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At least 19 recordsLinked to original sources
PubMed1976

Frozen section- frozen attitudes.

Patients with breast cancer who have clinically negative axillae, tumors 2 cm in diameter or less, and tumors with a moderate or low degree of anaplasticity are candidates for treatment by local excision and irradiation. A definitive histologic diagnosis should be made in all cases of breast cancer before a final treatment decision is made. This can be accomplished by needle or excisional biopsy. After a histologic diagnosis is established, the decision regarding treatment can be arrived at with the patient enering into the process. Those patients requiring mastectomy will be better able to cope with this, knowing why the operation was considered best for them. The elimination of frozen section diagnosis will free the patient from one of the great fears of the current treatment of breast cancer- subjecting herself to biopsy without knowing what the outcome will be. It will free the surgeon from the rigid sequence of frozen section followed by mastectomy and allow him to begin to rationally assign patients with proper criteria to conservative treatment, reserving mastectomy for those who do not meet these criteria.

Adult↗
PubMedDate not supplied

Excision of head and neck basal cell carcinoma with a rapid, cross-sectional, frozen-section technique.

OBJECTIVES: To compare a rapid, cross-sectional frozen-section technique with Mohs micrographic surgery, using recurrence rate and cost of treatment for excision of basal cell carcinoma as indicators to validate our indications for Mohs surgery. DESIGN: Retrospective study of 557 head and neck basal cell carcinomas excised over 10 years. MAIN OUTCOME MEASURES: Recurrence rates; tumor comparisons by size, location, and subtype; a life table, and a patient satisfaction survey. RESULTS: Recurrence rate for the cross-sectional technique was 2.1% at 5 years. Recurrent tumors had an average diameter of 1.56 cm (vs 1.04 cm for nonrecurrent tumors). Recurrences were in the cheek (30%), nose (20%), temple (20%), forehead/brow (10%), conchal bowl (10%), and postauricular crease (10%). Recurrences were nodular cystic (40%), micronodular (20%), multifocal (10%), and infiltrating (30%). A total of 86.6% of patients surveyed rated the aesthetic outcome of their surgery favorably. The cost compared with the cost of Mohs excision varied depending on the Current Procedural Terminology coding technique. CONCLUSIONS: Cross-sectional frozen-section recurrence rates can compare favorably with Mohs micrographic surgery. The cross-sectional frozen-section technique generated a cost savings over Mohs surgery that may not hold true for all practice settings. Margin size did not adversely affect aesthetic results. Loupe magnification x2.5 is important in our technique. We also offer a useful definition for recurrence.

Aged↗
PubMed1989

Alveolar soft part sarcoma. Assessment of immunohistochemical demonstration of desmin using paraffin sections and frozen sections.

The many different theories on the histogenesis of alveolar soft part sarcoma (ASPS) have caused great confusion. Owing to the recent rapid advance in immunohistochemical studies, two major hypotheses have been proposed. One group of researchers supports the idea that ASPS shows myogenic differentiation, while the other group opposes the idea. This confrontation is essentially one between a group that believes in the immunohistochemically demonstrated presence of desmin in ASPS and a group that denies it. In the present study we detected desmin in 6 of 10 formalin-fixed paraffin sections (although there were differences due to the use of five commercially available types of anti-desmin antibodies). When acetone-fixed paraffin sections and periodate-lysin-paraformaldehyde (PLP)-fixed frozen sections were used in one and three cases, respectively, they were found to be desmin positive, regardless of the type of antibody. The consistent positivity for all anti-desmin antibodies in the cases treated with acetone or PLP is very suggestive of a myogenous origin of ASPS. It is important to take into consideration the fact that formalin-fixed paraffin sections are not very suitable for immunohistochemical study of desmin.

Adolescent↗
PubMed2005

The value of frozen section analysis of the sentinel lymph node in clinically N0 squamous cell carcinoma of the oral cavity and oropharynx.

OBJECTIVE: To determine the feasibility and accuracy of fine-sectioned frozen-section analysis of the sentinel lymph node (SLN) in cN0 oral cavity and oropharynx squamous cell carcinoma. STUDY DESIGN: Thirty-one patients were included and underwent lymphoscintigraphy a day before surgery and marking of the SLN. Intraoperatively, the SLNs were identified using a gamma probe, excised, and analyzed using fine-sectioned frozen section. The remaining SLN tissue was fixed in formalin for further staining and immunohistochemical analysis. An elective neck dissection was performed in all patients and all excised lymph nodes were examined for metastatic disease. RESULTS: SLNs were identified preoperatively by lymphoscintigraphy as well as by gamma probe intraoperatively in all patients. A total of 82 sentinel lymph nodes were excised and analyzed by fine-sectioned frozen section. Micrometastases were found in 16 out of the 82 SLNs, upstaging 14 out of 31 patients (45%) from cN0 to pN+. Furthermore, a total of 1295 lymph nodes from the neck dissection specimens were analyzed, confirming only one more metastatic disease. Sensitivity and negative predictive value of SLN biopsy were 93% and 94% respectively for frozen section analysis. CONCLUSION: Our study shows that SLN biopsy in cN0 neck of patients with oral cavity and oropharyngeal carcinoma is both feasible and accurate. Provided that larger studies confirm our results, an elective neck dissection may become unnecessary if fine-sectioned frozen-section analysis of the SLN shows no nodal metastases in patients with cN0 oral cavity and oropharynx carcinoma.

