How the storage and shipping of the pathological reports of the frozen exams are performed is little discussed and specified 3,17,20, The processing of data for these tests in digital computer systems facilitates the review of cases and retrospective studies, and provides solid support for medical-legal issues In this study, In other studies this percentage varies from The accuracy rate of frozen section pathological examinations in the service in question However, other studies show even higher levels, ranging from This difference may be explained, at least in part, by different methods of analysis.
If it were used, for example, the methodology of two other works, who disregarded inconclusive tests, it would render the same diagnostic accuracy as Cerski et al. Moreover, in different series the diagnostic accuracy of frozen section examination is variable according to the anatomic site studied 11,12,18, The most examined organ in this study was the thyroid, with Inconclusive examinations lead to decreased accuracy when combined in the overall analysis. When we evaluate the specific anatomical sites in the present series, the accuracy of frozen section biopsy ranged from Upon comparative analysis of this study with other works in the literature, it appears that this percentage of inconclusive examinations may be framed within the acceptable.
However, other studies have reported lower values.
Biopsy Interpretation: The Frozen Section
False-negative results are often associated with diagnostic discrepancies, ranging from 0. As for false-positive results in this study, there was none, as observed by other authors 17,20,21 , although they may vary from 0. Problems and implicit technical limitations, insufficient material and lack of clinical information also contribute to discordant results 2,4,9,19, The lesions that most often lead to diagnostic disagreements are well differentiated malignant tumors that can be confused with proliferative conditions, poorly differentiated benign tumors and malignant lesions with associated inflammatory processes 7.
In this study all injuries that led to diagnostic discrepancies corresponded to malignant neoplasms. Unlike most of the series appraised, in this service no case of false-positive was observed. Rosen 23 said that when there is any uncertainty about the diagnosis, it is best to postpone it. He recommended that surgeons would accept the reports of inconclusive examinations instead of pressuring the pathologists to take an imprecise decision, and concluded that to minimize the frequency of false-positive results, the option of delaying diagnosis is appropriate.
Another group 6 suggested that pathologists and surgeons should not draw any conclusions from inconclusive interpretations and should proceed as if the tests were not performed. The main sites of diagnostic discordance in a study of the College of American Pathologists 9 involving institutions that assessed more than 90, frozen section exams were: skin As noted in this series, the gastrointestinal tract was the "site" that was associated with less diagnostic discrepancies in other series 9, The skin, on its turn, was the specific anatomical site that was mostly associated with false-negative tests 7.
This observation is similar to the one of this research We observed another anatomic site that was associated with two 1.
The diagnostic sensitivity of intraoperative surveys depends on the type of carcinoma. In this study, a number of thyroid nodules submitted for evaluation by frozen section was diagnosed as colloid goiter, which was confirmed by subsequent cuts in paraffin. This examination was considered concordant. However, in other areas of the specimen sent after the operation, papillary microcarcinoma was detected.
In the literature there are reports of 5. The frozen section diagnosis of pulmonary nodules can be difficult, especially in inflammatory and fibrotic tissue, which can be mistaken for malignant lesions By globally assessing the pathological frozen section exams and comparing them with subsequent examination of paraffin, we found a diagnostic accuracy of When analyzed by specific anatomic site, diagnostic accuracy ranged from In conclusion, this study reinforces the importance of integration between the professional activities of surgeons and pathologists, through confidence in the test results provided by frozen sections, tested by systematic and periodic evaluation of its accuracy in the service.
The centennial anniversary of the frozen section technique at the Mayo Clinic. Arch Pathol Lab Med ; 12 Frozen section of lung specimens. Accuracy of frozen section diagnosis in surgical pathology: review of a 1-year experience with 24, cases at Mayo Clinic Rochester. Mayo Clin Proc ; 70 12 Interinstitutional comparison of frozen section consultation in small hospitals: a College of American Pathologists Q-Probes study of 18, frozen section consultation diagnoses in small hospitals.enter
Frozen Section Library: Pleura
Indications and immediate patient outcomes of pathology intraoperative consultations. Arch Pathol Lab Med ; 1 Accuracy of and reasons for frozen sections: a correlative, retrospective study. Hum Pathol ; 19 9 Lung ventilation occurs by generation of negative pressure within the thorax due to simultaneous expansion of the rib cage and downward diaphragmatic excursion. The ventral wall of the bony thorax is the shortest dimension.
It extends from the suprasternal notch to the xiphoid—a distance of approximately 18 cm in the adult. It is formed by the vertically aligned manubrium, sternum, and xiphoid process. The first seven pairs of ribs articulate directly with the sternum, the next three pairs connect to the lower border of the preceding rib, and the last two terminate in the wall of the abdomen.
Biopsy Interpretation: The Frozen Section
The sides of the chest wall consist of the upper ten ribs, which slope obliquely downward from their posterior attachments. The posterior chest wall is formed by the 12 thoracic vertebrae, their transverse processes, and the 12 ribs Figure 18—1. The upper ventral portion of the thoracic cage is covered by the clavicle and the subclavian vessels. Laterally, it is covered by the shoulder girdle and axillary nerves and vessels; dorsally, it is covered in part by the scapula.
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The thorax, showing rib cage, pleura, and lung fields. The superior aperture of the thorax also called either the thoracic inlet or the thoracic outlet is a downwardly slanted 5- to cm kidney-shaped opening bounded by the first costal cartilages and ribs laterally, the manubrium anteriorly, and the body of the first thoracic vertebra posteriorly. The inferior aperture of the thorax is bounded by the 12th vertebra and ribs posteriorly and the cartilages of the 7th to 10th ribs and the xiphisternal joint anteriorly.
It is much wider than the superior aperture and is occupied by the diaphragm. The blood supply and innervation of the chest wall are via the intercostal vessels and nerves Figures 18—2 and 18—3 , and the upper thorax also receives vessels and nerves from the cervical and axillary regions. Intercostal muscles, vessels, and nerves. The parietal pleura is the innermost lining of the chest wall and is divided into four parts: the cervical pleura cupula , costal pleura, mediastinal pleura, and diaphragmatic pleura.
The visceral pleura is a mesodermal layer investing the lungs and is continuous with the parietal pleura, joining it at the hilum of the lung.
The potential pleural space is a capillary gap that normally Forgot Password? What is MyAccess? As a result, general and subspecialty pathologists, clinical practitioners of all types and radiologists must now have an understanding of the basic concepts of molecular pathology and their role in new diagnostic and therapeutic applications to patient care. Those medical practitioners, residents, fellows and students who need to refer to the terminology and concepts of molecular pathology in their patient care will find the "Basic Concepts of Mol.