Validation of frozen section in intraoperative decision making in malignancies

INTRODUCTION: The Frozen section procedure is a laboratory procedure to perform rapid microscopic pathological analysis of specimen. The technical name of this procedure is Cryosection. Frozen section is an important tool in the armamentarium of the surgical oncologist. Intraoperative diagnosis is extremely important and may provide direct evidence and foundation for the extent of the surgery. AIM OF STUDY: To validate the efficacy of frozen section in the intraoperative management of various malignancies , by comparing it with the permanent paraffin section. MATERIALS AND METHODS: Study Design: Prospective study Place of study : Department of Surgical Oncology Govt. Royapettah hospital, Kilpauk Medical College, Chennai. Duration of study : October 2011 – January 2014. Inclusion Criteria: 1. Patients requiring frozen section for primary diagnosis. When preoperative diagnosis/ biopsy not possible. Unexpected intraoperative findings & to assess the presence of synchronous lesions. 2. In patients with known malignancy; To assess margin status, To assess the extent of disease, 3. For assessment of lymph nodes; For establishing a diagnosis, To assess involvement of the node, in case of known primary, Sentinel node evaluation in selected cases. 4. Assessment of specimen adequacy To assess the adequacy of specimen in difficult biopsies Exclusion criteria: 1. When intraoperative pathological diagnosis has no immediate surgical implications. 2. Technically difficult specimen such as heavily ossified tissue. 3. When the primary diagnosis is not known and the primary lesion size < 1 cm, Frozen section is not indicated because enough tissue would not be available for the permanent section. CONCLUSION: Frozen section is reliable and accurate for intraoperative evaluation of nodes, margin status and for the primary diagnosis of most tumors. However, it has limited value in the evaluation of certain tumors like melanoma, follicular neoplasms of the thyroid, lymphomas, borderline ovarian tumors and pancreatic mass lesions. Tumors with a large necrotic component and very small samples pose challenges in evaluation by frozen section due to high sampling errors and technical difficulty respectively. Frozen section evaluation is an accurate means of intraoperative diagnosis and its efficacy can be validated at our centre