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Comparison of Barium Enema and frozen section results in the diagnosis of Hirschsprung's Disease in a tertiary care hospital at Aceh, Indonesia

Rizky M, Isa MM, Kamarlis RK

Med J Malaysia, 2020 05;75(Suppl 1):37-40.
PMID: 32471967

INTRODUCTION: Hirschsprung's Disease (HD) also called congenital aganglionic megacolon is a disorder caused by undeveloped distal to proximal intestinal nerve ganglion cells. Diagnosis includes determining the aganglionic segment through barium enema radiology examination and histopathology of frozen section with permanent section as gold standard. Determining the diagnostic value of this modality is important for operative management decision.
MATERIALS AND METHODS: The study was a retrospective, cross-sectional study with diagnostic test design. Patient data were obtained in the form of clinical symptoms, barium enema, and frozen section expertise were assessed for the suitability of the diagnostic value by referring to the permanent section as the gold standard.
RESULT: Thirty-four patient data were obtained. The sensitivity, specificity, and accuracy of barium enemas were 95%, 69.2%, and 82%, respectively. The values of sensitivity, specificity, and accuracy of frozen section were 95%, 92.8%, and 88%, respectively. The Cohen-Kappa statistic value was 0.62 (good agreement).
CONCLUSION: Accuracy of FS is better than barium enema in diagnosing HD. In health care center with limitation of histopathological facility, BE could be used as the alternative procedure as interrater comparisons showed good agreement. Therefore, either frozen section or barium enema can be carried out in common or in separate term.

Matched MeSH terms: Frozen Sections*
Diagnostic Accuracy of Cytology Smear and Frozen Section in Glioma

Mat Zin AA, Zulkarnain S

Asian Pac J Cancer Prev, 2019 Feb 26;20(2):321-325.
PMID: 30803189

Glioma is the commonest primary intracranial tumour and it has been the most predominant tumour in many studies.
It accounts for 24.7% of all primary brain tumour and 74.6% of malignant brain tumour. Intraoperative diagnosis
plays a crucial role in determining the patient management. Frozen section has been the established technique in
providing rapid and accurate intraoperative diagnosis. However due to some disadvantages like ice crystal artefact,
high expenditure and requirement of skilled technician, there is increase usage of cytology smear either replacing or
supplementing frozen section technique. The aim of this review is to determine the diagnostic accuracy of cytology
smear and frozen section in glioma and to see whether there is significant difference between those techniques. The
overall diagnostic accuracy for frozen section in glioma ranging from 78.4% to 95% while for cytology smear, the
diagnostic accuracy ranging from 50% to 100%. Based on certain literatures, no statistically difference was observed
in diagnostic accuracy of cytology smear and frozen section. Thus, cytology smear provides an alternative method in
establishing intraoperative diagnosis. Both cytology smear and frozen section are complimentary to each other. It is
recommended to use both techniques to improve the diagnostic accuracy in addition with adequate knowledge, clinical
history, neuroimaging and intraoperative findings.

Matched MeSH terms: Frozen Sections*
Intra-Operative Frozen Sections for Ovarian Tumors – A Tertiary Center Experience

Md Arshad NZ, Ng BK, Md Paiman NA, Abdullah Mahdy Z, Mohd Noor R

Asian Pac J Cancer Prev, 2018 Jan 27;19(1):213-218.
PMID: 29373916

Background: Accuracy of diagnosis with intra-operative frozen sections is extremely important in the evaluation of ovarian tumors so that appropriate surgical procedures can be selected. Study design: All patients who with intra-operative frozen sections for ovarian masses in a tertiary center over nine years from June 2008 until April 2017 were reviewed. Frozen section diagnosis and final histopathological reports were compared. Main outcome measures: Sensitivity, specificity, positive and negative predictive values of intra-operative frozen section as compared to final histopathological results for ovarian tumors. Results: A total of 92 cases were recruited for final evaluation. The frozen section diagnoses were comparable with the final histopathological reports in 83.7% of cases. The sensitivity, specificity, positive predictive value and negative predictive value for benign and malignant ovarian tumors were 95.6%, 85.1%, 86.0% and 95.2% and 69.2%, 100%, 100% and 89.2% respectively. For borderline ovarian tumors, the sensitivity and specificity were 76.2% and 88.7%, respectively; the positive predictive value was 66.7% and the negative predictive value was 92.7%. Conclusion: The accuracy of intra-operative frozen section diagnoses for ovarian tumors is high and this approach remains a reliable option in assessing ovarian masses intra-operatively.

