at least borderline” at frozen section. Thirteen of forty-one women (31.7%) following “at least borderline” frozen section diagnosis and 14 of 182 women (7.7%) following a straightforward borderline frozen section diagnosis were diagnosed with invasive carcinoma at paraffin section evaluation (p < 0.001). When compared to straightforward borderline frozen section diagnoses, the proportion of women diagnosed with invasive carcinoma increased from 3.1 to 35.7% for serous tumors (p = 0.001), 10.0 to 21.7% for mucinous tumors (p = 0.129) and 50.0 to 75.0% (p = 0.452) in case of other histologic subtypes following an “at least borderline” frozen section diagnosis. Conclusions Overall, when compared to women with a decisive borderline frozen section diagnosis, women diagnosed with “at least borderline” frozen section diagnoses were found to have a higher chance of carcinoma upon final diagnosis (7.7% vs 31.7%). Especially in the serous subtype, full staging during initial surgery might be considered after preoperative consent to prevent a second surgical procedure or chemotherapy in unstaged women. Further studies are needed to evaluate whether additional sampling in case of an “at least borderline” diagnosis may decrease the risk of surgical over-treatment.

scholarly journals Correlation of Biomarkers and Frozen Section Diagnosis with Paraffin Histopathological Diagnosis in Suspected Ovarian Cancer

2019 ◽  
Vol 4 ◽  
pp. 67-71
Author(s):  
Tanushri Mukherjee ◽  
Soma Mukherjee ◽  
Parikshit Sanyal ◽  
Vikram Bharadwaj ◽  
S Sampath ◽  
...  
Keyword(s):  
Decision Making ◽  
Predictive Value ◽  
Frozen Section ◽  
False Negative ◽  
Paraffin Section ◽  
Histopathological Diagnosis ◽  
Diagnostic Dilemma ◽  
Ovarian Cancers ◽  
Frozen Section Diagnosis ◽  
Malignant Lesions

Introduction: Ovarian cancers pose diagnostic dilemma and is problematic for decision making for the gynecological oncologist as well as the pathologist. The use of intra-operative frozen section can aid significantly in decision making and assist in choosing the correct operative path once a mass lesion of ovaries is discovered. Materials and Methods: Over a two-year period, 50 cases of Suspected Ovarian cancers were examined by intra- operative frozen section as well as followed up with histopathology in paraffin sections. Results were categorized in two strata—benign and malignant. Results: A comparison between frozen-section diagnosis and findings on paraffin section showed that the sensitivity of frozen section in diagnosis of malignant lesions is 97.14%, with specificity 93.33%, positive predictive value 97.14% and negative predictive value 93.33%. Among 50 cases, one case was reported as false positive and one was reported as false negative. Conclusion: Intra-operative frozen section is a highly sensitive and specific modality for the diagnosis of malignant lesions of the ovary.

scholarly journals Diagnostic Accuracy of Intraoperative Frozen Sections in the Diagnosis of Central Nervous System Lesions: A Hospital-Based Study

2020 ◽  
Vol 19 (3) ◽  
Author(s):  
TT Win ◽  
SE Tuan Sharif ◽  
AA Mat Zin
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Predictive Value ◽  
Frozen Section ◽  
False Positive Rate ◽  
False Negative ◽  
False Negative Rate ◽  
Low Grade ◽  
Causes Of Errors ◽  
Positive Rate