Aged↗
PubMed2003

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

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.

False Positive Reactions↗
PubMed1995

Analysis of renal allograft frozen-sections.

Frozen-section analysis of renal allograft biopsy specimens is performed to permit modification of therapy during acute events in transplanted patients. Over a two-year period, out of 110 renal allograft biopsies 66 were analyzed on a frozen-section. The authors compared diagnoses obtained on a fresh-material frozen-section with those following profound specimen analysis. The accurate diagnosis was achieved in 61 (92.4%) cases, acute rejection being predominant (53 cases). Missdiagnoses referred to oxalosis (1 case), acute rejection (2 cases), acute pyelonephritis (1 case) and cortical infarction (1 case). The authors conclude that a frozen-section analysis is a useful tool in cases requiring fast decision.

Biopsy↗
PubMed1984

An improved procedure for immunoelectron microscopy: ultrathin plastic embedding of immunolabeled ultrathin frozen sections.

Ultrathin frozen sections are ideal substrates with which to carry out immunolabeling experiments in electron microscopy. However, the ultrastructural delineation in positively stained frozen sections has not been as detailed as in conventionally osmium-stained and plastic-embedded sections. We now describe a simple technique in which immunolabeled ultrathin frozen sections are subsequently treated with osmium tetroxide, dehydrated, and then embedded in plastic by impregnation with a monomer to the thickness of the section, followed by polymerization of the monomer. By this technique ultrastructural definition as good as that of conventional plastic sections is achieved, while the high density and specificity of immunolabeling characteristic of ultrathin frozen sections are retained.

Animals↗
PubMed1986

Frozen-section diagnosis in surgical pathology. A prospective analysis of 526 frozen sections.

Five hundred eighty-six consecutive frozen-section consultations performed during a 1-year period were studied prospectively in order to assess the accuracy of the method and develop a quality control mechanism. The overall accuracy was 97.1%. The accuracy of the method with breast lesions was 97.9%. Specimens from the gastrointestinal tract and thyroid were incorrectly interpreted in 5% of the cases. The accuracy for lymph node specimens was 96.2%, with more than 50% consulted out of curiosity. The authors conclude that frozen section of lymph node is not recommended. Most of the errors were sampling errors made by the pathologist. The authors therefore conclude that in clinically suspected malignancy, more than one sample must be examined in order to decrease the false-negative diagnosis in frozen section.

Breast Neoplasms↗
PubMed1972

Detection of DNA by tritiated actinomycin D on ultrathin frozen sections.

Ultrathin frozen sections of fresh liver tissue were floated on actinomycin D-(3)H. Quantitative high resolution radioautography was performed to determine the value of the method for detection of DNA by electron microscopy. A complete series of control experiments involving various treatments of frozen sections with enzymes (pronase, DNase) and 0.1 N HCl were also carried out to determine the specificity of the labeling. The results indicate the value of the method for detection of DNA directly on ultrathin frozen sections. Short treatments with pronase followed by DNase reduce the labeling to zero, whereas removal of chromosomal proteins with HCl increases the amount of radioactivity in the nucleus considerably. The results are discussed in view of the future applications opened by ultracryotomy, since radioautographic detection of various macromolecules and cellular components by labeled compound with specific affinities will now be possible.

Animals↗
PubMed1996

Interinstitutional comparison of frozen section consultation in small hospitals: a College of American Pathologists Q-Probes study of 18,532 frozen section consultation diagnoses in 233 small hospitals.