Matched MeSH terms: Frozen Sections
Fulltext Intra-operative frozen section consultation: concepts, applications and limitations

Jaafar H

Malays J Med Sci, 2006 Jan;13(1):4-12.
PMID: 22589584

Intra-operative frozen section plays an important role in the management of surgical patients and yet it must be used prudently to avoid the indiscriminate usage of this important technique. As it is subjected to many limitations in comparison to the paraffin embedded tissue sections, this review aims to highlight the important concepts and principle of intra-operative frozen section consultation as well as discussing the limitations of this technique. This will then allow the endusers of this technique to be more informed and more selective in their decisions when requesting for a frozen section report.

Matched MeSH terms: Frozen Sections
Fulltext An audit of intraoperative frozen section in Johor

Khoo JJ

Med J Malaysia, 2004 Mar;59(1):50-5.
PMID: 15535336 MyJurnal

A 4-year-review was carried out on intraoperative frozen section consultations in Sultanah Aminah Hospital, Johor Bahru. Two hundred and fifteen specimens were received from 79 patients in the period between January 1999 and December 2002. An average of 2.72 specimens per patient was received. The overall diagnostic accuracy was high, 97.56%. The diagnoses were deferred in 4.65% of the specimens. False positive diagnoses were made in 3 specimens (1.46%) and false negative diagnoses in 2 specimens (0.98%). This gave an error rate of 2.44%. The main cause of error was incorrect interpretation of the pathologic findings. In the present study, frozen sections showed good sensitivity (97.98%) and specificity (97.16%). Despite its limitations, frozen section is still generally considered to be an accurate mode of intraoperative consultation to assist the surgeon in deciding the best therapeutic approach for his patient at the operating table. The use of frozen section with proper indications was cost-effective as it helped lower the number of reoperations. An audit of intraoperative frozen section from time to time serves as part of an ongoing quality assurance program and should be recommended where the service is available.

Matched MeSH terms: Frozen Sections/standards*
Accuracy of intraoperative consultation for ovarian tumours: Experience in an Indonesian teaching hospital

Fauziah D, Anggoro R R

Malays J Pathol, 2020 Dec;42(3):409-414.
PMID: 33361722

BACKGROUND: Ovarian tumours are a very heterogeneous group of tumours, consisted of non-neoplastic and neoplastic lesions. Preoperative diagnoses in most conditions are inconclusive due to similar clinical, radiological and laboratory findings. Intraoperative consultation is crucial because it can provide rapid diagnosis leading to a suitable surgical management for the patients.
OBJECTIVE: To obtain profile, accuracy and concordance rates of ovarian intraoperative consultation in Dr. Soetomo Hospital Surabaya, a teaching hospital in Indonesia.
MATERIALS AND METHODS: Observational retrospective study, using data from archives of intraoperative consultation reports in Dr. Soetomo General Hospital Surabaya within 2012-2016 period. There were 734 cases of ovarian intraoperative consultations, all then proceed to permanent sections. Accuracy, sensitivity, and specificity rates were calculated.
RESULTS: Overall accuracy was 89.5%. Sensitivity for benign, borderline and malignant cases were 98.49%, 71.19% and 84.01%, respectively. Specificity were 90.32%, 95.11% and 98.72%, respectively.
CONCLUSION: Intraoperative consultation for ovarian tumours has a reliable diagnostic value in benign and malignant lesion, but lower value in borderline tumours.

Matched MeSH terms: Frozen Sections*
Intraoperative frozen section sentinel lymph node assessment in breast cancer: A tertiary institution experience

Lai SK, Masir N, Md Pauzi SH

Malays J Pathol, 2018 Aug;40(2):121-128.
PMID: 30173228 MyJurnal

INTRODUCTION: Intraoperative frozen section lymph node assessment helps to predict axillary lymph node metastasis in breast cancer. However, the accuracy of this frozen section analysis may vary among institutions. This study describes our institution's experience in intraoperative analysis of sentinel lymph node and aims to determine the accuracy, sensitivity and specificity of our assessment.
MATERIALS AND METHODS: We retrospectively analysed the histopathological material and data from 82 breast cancer patients diagnosed over a period of four years who underwent intraoperative frozen section evaluation of sentinel lymph nodes.
RESULTS: Frozen section analysis detected metastasis in 13 out of 82 cases and definitive pathological examination on the paraffin section confirmed these positive findings. There was no false positive case (specificity of 100%). The true positive cases comprised seven macrometastases, five micrometastases and one isolated tumour cells. Sampling error was noted in two cases in which the malignant cells were only present in the deeper final paraffin sections (false negative rate of 13.3%). The test sensitivity was 86.7% and the accuracy rate was 97.5%. These findings are comparable to other published data.
CONCLUSION: Intraoperative frozen section analysis is a safe and reliable method for assessment of sentinel lymph node. Knowledge on limitation of frozen section analysis with diligent evaluation of frozen section specimen will be beneficial in reducing interpretation error.

