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326:, a sample of the suspected metastasis is sent for cryosection to confirm its identity. This will help the surgeon decide whether there is any point in continuing the operation. Usually, aggressive surgery is performed only if there is a chance to cure the patient. If the tumor has metastasized, surgery is usually not curative, and the surgeon will choose a more conservative surgery, or no resection at all. If a tumor has been resected but it is unclear whether the resection margin is free of tumor, an intraoperative consultation is requested to assess the need to make a further resection for clear margins. In a
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diagnosis was good, as confirmed later by regular biopsy. On the contrary, where the frozen section diagnosis was a borderline tumor, neither confirming not ruling out cancer, the diagnosis was less accurate. The review suggests that in such situations of uncertainty, surgeons may choose to perform additional surgery in this group of women at the time of their initial surgery in order to reduce the need for a second operation, as on an average one out of five of these women were subsequently found to have cancer.
172:; this compound is known by many names and when frozen has the same density as frozen tissue. At this temperature, most tissues become rock-hard. Usually a lower temperature is required for fat or lipid rich tissue. Each tissue has a preferred temperature for processing. Subsequently, it is cut frozen with the microtome portion of the cryostat, the section is picked up on a glass slide and stained (usually with
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inside a freezer. The microtome can be compared to a very accurate "deli" slicer, capable of slicing sections as thin as 1 micrometre. The usual histology slice is cut at 5 to 10 micrometres. The surgical specimen is placed on a metal tissue disc which is then secured in a chuck and frozen rapidly to
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A Cochrane systematic review published in 2016 analysed all studies that reported diagnostic accuracy of frozen sections in women undergoing surgery for suspicious tumor in ovary. The review concluded that for tumors that were clearly either benign or malignant on frozen section, the accuracy of the
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masked by formalin. The cryostat is available in a small portable device weighing less than 80 lb (36 kg), to a large stationary device 500 lb (230 kg) or more. The entire histologic laboratory can be carried in one portable box, making frozen section histology a possible tool in
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If surgery is explorative, rapid examination of a lesion might help identify the possible cause of a patient's symptoms. It is important to note, however, that the pathologist is very limited by the poor technical quality of the frozen sections. A final diagnosis is rarely offered intraoperatively.
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preparations taken on the specimen (e.g. touch imprints), and aliquoting of the specimen for special studies (e.g. molecular pathology techniques, flow cytometry). The report given by the pathologist is often limited to a "benign" or "malignant" diagnosis, and communicated to the surgeon operating
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also involved frozen section, but only after formalin fixation, and pathologist Dr
William Welch, also at Hopkins, experimented with Cullen's procedure but without clinical consequences. Hence, Wilson is generally credited with truly pioneering the procedure (Gal & Cagle, 2005).
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technique (around 10 minutes vs 16 hours). However, the technical quality of the sections is much lower. The entire laboratory can occupy a space less than 9-square-foot (0.84 m), and minimal ventilation is required compared to a standard wax embedded specimen laboratory.
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The quality of the slides produced by frozen section is of lower quality than formalin fixed paraffin embedded tissue processing. While diagnosis can be rendered in many cases, fixed tissue processing is preferred in many conditions for more accurate diagnosis.
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Rarely, cryosections are used to detect the presence of substances lost in the traditional histology technique, for example lipids. They can also be used to detect some
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The principal use of the frozen section procedure is the examination of tissue while surgery is taking place. This may be for various reasons. In the performance of
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is clear of residual cancer, or if residual cancer is present at the resection margin. The method of processing is usually done with the
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via intercom. When operating on a previously confirmed malignancy, the main purpose of the pathologist is to inform the surgeon if the
330:, a sentinel node containing tumor tissue prompts a further lymph node dissection, while a benign node will avoid such a procedure.
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Fastening the chuck on the cryotome and cut relatively thick sections until the full tissue surfaces of interest are exposed
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Ratnavelu, ND; Brown, AP; Mallett, S; Scholten, RJ; Patel, A; Founta, C; Galaal, K; Cross, P; Naik, R (1 March 2016).
518:"Intraoperative frozen section analysis for the diagnosis of early stage ovarian cancer in suspicious pelvic masses"
363:, which is a very similar device to crytome, can cut ultrathin blocks of tissue, and that tissue can be observed by
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Advancing the specimen over the blade while holding the section down to prevent it from folding onto itself
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The frozen section procedure as practiced today in medical laboratories is based on the description by Dr
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Gal AA, Cagle PT (2005). "The 100-year anniversary of the description of the frozen section procedure".
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properties can be studied without embedding of the tissue, and so the molecular conservation is better.
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about –20 to –30 °C. The specimen is placed in a gel-like embedding medium, usually
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Applying a conductor (unless it's a thin specimen that needs to stand on its side)
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in 1905. Wilson developed the technique from earlier reports at the request of Dr
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367:. The cutting thickness of ultracryotome is about dozens of nanometers. The
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184:). The preparation of the sample is much more rapid than with traditional
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Breaking off any embedding medium that reaches below the chuck's plate
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Continue until all the tissue of interest is in the section
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Using freeze spray to quicken the freezing if available
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81:is the name given to the whole intervention by the
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401:"Testing Biopsy and Cytology Specimens for Cancer"
85:, which includes not only frozen section but also
50:analysis of a specimen. It is used most often in
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309:Minimal time in solutions for frozen sections.
62:device that cold cuts thin blocks of frozen
525:The Cochrane Database of Systematic Reviews
216:Covering the specimen with embedding medium
89:evaluation of the specimen, examination of
54:. The technical name for this procedure is
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151:The key instrument for cryosection is the
102:technique. But margin controlled surgery (
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204:Putting specimens on one or more chucks.
126:, surgeon and one of the founders of the
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16:Rapid histological sectioning procedure
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571:. Atlas of Plant and Animal Histology
300:Putting a glass slide on the tissue.
25:optimal cutting temperature compound
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365:transmission electron microscopy
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79:intraoperative consultation
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37:frozen section procedure
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136:Johns Hopkins Hospital
130:Earlier reports by Dr
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422:TheFreeDictionary.com
346:Accuracy of diagnosis
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610:Anatomical pathology
342:primitive medicine.
442:Wilson LB. (1905).
381:Frozen tissue array
192:Steps of cryotomy:
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174:hematoxylin
128:Mayo Clinic
83:pathologist
56:cryosection
48:microscopic
604:Categories
575:3 November
427:3 November
418:"Cryotome"
387:References
44:laboratory
186:histology
157:microtome
147:Procedure
140:Baltimore
60:microtome
555:26930463
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375:See also
339:antigens
153:cryostat
91:cytology
68:cryotome
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114:History
620:Biopsy
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178:eosin
87:gross
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475:JAMA
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314:Uses
176:and
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