Focal or Diffuse Lesions in Persistent Hyperinsulinemic Hypoglycemia of Infancy: Concerns about Interpretation of Intraoperative Frozen Sections

2001 ◽  
Vol 4 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Virpi V. Smith ◽  
Marian Malone ◽  
R. Anthony Risdon
Keyword(s):  
Islet Cells ◽  
Frozen Section ◽  
Focal Lesion ◽  
Hyperinsulinemic Hypoglycemia ◽  
Frozen Sections ◽  
Paraffin Sections ◽  
Focal Lesions ◽  
Histological Changes ◽  
Diffuse Disease ◽  
Intraoperative Management

Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) results from defects of regulated insulin release from pancreatic (3 cells and is often refractory to medical treatment. Histological changes in the pancreas associated with PHHI may be focal or diffuse, and the intraoperative confirmation and siting of focal lesions would require frozen section diagnosis. The recognition of focal involvement and its distinction from diffuse disease by frozen section depends on the identification and distribution pattern of islet cells with large hyperchromatic nuclei. This study was designed to test the feasibility of using this parameter in PHHI to delineate focal from diffuse diseases prior to the introduction of frozen sections to guide intraoperative management in our institution. A total of 66 coded and randomized paraffin sections (from 18 PHHI and 4 postmortem pancreases) were scored by three independent observers into the following categories: a focal lesion (A), no large endocrine nuclei (B), few large endocrine nuclei (C), and frequent large endocrine nuclei (D). Interobserver concordance was complete in 88%, but there were minor discrepancies in the remaining 12%. When a focal lesion was present in one section no large endocrine nuclei were seen in sections from the rest of the pancreas. In four patients with diffuse PHHI, no or only very scanty large endocrine nuclei were seen. From this finding, and the observation that in other examples of diffuse disease, large endocrine nuclei were sparse even in large paraffin sections, we have reservations about using small frozen sections for reliable diagnosis.

scholarly journals Cytokeratin on Frozen Sections of Sentinel Node May Spare Breast Cancer Patients Secondary Axillary Surgery

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Elisabeth Specht Stovgaard ◽  
Tove Filtenborg Tvedskov ◽  
Anne Vibeke Lænkholm ◽  
Eva Balslev
Keyword(s):  
Breast Cancer ◽  
Sentinel Node ◽  
Predictive Value ◽  
Frozen Section ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Frozen Sections ◽  
Paraffin Sections ◽  
Significant Difference ◽  
Diagnostic Values

Background. The feasibility and accuracy of immunohistochemistry (IHC) on frozen sections, when assessing sentinel node (SN) status intraoperatively in breast cancer, is a matter of continuing discussion. In this study, we compared a center using IHC on frozen section with a center not using this method with focus on intraoperative diagnostic values. Material and Methods. Results from 336 patients from the centre using IHC intraoperatively were compared with 343 patients from the center not using IHC on frozen section. Final evaluation on paraffin sections with haematoxylin-eosin (HE) staining supplemented with cytokeratin staining was used as gold standard. Results. Significantly more SN with isolated tumor cells (ITCs) and micrometastases (MICs) were found intraoperatively when using IHC on frozen sections. There was no significant difference in the number of macrometastases (MACs) found intraoperatively. IHC increased the sensitivity, the negative predictive value, and the accuracy of the intraoperative evaluation of SN without decreasing the specificity and positive predictive value of SN evaluation. Conclusions. IHC on frozen section leads to the detection of more ITC and MIC intraoperatively. As axillary lymph node dissection (ALND) is performed routinely in some countries when ITC and MIC are found in the SN, IHC on frozen section provides valuable information that can lead to fewer secondary ALNDs.

Intraoperative Consultation, Cytologic Preparations, and Frozen Section in the Central Nervous System

2005 ◽  
Vol 129 (12) ◽  
pp. 1635-1652 ◽  
Author(s):  
Suzanne Z. Powell
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Frozen Section ◽  
Error Rates ◽  
Diagnosis And Treatment ◽  
Frozen Sections ◽  
Simplified Approach ◽  
Intraoperative Management ◽  
The Central Nervous System ◽  
Careful Assessment

Abstract Context.—Intraoperative evaluation of lesions in the central nervous system requires the correlation of clinical, radiologic, and histologic data and knowledge of clinicopathologic entities and their common locations. Advances in neuroimaging during the last 20 years have revolutionized the diagnosis and treatment of central nervous system diseases. The diagnosis and treatment of patients have improved because of these changes and have allowed access to regions that were previously inaccessible. These new approaches have placed the pathologist in a key role in the diagnosis and treatment of patients with central nervous system lesions. Assessment of the adequacy of the material, particularly for stereotactic biopsies, is necessary, and a combination of cytologic imprint preparations and frozen sections are often used. This review discusses many of the issues involved in intraoperative consultation and provides a simplified approach to the differential diagnosis of a variety of central nervous system lesions that may be encountered intraoperatively. Objective.—To provide guidelines for and address potential pitfalls in the intraoperative management of the central nervous system. Data Sources.—Author's experience and pertinent literature. Conclusions.—Careful assessment of the gross specimen coupled with prudent use of frozen sections and cytologic imprint preparations is pivotal to reducing intraoperative error rates and preventing needless anxiety for the patient.

