Intraoperative consultation, also known as frozen section examination, is a crucial medical procedure used for immediate decision-making during surgery. It involves the rapid analysis of a tissue sample obtained during an operation to provide real-time information about its nature. This technique is useful when the surgeon cannot afford to wait for the standard processing time required for traditional histopathological examination.
Frozen section procedure
The frozen section procedure begins when a fresh tissue sample is excised during oncologic surgery, while the patient is under anesthesia and is operated upon. This tissue is promptly sent to the pathology lab, where a pathologist performs a gross examination to assess its characteristics. Instead of preserving the tissue in wax blocks for later analysis, the tissue is rapidly frozen in a special solution, forming a cube around the specimen. Subsequently, a machine called a cryostat is used to slice the frozen tissue into thin sections, which are then stained with dye and observed under a microscope.
However, it is important to note that frozen section examination is not as detailed or accurate as traditional histopathology using wax-embedded tissues.
What is the purpose of intraoperative consultation?
The primary purpose of intraoperative consultation is to ensure that all cancerous tissue is adequately removed during surgery. If the surgeon has doubts about completely removing the tumor, they may opt for a frozen section procedure to ascertain the presence of any remaining cancerous cells. In case cancer cells are detected, additional excision of tissue is necessary during the same surgery. Furthermore, the frozen section examination is also performed to assess surgical margins, determine the nature of lesions, and evaluate whether the tumor is confined to a specific area or has spread to other parts of the body.
Some of the potential risks include errors in the pathologist's diagnosis, which can lead to false-positive or false-negative results. Additionally, there is a possibility of sampling error, where the analyzed tissue section might not be fully representative of the entire tumor. For certain types of tissue, such as bones or calcified tissue, frozen section examination is not suitable due to calcium deposits.
Intraoperative consultation, or frozen section examination, plays a critical role in ensuring the accuracy and success of surgical procedures, particularly in oncologic surgeries. Despite its limitations and potential risks, this procedure remains a valuable tool for surgeons and pathologists to make informed decisions promptly, thus contributing to better patient outcomes and increased precision in cancer treatment.