Introduction: Intraoperative frozen section (FS) is an important tool in the management of neoplastic and non-neoplastic central nervous system (CNS) lesions. Although the final pathological diagnosis is based on the findings in paraffin tissue sessions, interpreting FS of CNS lesion is to assist the neurosurgeon in making the accurate judgment regarding the nature of the lesion and tissue adequacy. This study was to evaluate the agreement between FS and paraffin sections (PS) results; and to highlight the possible causes of error in discrepancy between FS and PS. Materials & Methods: This is a retrospective study of 85 cases of FS. H&E stained sections of both FS and PS of all these cases were reviewed with their histopathological reports. FS and PS results were compared. Possible causes of errors were reviewed and recorded. Results: Out of 85 cases; 76 cases (89.4%) showed no discrepancy, 2 cases (2.4%) minor discrepancy and 7 cases (8.2%) discrepancy. Sensitivity and specificity of FS were 90.1% and 85.7% respectively. Positive predictive value was 97.0% and negative predictive value was 63.1%. The false positive rate was 14.2% and false negative rate was 36.8%. The overall accuracy of FS was 89.4%. Conclusion: Our results showed high accuracy and specificity of FS. Therefore, FS is still useful, an effective tool for neurosurgeon although there are some challenges for histopathologists in reporting FS. The commonest discrepancy was seen between reactive gliosis and low-grade glioma. Over-diagnosis or under-diagnosis of FS can be reduced by closed cooperation among pathologist, neurosurgeon and radiologist.

Comparative study of ultrasonographic findings with the operative findings of biliary surgery

2020 ◽  
Vol 22 (1) ◽  
pp. 25-29
Author(s):  
Zubayer Ahmad ◽  
Mohammad Ali ◽  
Kazi lsrat Jahan ◽  
ABM Khurshid Alam ◽  
G M Morshed
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Imaging Modality ◽  
False Positive Rate ◽  
Gallstone Disease ◽  
False Negative ◽  
False Negative Rate ◽  
Biliary Disease ◽  
Biliary Surgery ◽  
Operative Findings

Background: Biliary disease is one of the most common surgical problems encountered all over the world. Ultrasound is widely accepted for the diagnosis of biliary system disease. However, it is a highly operator dependent imaging modality and its diagnostic success is also influenced by the situation, such as non-fasting, obesity, intestinal gas. Objective: To compare the ultrasonographic findings with the peroperative findings in biliary surgery. Methods: This prospective study was conducted in General Hospital, comilla between the periods of July 2006 to June 2008 among 300 patients with biliary diseases for which operative treatment is planned. Comparison between sonographic findings with operative findings was performed. Results: Right hypochondriac pain and jaundice were two significant symptoms (93% and 15%). Right hypochondriac tenderness, jaundice and palpable gallbladder were most valuable physical findings (respectively, 40%, 15% and 5%). Out of 252 ultrasonically positive gallbladder, stone were confirmed in 249 cases preoperatively. Sensitivity of USG in diagnosis of gallstone disease was 100%. There was, however, 25% false positive rate detection. Specificity was, however, 75% in this case. USG could demonstrate stone in common bile duct in only 12 out of 30 cases. Sensitivity of the test in diagnosing common bile duct stone was 40%, false negative rate 60%. In the series, ultrasonography sensitivity was 100% in diagnosing stone in cystic duct. USG could detect with relatively good but less sensitivity the presence of chronic cholecystitis (92.3%) and worm inside gallbladder (50%). Conclusion: Ultrasonography is the most important investigation in the diagnosis of biliary disease and a useful test for patients undergoing operative management for planning and anticipating technical difficulties. Journal of Surgical Sciences (2018) Vol. 22 (1): 25-29

scholarly journals Preliminary Results of MyCog, a Brief Assessment for the Detection of Cognitive Impairment in Primary Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 259-260
Author(s):  
Laura Curtis ◽  
Lauren Opsasnick ◽  
Julia Yoshino Benavente ◽  
Cindy Nowinski ◽  
Rachel O’Conor ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Cognitive Aging ◽  
False Positive ◽  
False Positive Rate ◽  
False Negative ◽  
False Negative Rate ◽  
Self Report ◽  
Card Sorting ◽  
Primary Care Settings