Frozen Section and the Surgical Pathologist: A Point of View

2009 ◽  
Vol 133 (7) ◽  
pp. 1135-1138 ◽  
Author(s):  
Jerome B. Taxy
Keyword(s):  
Resident Education ◽  
Frozen Section ◽  
Definitive Diagnosis ◽  
Organ System ◽  
Point Of View ◽  
Clinical Knowledge ◽  
Frozen Sections ◽  
Intraoperative Management ◽  
Tissue Disposition ◽  
Point Of Intersection

Abstract Frozen section is a prominent point of intersection between surgeons and pathologists. It is regarded as the most definitive—but not the sole—form of intraoperative consultation. Its role in tissue triage, diagnosis, and intraoperative management should not be misconstrued as a shortcut to a definitive diagnosis. Although the pathologist remains in control of the tissue disposition, frozen sections are ideally requested and executed as a collaborative effort. Frivolous requests with no direct consequences for the conduct of a given procedure should not be honored. Frozen section plays a material role in resident education and may be the last vestige of general surgical pathology in an era of organ system specialization. Frozen section will retain its relevance only in the context of broad clinical knowledge by the pathologist and judicious utilization by the surgeon, both in the ultimate service of the patient.

scholarly journals Role of frozen section analysis of testicular/paratesticular fibrous pseudotumours: a five-case experience

2013 ◽  
Vol 5 (4) ◽  
pp. 47
Author(s):  
Jennifer Gordetsky ◽  
Jennifer Findeis-Hosey ◽  
Erdal Erturk ◽  
Edward M. Messing ◽  
Jorge L. Yao ◽  
...  
Keyword(s):  
Frozen Section ◽  
Frozen Sections ◽  
Frozen Section Analysis ◽  
Intraoperative Management ◽  
Radical Orchiectomy ◽  
Section Analysis

Background: Fibrous pseudotumours of the testicular and paratesticulartissues are fibroinflammatory reactive lesions that canclinically mimic neoplasms. Very little is known about the role offrozen section analysis (FSA) for these lesions in terms of intraoperativesurgical management.Methods: We recently experienced 5 patients with testicular/paratesticularfibrous pseudotumours in whom frozen sections wereused to demonstrate its non-neoplastic nature prior to the decisionfor radical surgery.Results: In 2 cases, FSA resulted in testicular-sparing surgery. Incontrast, the remaining 3 cases ultimately underwent radical orchiectomy,due to questionable viability of the testicle involved byinflammatory/infiltrative lesions and in 1 case a slight possibilityof lymphoproliferative malignancy.Conclusion: Urologists should be aware of this entity and its grossfeatures, such as firm masses and diffuse fibrous proliferation encasingthe testicle to help determine intraoperative management. Inselect cases, intraoperative FSA is helpful in obviating radicalorchiectomy.

scholarly journals Role of Intraoperative Frozen Section Diagnosis in the Management of Patients with CNS Lesions: Evaluation of 60 Consecutive Intraoperative Frozen Sections from 1991 to 1993

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Seyed Mirsattari ◽  
Fraser W. Saunders
Keyword(s):  
Frozen Section ◽  
Imaging Techniques ◽  
Frozen Sections ◽  
Tissue Samples ◽  
Tissue Sections ◽  
Intraoperative Management ◽  
Clinical Diagnoses ◽  
Cns Lesions

To determine the role of intraoperative frozen sections (FSs) in the management of patients with central nervous system (CNS) lesions, 60 consecutive intraoperative clinical diagnoses of CNS lesions were presented and compared with concomitantly obtained FS diagnoses. Clinical diagnoses were established byhistory, physical examination, imaging techniques, and gross appearance of the abnormal tissue in situ. Tissue samples were obtained intraoperatively and processed for FS diagnoses. The findings of the FS diagnoses were reported to the operating room and compared with the clinical diagnoses. The remainingbiopsy samples were used to prepare paraffin-embedded tissue sections from which the definitive diagnoses were made. Comparison of the clinical and FS diagnoses, using paraffin-embedded tissue as the true diagnosis, shows that FS diagnosis has a limited contribution to intraoperative patient management by the neurosurgeon. The rate of diagnostic failures between the two techniques was very similar; clinical diagnoses and FSs were misinterpreted in 12 and 11 of the 60 cases, respectively. Compared to a clinical diagnosis, the intraoperative FS technique provided no significant improvement in diagnosis and management; it altered the intraoperative management of the patients in 2 of 60 cases.