OBJECTIVE: To study pathology intraoperative consultation practices and the accuracy of diagnoses made by frozen section. DESIGN: In 1994, participants in the College of American Pathologists Q-Probes laboratory quality improvement program each completed questionnaires and prospectively collected data on up to 20 frozen section procedures performed over a 5-month period. SETTING: Surgical pathology laboratories serving private and public hospitals with 300 or fewer occupied beds. PARTICIPANTS: Two hundred thirty-two North American institutions and one New Zealand institution. MAIN OUTCOME MEASURES: The discordance and deferral rates of frozen section diagnoses and the reasons for frozen section discordance relative to corresponding diagnoses made on permanent (paraffin) sections. Calculation of frozen section discordance rates excluded diagnoses of subtypes or grade of malignancy, biopsies on specimens in which there was no gross lesion (eg, mammographic specimens), thyroid follicular lesions, tissue taken only to determine adequacy for other studies (eg, estrogen-binding proteins), and frozen sections performed to evaluate margins of specimens oriented en face. RESULTS: Out of 18,532 frozen section diagnoses performed on 327,884 surgical cases, 859 (4.6%) diagnoses were deferred until permanent sections were available for review; 17,357 (98.2%) nondeferred diagnoses agreed with, and 316 (1.8%) disagreed with, those diagnoses rendered on permanent sections. The most common cause of discordance was underdiagnosis of neoplasia, usually due to block- or tissue-sampling errors. CONCLUSIONS: We recommend that laboratories routinely monitor frozen section discordance, cut additional sections deeper into the frozen block and/or sample additional tissue when the initial frozen section diagnosis is negative or nonproductive, reconcile all discordant frozen section diagnoses in the final report, and periodically assess the value of performing frozen section examinations.

Diagnostic Errors↗
PubMed1997

Frozen-section-guided breast-conserving surgery: implications of diagnosis by frozen section as a guide to determining the extent of resection.

This study was conducted to analyze retrospectively the results of performing sector resection on 56 breasts in 54 patients with breast cancer. The glands were resected with a 2-cm tumor-free margin on both lateral sides and the distal side, and with more than a 3-cm tumor-free margin on the nipple side. The frequency of positive resection margins for the cancer cells was 7/56 (12.5%) on the nipple side and 12/46 (26.1%) on the lateral sides, with an overall frequency of 15/56 (26.8%). There were positive resected margins for cancer cells on both the nipple and lateral sides in 4/46 patients (9%). Assuming the equivocal margins were positive for cancer cells, an accurate diagnosis by frozen section examination was made in 51 of the 56 operations (91.1%). Additional resection of the margins was performed in all 20 cases of a positive resected margin for cancer cells according to the diagnosis by frozen section. Thereafter, the resected margins became negative in 13 cases (65%), but remained positive in 7 cases (35%). These results show that performing diagnosis by frozen section of the surgical margins is an effective guide to resecting tumors adequately.

Adult↗
PubMed1994

Immunohistochemical detection of sex steroid receptors in breast cancer using routine paraffin sections: comparison with frozen sections and enzyme immunoassay.

Estrogen and progesterone receptors (ER and PR) on 48 surgically removed breast cancers were evaluated by three methods: immunoenzymatic (ER/PR-EIA), immunohistochemical in frozen sections (ER/PR-ICA), and immunohistochemical in paraffin sections (ER/PR-PAR). The monoclonal antibodies H222 and KD68 were used for immunohistochemical detection of ER and PR, respectively. Immunohistochemical stains for pS2, an estrogen-regulated protein, were also done for compatibility with previous ER/PR-PAR studies. We assessed concordance with chi-square and Pearson's correlation coefficient. We concluded that ER/PR-PAR is the least sensitive of the three assays (90.9% ER, 88.5% PR) and, until appropriate technical and clinical validation is achieved, should not be used as a first-line assay. Also, because of this lower sensitivity, we recommended that pS2 evaluation always accompany ER/PR-PAR to facilitate distinction between clinical negatives and those due to irretrievably lost immunoreactivity. We also conclude that ER/PR-ICA is a good semi-quantitative method that, in combination with ER/PR-EIA, most accurately assesses receptor status.

Breast Neoplasms↗
PubMed1971

Improved techniques for the preparation of ultrathin frozen sections.

Ultrathin frozen sections of biological tissues for electron microscopy provide certain advantages in cytochemical studies in which the penetration of cells by large molecules is necessary and in morphological studies of cellular constituents which are dissolved by the reagents employed in routine plastic embedding. The recent introduction of several types of commercially available cryo-ultramicrotomes makes it possible for many laboratories to employ this valuable tool. This paper summarizes recent improvements in the methods developed in this laboratory for preparing ultrathin frozen sections and reviews some of the inherent problems involved in their use. These procedures may serve as a baseline for other investigators who can then modify or adapt them for their specific purposes.

Adrenal Glands↗
PubMed1998

Intraoperative confirmation of parathyroid tissue during parathyroid exploration: a retrospective evaluation of the frozen section.