Abstract Early detection of Cognitive impairment (CI) is imperative to identify potentially treatable underlying conditions or provide supportive services when due to progressive conditions such as Alzheimer’s Disease. While primary care settings are ideal for identifying CI, it frequently goes undetected. We developed ‘MyCog’, a brief technology-enabled, 2-step assessment to detect CI and dementia in primary care settings. We piloted MyCog in 80 participants 65 and older recruited from an ongoing cognitive aging study. Cases were identified either by a documented diagnosis of dementia or mild cognitive impairment (MCI) or based on a comprehensive cognitive battery. Administered via an iPad, Step 1 consists of a single self-report item indicating concern about memory or other thinking problems and Step 2 includes two cognitive assessments from the NIH Toolbox: Picture Sequence Memory (PSM) and Dimensional Change Card Sorting (DCCS). 39%(31/80) participants were considered cognitively impaired. Those who expressed concern in Step 1 (n=52, 66%) resulted in a 37% false positive and 3% false negative rate. With the addition of the PSM and DCCS assessments in Step 2, the paradigm demonstrated 91% sensitivity, 75% specificity and an area under the ROC curve (AUC)=0.82. Steps 1 and 2 had an average administration time of &lt;7 minutes. We continue to optimize MyCog by 1) examining additional items for Step 1 to reduce the false positive rate and 2) creating a self-administered version to optimize use in clinical settings. With further validation, MyCog offers a practical, scalable paradigm for the routine detection of cognitive impairment and dementia.

scholarly journals Ultrasound guided needle biopsy of axilla to evaluate nodal metastasis after preoperative systemic therapy in cohort of 106 breast cancers enriched with BRCA1/2 pathogenic variant carriers

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Baiba Līcīte ◽  
Arvīds Irmejs ◽  
Jeļena Maksimenko ◽  
Pēteris Loža ◽  
Genādijs Trofimovičs ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
False Positive Rate ◽  
False Negative ◽  
False Negative Rate ◽  
Axillary Node ◽  
Pathogenic Variant ◽  
Axillary Lymph ◽  
Ultrasound Guided ◽  
Node Positive

Abstract Background Aim of the study is to evaluate the role of ultrasound guided fine needle aspiration cytology (FNAC) in the restaging of node positive breast cancer after preoperative systemic therapy (PST). Methods From January 2016 – October 2020 106 node positive stage IIA-IIIC breast cancer cases undergoing PST were included in the study. 18 (17 %) were carriers of pathogenic variant in BRCA1/2. After PST restaging of axilla was performed with ultrasound and FNAC of the marked and/or the most suspicious axillary node. In 72/106 cases axilla conserving surgery and in 34/106 cases axillary lymph node dissection (ALND) was performed. Results False Positive Rate (FPR) of FNAC after PST in whole cohort and BRCA1/2 positive subgroup is 8 and 0 % and False Negative Rate (FNR) – 43 and 18 % respectively. Overall Sensitivity − 55 %, specificity- 93 %, accuracy 70 %. Conclusion FNAC after PST has low FPR and is useful to predict residual axillary disease and to streamline surgical decision making regarding ALND both in BRCA1/2 positive and negative subgroups. FNR is high in overall cohort and FNAC alone are not able to predict ypCR and omission of further axillary surgery. However, FNAC performance in BRCA1/2 positive subgroup is more promising and further research with larger number of cases is necessary to confirm the results.

scholarly journals A Method of Segmenting Apples Based on Gray-Centered RGB Color Space

2021 ◽  
Vol 13 (6) ◽  
pp. 1211
Author(s):  
Pan Fan ◽  
Guodong Lang ◽  
Bin Yan ◽  
Xiaoyan Lei ◽  
Pengju Guo ◽  
...  
Keyword(s):  
Vision System ◽  
False Positive Rate ◽  
Clustering Algorithms ◽  
False Negative ◽  
Color Space ◽  
False Negative Rate ◽  
Feature Selection Method ◽  
Image Features ◽  
Accurate Identification ◽  
Rgb Color Space

In recent years, many agriculture-related problems have been evaluated with the integration of artificial intelligence techniques and remote sensing systems. The rapid and accurate identification of apple targets in an illuminated and unstructured natural orchard is still a key challenge for the picking robot’s vision system. In this paper, by combining local image features and color information, we propose a pixel patch segmentation method based on gray-centered red–green–blue (RGB) color space to address this issue. Different from the existing methods, this method presents a novel color feature selection method that accounts for the influence of illumination and shadow in apple images. By exploring both color features and local variation in apple images, the proposed method could effectively distinguish the apple fruit pixels from other pixels. Compared with the classical segmentation methods and conventional clustering algorithms as well as the popular deep-learning segmentation algorithms, the proposed method can segment apple images more accurately and effectively. The proposed method was tested on 180 apple images. It offered an average accuracy rate of 99.26%, recall rate of 98.69%, false positive rate of 0.06%, and false negative rate of 1.44%. Experimental results demonstrate the outstanding performance of the proposed method.