Frozen section accuracy in the lymph node staging of prostatic carcinoma

1995 ◽  
Vol 62 (1_suppl) ◽  
pp. 14-18
Author(s):  
C. Terrone ◽  
G. Pelucelli ◽  
L. Bellei ◽  
S. Rocca Rossetti ◽  
G. Valente
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Prostatic Carcinoma ◽  
Frozen Section ◽  
Clinical Stage ◽  
False Negative ◽  
Lymph Node Staging ◽  
Frozen Sections ◽  
Paraffin Sections ◽  
Node Metastases

— We investigated the accuracy of frozen sections in the detection of pelvic lymph node metastases in prostatic carcinoma. A group of 77 patients with clinical stage B or C prostatic cancer underwent staging pelvic lymphadenectomy followed by radical prostatectomy in 71 cases. Frozen section examination was performed in 46 cases because of the presence of suspicious lymph nodes. The accuracy of frozen section was 95.5% with 5.4% false negative results. Out of 24 patients with lymph node metastases confirmed by paraffin sections, 20 had frozen sections: 9 positive for cancer, 2 false negatives and 9 true negatives. Of the 31 patients from whom frozen sections were not obtained, 4 were found to have lymph node metastases on paraffin sections. In these 4 cases and in the presence of true negative frozen sections, nodal disease was minimal in 75% of patients. The results suggest that frozen sections are a useful tool to detect lymph node metastases. The accuracy depends on the experience of the histopathologist and the volume of the metastases.

scholarly journals Intraoperative ultrasound imaging in the surgical treatment of congenital hyperinsulinism: prospective, blinded study

BJS Open ◽  
2020 ◽  
Vol 5 (2) ◽  
Author(s):  
A P Bjarnesen ◽  
P Dahlin ◽  
E Globa ◽  
H Petersen ◽  
K Brusgaard ◽  
...  
Keyword(s):  
Ultrasound Imaging ◽  
Intraoperative Ultrasound ◽  
Clinical Impact ◽  
Focal Lesion ◽  
Congenital Hyperinsulinism ◽  
Frozen Sections ◽  
Focal Lesions ◽  
Preoperative Prediction ◽  
Pet Ct ◽  
Intraoperative Ultrasound Imaging

Abstract Background In congenital hyperinsulinism (CHI), preoperative prediction of the histological subtype (focal, diffuse, or atypical) relies on genetics and 6-[18F]fluoro-l-3,4-dihydroxyphenylalanine (18F-DOPA) PET–CT. The scan also guides the localization of a potential focal lesion along with perioperative frozen sections. Intraoperative decision-making is still challenging. This study aimed to describe the characteristics and potential clinical impact of intraoperative ultrasound imaging (IOUS) during CHI surgery. Methods This was a prospective, observational study undertaken at an expert centre over a 2-year interval. IOUS was performed blinded to preoperative diagnostic test results (genetics and 18F-DOPA PET–CT), followed by unblinding and continued IOUS during pancreatic resection. Characteristics and clinical impact were assessed using predefined criteria. Results Eighteen consecutive, surgically treated patients with CHI, with a median age of 5.5 months, were included (focal 12, diffuse 3, atypical 3). Focal lesions presented as predominantly hypoechoic, oval lesions with demarcated or blurred margins. Patients with diffuse and atypical disease had varying echogenicity featuring stranding and non-shadowing hyperechoic foci in three of six, whereas these characteristics were absent from those with focal lesions. The blinded IOUS-based subclassification was correct in 17 of 18 patients; one diffuse lesion was misclassified as focal. IOUS had an impact on the surgical approach in most patients with focal lesions (9 of 12), and in those with diffuse (2 of 3) and atypical (2 of 3) disease when the resection site was close to the bile or pancreatic duct. Conclusion Uniform IOUS characteristics made all focal lesions identifiable. IOUS had a clinical impact in 13 of 18 patients by being a useful real-time supplementary modality in terms of localizing focal lesions, reducing the need for frozen sections, and preserving healthy tissue and delicate structures.

