Frozen sections – appropriate use and limitation

(Aotea News, December 2009)

Dr Rupa Maitra
Anatomic Pathologist

The frozen section is a valuable intraoperative tool that can add to a patient’s standard of care, if used appropriately.

However, the decision to request a frozen section must not be made lightly, as the procedure is disruptive to the surgical procedure and lab workflow

There are also significant limitations in frozen section analysis. These include:

• issues with sampling
• interpretive difficulties resulting from time pressure, artefacts in the section
• lack of special stains to aid diagnosis
• frozen tissue being less suitable for further testing with histochemical and immunohistochemical stains. This may prevent a definitive diagnosis if fresh tissue is not available.

A request for frozen section is appropriate if the intraoperative diagnosis will:

• make a difference to the procedure
• avoid subsequent surgical procedures
• assist in staging
• determine surgical margin status
• help investigate unexpected findings at time of surgery.

Importantly, the operator needs to be on site and available to receive a report from a frozen section test, keeping in mind that there is a potential negative impact on a patient if it is used inappropriately.