Accuracy of intra-operative frozen section consultation of gastrointestinal biopsy samples in correlation with the final histopathological diagnosis

Abstract

Introduction: Frozen section (FS) is an intraoperative diagnostic tool which provides the operating surgeon with a rapid diagnosis, helping him to make a timely decision which may have a significant impact on patient management & prognosis. Hence the efficiency of this technique has to be periodically reviewed to ensure that the quality of the sections and agreement between frozen section diagnosis and final diagnosis remain at an acceptable level. Objective: To assess accuracy, sensitivity & specificity of Intra-operative frozen section in the diagnosis of a lesion & in determining the adequacy of surgical resection margins in gastrointestinal surgeries. Methods: Total 220 cases and 521 intra-operative FS specimen during gastro-intestinal surgeries were analysed. The samples were sent for intraoperative diagnosis and margin assessment. The initial FS report was then correlated with the final histopathology report and the concordance rate & reasons for discrepancies were analysed. Results: After the correlation of all the specimen with final histopathology, the diagnosis was conclusive in 99.2 % (215 cases) & deferred in 0.8 %(5 cases). The cases with conclusive diagnoses showed a concordance rate of 91.1% for all cases and 95.9% for all specimens (excluding deferrals). Sensitivity and specificity of FS diagnosis as compared to histopathology was found to be 89.3% and 98.4% respectively. Conclusion: The accuracy, sensitivity, specificity of frozen section diagnosis in this study are comparable with most international quality control statistics for frozen sections. Keeping the limitations and pitfalls in mind, FS technique is very reliable in good hands.