RESEARCH ON VALUE OF INTRAOPERATIVE FROZEN SECTION EXAMINATION OF THE COMMON TUMORS AT HUE UNIVERSITY HOSPITAL

2011 ◽  
pp. 67-73
Author(s):  
Cong Thuan Dang ◽  
Thi Thu Thao Le
Keyword(s):  
Sensitivity And Specificity ◽  
Frozen Section ◽  
Analysis Data ◽  
Poor Quality ◽  
University Hospital ◽  
Frozen Sections ◽  
Intraoperative Frozen Section ◽  
Frozen Section Examination ◽  
Incorrect Diagnosis ◽  
The Common

Background: To evaluate the accuracy and the pitfalls of frozen section examination in diagnosis the common tumors at Hue University Hospital. Materials and method: A retrospective analysis data of 99 consecutive patients from 2007 to 2009 were evaluated and analyzed the major pitfalls. In our 99 patients, 100% cases we compared histological diagnosis on frozen sections with those on paraffin sections. Results: The majority of frozen section examinations were the thyroid lesions 37.4%, breast lesions 25.2%, lymph nodes 16.1%, ovary 9.1% and less common in other diseases (12.1%). The accuracy, sensitivity and specificity of the intraoperative frozen section examination were 93.9%, 89.1% and 98.1% respectively. The main factors causing incorrect diagnosis in frozen section are: Misinterpretation, poor quality of frozen sections, improper sampling in sectioning and difficult to result interpretation. Conclusion: The frozen section analysis of suspect lesions displays good sensitivity and specificity characteristics.

scholarly journals Comparison between C-arm cone beam computed tomography and interventional angiography in transarterial chemoembolization of hepatocellular carcinoma

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Ibraheim Ahmed Diab ◽  
Shaimaa Abdel-hamid Hassanein ◽  
Hala Hafez Mohamed
Keyword(s):  
Computed Tomography ◽  
Hepatocellular Carcinoma ◽  
Cone Beam Computed Tomography ◽  
Vascular Anatomy ◽  
Cone Beam ◽  
Focal Lesion ◽  
Focal Lesions ◽  
Conventional Angiography ◽  
Interventional Angiography ◽  
Cross Sectional

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy of adults. One of the established treatment procedures performed worldwide for HCC is transcatheter arterial chemoembolization (TACE). By using conventional angiography in TACE, we can detect and identify the vascular anatomy of the liver through obtaining 2D images. Recently C-arm cone beam computed tomography (CBCT) is introduced for obtaining cross-sectional and three-dimensional (3D) images for better visualization of small tumors and their feeding arteries. Results The number of detected focal lesions by angiography was 51 compared to 87 focal lesion detected by CBCT; of those, 45 and 77 were active lesions by both procedures respectively. For lesions, less than 1 cm CBCT detected 23 lesions while angiography detected only one lesion. Angiography detected 87 feeding arterial branch while cone beam CT-HA detected 130 branches to the same number of target lesion. Feeder tractability and confidence were better by CBCT. Conclusion CBCT is superior to angiography in tumor detectability, detection of lesions less than 1 cm, feeder detection, and feeder traction; however, conventional angiography and DSA are irreplaceable. Thus, combination of CBCT with angiography during TACE produces better results and less complication.

scholarly journals Apparent diffusion coefficient for differentiating between benign and malignant hepatic focal lesions

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Sherif Abugamra ◽  
Aya Yassin ◽  
Asmaa Saber Mostafa Abdel-Rehim ◽  
Dina Sayed Sheha
Keyword(s):  
Hepatocellular Carcinoma ◽  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Focal Lesion ◽  
Benign Lesions ◽  
Focal Lesions ◽  
Significant Difference ◽  
Apparent Diffusion ◽  
Malignant Lesions ◽  
The Mean

Abstract Background The aim of this study was to prospectively evaluate the role of diffusion weight MRI (DWI) in the characterization of hepatic focal lesions by using apparent diffusion coefficient (ADC). Thirty patients (18 women, 12 men; mean age 48.5 years) with hepatic focal lesions were included in this study. Patients underwent DW MR imaging with the SPLICE sequence. ADC of each focal lesion carcinoma was calculated from DW MR Images obtained with low and high b values. ADCs were compared among pathological types of focal lesions. Results Among the 30 patients included in the study, 46 focal lesions were detected. Twenty-four lesions were metastatic lesions from primary cancer, 7 lesions were hepatocellular carcinoma (HCC), 9 lesions were hemangiomas, and 6 lesions were simple cysts. There was highly significant difference between the mean ADC of the malignant lesions (metastasis and HCC) and the mean ADC of benign lesions (hemangiomas and cysts). The ADC of malignant lesion was much less than that of benign lesion. The mean ADC of malignant lesions (n = 31) was 0.73 ± 0.19 × 10−3 mm2/s, and the mean ADC of benign lesions (n = 15) was 1.94 ± 0.68 × 10−3 mm2/s (p value < 0.001). There was no significant difference between the cysts and hemangiomas. There was no statistically significant difference between the metastases and hepatocellular carcinoma. Conclusion ADCs values were able to differentiate benign from malignant lesions. ADC should be considered in the work up of patients with hepatic focal lesions.

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