Although the frozen section is widely used to identify tissue type during parathyroid exploration in patients with hyperparathyroidism, questions regarding its accuracy have been raised. Frozen section error has been identified as a significant factor contributing to surgical failure. The purpose of this study was to establish the accuracy of frozen section in this setting and to identify pitfalls underlying frozen section error. The final pathologic diagnoses were compared with the paired frozen section diagnoses for all patients who underwent parathyroid exploration at this institution in the period between 1984 and 1997. For those cases in which a discrepancy was identified, the original histopathology slides and the medical records were reviewed. Of the 1579 frozen sections, a definitive and accurate diagnosis could not be determined in 20 cases (1.3%); in 7 (0.4%), the frozen section diagnosis was deferred, and in the other 13 cases, the frozen section diagnosis was incorrect. Overall accuracy rate was 99.2% after deferred cases were excluded. Frozen section artifact, sampling error, and judgmental error contributed to deferred or incorrect diagnoses. Several features confounded the distinction between parathyroid and thyroid tissue in 10 cases: the coexistence of parathyroid and nodular thyroid disease; intrathyroidal parathyroid glands showing conspicuous follicle formations or abundant oncocytic cells; and thyroid nodules with fatty stroma. The frozen section is a highly reliable means of identifying tissue type during parathyroid exploration. In exceptional cases, however, the distinction between parathyroid and thyroid tissue may not be possible owing to a striking overlap seen at the clinical, gross, and microscopic levels.

Artifacts↗
PubMed1997

Interinstitutional comparison of frozen section turnaround time. A College of American Pathologists Q-Probes study of 32868 frozen sections in 700 hospitals.

OBJECTIVES: To study the intraoperative turnaround time for performing a frozen section (FS) and to examine pathology practice variables that influence it. DESIGN: Over a 4-month period in 1995, participants in the College of American Pathologists Q-Probes laboratory quality improvement program prospectively collected data on up to 30 FS procedures performed on elective inpatient surgical cases and completed questionnaires profiling their FS practice characteristics. SETTING: Surgical pathology laboratories serving private and public hospitals. PARTICIPANTS: Seven hundred institutions located in North America (667), Australia (12), New Zealand (1), the United Kingdom (3), Hong Kong (1), Mexico (1), and Norway (1). MAIN OUTCOME MEASURES: The 90% FS block completion time defined as the time interval, in minutes, within which the fastest 90% of all FS blocks were completed, measured from the time pathologists received FS specimens to the time they communicated FS results to the surgeon. RESULTS: Participants submitted data on 32868 FS blocks. Ninety percent of FS procedures were completed within 20 minutes. Frozen section turnaround times exceeding 20 minutes, termed outlier turnaround times, were more likely to occur when more than one pathologist participated in the FS diagnosis, pathology residents and medical students participated in the FS procedure, the pathologist had to retrieve and review previous case material during the FS procedure, the pathologist simultaneously received additional specimens from other FS cases, the pathologist was unable to reach a final FS diagnosis, and when technical problems occurred during the FS procedure. Seventy percent of all participating hospitals completed 90% of their frozen sections within 20 minutes. The institutional 90% completion times were shorter for hospitals containing 300 or fewer occupied beds than for those containing more than 300 occupied beds. CONCLUSIONS: The data suggest that 90% of FS block turnaround times can be performed within 20 minutes, measured from the time that pathologists receive FS specimens to the time that pathologists return FS diagnoses to surgeons.

Australia↗
PubMed1980

Immunochemistry on ultrathin frozen sections.

Ultrathin frozen sections can be cut smoothly from many fixed and appropriately treated specimens. To use such sections for immunochemical localization of intracellular antigens, fixation conditions must be selected to optimize at least three variables, namely, preservation of ultrastructure, preservation of antigenicity and retention of accessibility of the antigen to the antibody. Furthermore, staining of the sections must be such that both the immunolabels and structures are clearly recognized. Our efforts to attain these goals are described in relation to their historical background. Although there are still problems to be solved and improvements to be made, we now consider that cryoultramicrotomy has reached the stage of being useful in studying many questions which will not be easily approached otherwise.

Animals↗
PubMed1991

In situ visualization of hemopoietic cell subsets and stromal elements in rat and mouse bone marrow by immunostaining of frozen sections.

We have developed a method to section frozen long bones of rat and mouse and stained bone marrow (BM) by (double) immunofluorescence and immunoperoxidase. Here we report this method and reveal the location of early hemopoietic progenitors (Thy-1) and myeloid cells (Mac-1) in mouse BM, and early hemopoietic progenitors and lymphoid cells (Thy-1), erythroid cells (HIS49), and macrophages (ED2) in rat BM. In mouse BM our new findings include (a) the scattered localization of early hemopoietic progenitors (Thy-1low) all over the marrow, and (b) the presence of Thy-1+ stromal cells, mainly subendosteally. In rat BM an important finding is that of (a) a subendosteal region of 12-14 hemopoietic cell layers characterized by an abundance of Thy-1 and the virtual absence of erythroid cells, and (b) the scattering of Thy-1very bright cells which are candidates for the earliest hemopoietic progenitors in this species. The results illustrate that the technique is an excellent tool for studying the topology of BM as an organ of hemopoiesis.

Animals↗