Content area
Objectives
Monitoring of frozen section diagnostic performance provides an important quality improvement measure.
Methods
Surgical specimens involving a frozen section diagnosis over a 3-year period were retrospectively reviewed. Glass slides were reviewed on cases with discordance. Discordance and deferral rates were calculated.
Results
Of 3,675 frozen section diagnoses included, 96 (2.7%) were discordant with the final diagnosis. Additionally, 114 frozen section diagnoses (3.1%) were deferred. The organ-specific discordance rates were lowest in breast and genitourinary specimens and highest for pancreas, lymph node, and gynecologic specimens. Deferral rates were highest in musculoskeletal, breast, and hepatobiliary cases and lowest in thyroid, parathyroid, and neuropathology cases. Discordance was explained by block-sampling error (45%), specimen-sampling error (27%), or interpretation error (27%). Discordant frozen section diagnoses from gynecologic specimens were responsible for 81% of specimen-sampling errors; frozen section diagnoses of lymph nodes, head and neck, and pancreas were responsible for 54% of interpretation errors; 51% of block-sampling errors involved lymph node evaluation for metastatic carcinoma.
Conclusions
Careful gross evaluation and microscopic examination of multiple levels should minimize specimen-sampling error and block-sampling error, respectively. Periodic review of accuracy and deferral rates may help reduce errors and improve the overall performance of this essential procedure.
Details
; Muhammad Masood Hassan 2 ; Zhong, Wen 3 ; Kousar, Aisha 1 ; Takeda, Kotaro 1 ; Donthi, Deepak 4 ; Rizvi, Areeba 1 ; Majeed, Marwan 1 ; Younes, Ahmed I 1 ; Ali, Ahlam 5 ; Sutton, Ann 1 ; Murray, Gina 1 ; Thayyil, Abdullah 1 ; Fallon, John 1 ; Geisinger, Kim 6 1 Department of Pathology and Laboratory Medicine, East Carolina University/Vidant Medical Center , Greenville, NC , USA
2 Department of Pathology, University of Mississippi Medical Center , Jackson , MS , USA
3 Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center , Pittsburgh, PA , USA
4 Department of Pathology, University of Texas Southwestern Medical Center , Dallas , TX , USA
5 Department of Pediatrics, Faculty of Medicine, Omar Al-Mukhtar University, Al Bayda , Libya and
6 The Joint Pathology Center , Silver Spring, MD , USA