Matched MeSH terms: Frozen Sections/methods*
Prospective study comparing scrape cytology with frozen section in the intraoperative identification of parathyroid tissue

Rohaizak M, Munchar MJ, Meah FA, Jasmi AY

Asian J Surg, 2005 Apr;28(2):82-5.
PMID: 15851358

Intraoperative identification of parathyroid tissue is crucial during parathyroid surgery. Frozen section is the most common tool, but is time-consuming and expensive. Scrape cytology is a modification of imprint cytology that provides rapid and cheap intraoperative identification of parathyroid tissue, but its reliability remains controversial. We assessed the sensitivity and specificity of scrape cytology in the intraoperative identification of parathyroid tissue.

Matched MeSH terms: Frozen Sections
Fulltext Ectopic Esthesioneuroblastoma of the Sphenoclivus: A Rare Entity

Zahedi FD, Gendeh BS, Husain S, Kumar R, Kew TY

Indian J Otolaryngol Head Neck Surg, 2017 Mar;69(1):125-129.
PMID: 28239593 DOI: 10.1007/s12070-016-0978-0

Esthesioneuroblastoma is a rare malignant neoplasm of oflactory neuroepithelium and usually located at the olfactory cleft at superior nasal cavity. Ectopic localization of esthesioneuroblastoma is even rarer and usually posed with a diagnostic dilemma and delay in the diagnosis and management, We report a rare case of ectopic esthesioneuroblastoma of the sphenoclivus with the presentation of intermittent unilateral epistaxis, intermittent intractable headache without anosmia. Nasal endoscopy findings showed a pulsatile mass at the anterior face of the sphenoid sinus with extension posteriorly towards the clivus region and occupying the floor of the sphenoid sinus. Endonasal transclival endoscopic excision of tumour was performed which involved otorhinolaryngology surgeon and neurosurgeon with intraoperative navigation imaging and frozen section. The histopathological findings was esthesioneuroblastoma. Due to its rarity and unusual presentation, the diagnosis of ectopic esthesioneuroblastoma is difficult and can be misdiagnosed with the other type of malignancy. Therefore, the histopathological result is important in confirming the type of tumour and can lead to the next step of management.

Matched MeSH terms: Frozen Sections
Fulltext Evaluation Study of Intraoperative Cytology Smear and Frozen Section of Glioma

Zulkarnain S, Yunus N, Kandasamy R, Zun AB, Mat Zin AA

Asian Pac J Cancer Prev, 2020 Oct 01;21(10):3085-3091.
PMID: 33112571 DOI: 10.31557/APJCP.2020.21.10.3085

OBJECTIVE: Glioma is the commonest primary malignant brain tumour. Diagnosis is made based on cytology smear, frozen section and histopathological examination. Intraoperative pathological diagnosis using either cytology smear, frozen section or combination of both, plays a crucial role in patient's future management and prognosis. This study aims to determine the accuracy of cytology smear and frozen section in glioma, and to compare the difference between both techniques.
METHODS: A cross-sectional study was conducted involving 22 cases of glioma diagnosed intraoperatively from January 2013 until August 2019 in Hospital Universiti Sains Malaysia. The selected tissues were processed for cytology smear and frozen section. The remaining tissues were proceeded for paraffin section. The diagnosis was categorized as either low-grade or high-grade glioma based on cellularity, nuclear pleomorphism, mitotic count, microvascular proliferation and necrosis. The sensitivity and specificity of frozen section and cytology smears were determined based on paraffin section being as the gold standard. The accuracy of both techniques was compared using statistical analysis.
RESULTS: The overall sensitivity and specificity of cytology smear were 100% and 76.9%, respectively. Meanwhile, the sensitivity and specificity of frozen section were 100% and 84.6%. There was no significant difference in diagnostic accuracy between cytology smear and frozen section in glioma (p>0.05).
CONCLUSION: Cytology smears provides an alternative method for frozen section due to good cellularity and morphology on smear. Cytology smear is rapid, inexpensive, small amount of tissue requirement and less technical demand. This finding may benefit to the hospital or treatment centres where frozen section facility is unavailable.

Matched MeSH terms: Frozen Sections