Frozen Section of Thyroid and Parathyroid Specimens

2005 ◽  
Vol 129 (12) ◽  
pp. 1575-1584 ◽  
Author(s):  
Rose C. Anton ◽  
Thomas M. Wheeler
Keyword(s):  
Thyroid Nodules ◽  
Frozen Section ◽  
False Positive Rate ◽  
Cost Effective ◽  
Needle Aspiration ◽  
Thyroid Lobectomy ◽  
Parathyroid Lesions ◽  
Surgical Evaluation ◽  
Positive Rate ◽  
Accurate Procedure

Abstract Context.—Preoperative fine-needle aspiration of thyroid lesions has greatly diminished the need for surgical evaluation. However, because thyroid nodules are common lesions, many still require surgical intervention and represent a substantial number of cases that the pathologist encounters in the frozen section laboratory. Objective.—Comprehensive reviews of frozen section indications, as well as gross, cytologic, and histologic features of the most common and diagnostically important thyroid and parathyroid lesions, are presented to provide a guideline for proper triage and management of these cases in the frozen section laboratory. The most common pitfalls are discussed in an attempt to avoid discordant diagnoses. Data Sources.—Thyroid lobectomy, subtotal or total thyroidectomy, and parathyroid biopsy or parathyroidectomy cases are included in this review. Conclusions.—The frozen section evaluation of thyroid and parathyroid lesions remains a highly accurate procedure with a low false-positive rate. Gross inspection, complemented by cytologic and histologic review, provides the surgeon with the rapid, reliable, cost-effective information necessary for optimum patient care.

scholarly journals Evaluation of a step-by-step approach to frozen section diagnosis in ovarian masses

2021 ◽  
Vol 12 (12) ◽  
pp. 133-139
Author(s):  
Ashumi Gupta ◽  
Neelam Jain
Keyword(s):  
Sensitivity And Specificity ◽  
Malignant Tumors ◽  
Frozen Section ◽  
Tertiary Care ◽  
False Negative ◽  
Significant Proportion ◽  
False Negative Rate ◽  
Accurate Diagnosis ◽  
Care Hospital ◽  
Ovarian Masses

Background: Ovarian cancer forms a significant proportion of cancer-related mortality in females. It is often detected late due to non-specific clinical presentation. Radiology and tumor markers may indicate an ovarian mass. However, exact diagnosis requires pathological evaluation, which may not be possible before surgery. Intraoperative frozen section (FS) is, therefore, an important modality for the diagnosis of ovarian masses. Aims and Objectives: This study was conducted to study step-by-step approach along with diagnostic utility and accuracy of intraoperative FS in diagnosis of ovarian masses. Materials and Methods: Retrospective comparative analysis was done to determine the diagnostic accuracy of FS as compared to routine histopathology in the pathology department of a tertiary care hospital. Diagnostic categorization was done into benign, borderline, and malignant. Overall accuracy, sensitivity, and specificity of FS technique were calculated. Results: Out of 51 cases, FS analysis yielded accurate diagnosis in 94.1% of ovarian masses. Intraoperative FS had a sensitivity of 94.7%, specificity of 96.9%, 3.1% false-positive rate, and 5.3% false-negative rate in malignant tumors. In benign lesions, FS had 91.7% sensitivity and 100% specificity. FS had 75% sensitivity and 96.4% specificity in cases of borderline tumors. Conclusion: FS is a fairly accurate technique for intraoperative evaluation of ovarian masses. It can help in deciding the extent of surgery. It distinguishes benign and malignant tumors in most cases with high sensitivity and specificity. A methodical approach is useful in determining accurate diagnosis on FS diagnosis.

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