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Michael Mbagwu, Alexander Knezevic, Hans Barron Heymann, Sarah Eichinger, Paul Bryar; Assessing the Accuracy of Intraoperative Frozen Sections for the Evaluation of Orbital Lesions. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5624. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Intraoperative frozen sectioning is an important technique for evaluating orbital lesions and commonly dictates subsequent steps for surgical management. Although radiological techniques have improved, histopathologic diagnosis is the standard for definitive diagnosis of suspected malignancies. Obtaining accurate results from frozen sectioning is challenging during orbital and oculoplastic surgeries due to a desire to minimize unnecessary tissue extraction and preserve as much of the tissue as possible for permanent pathology. This study assesses the accuracy of frozen sections by comparing them to final pathology results of orbital lesions.
A retrospective chart review was conducted using the Northwestern Enterprise Data Warehouse for all adult patients who had orbital biopsies with intraoperative frozen sections from January 2000-October 2014. This study was approved by the Northwestern IRB.
95 orbital biopsies from 65 patients were identified as having both frozen sections and corresponding final pathology results. The average number of samples was 1.5 per patient (range 1-9 samples per patient). 53 patients had 1 sample (81.5%). The frozen section diagnosis concurred with the final permanent histologic section result in 86 of the 95 biopsies (90.5%). Of the 9 frozen sections that did not correlate with the final pathologic diagnosis, 5 (55.6%) were read as fibrous/necrotic tissue and resulted in a final pathology diagnosis of amyloidosis, 1 (11.1%) was initially read as necrotic tissue but resulted in a final diagnosis of lymphoid hyperplasia, 1 (11.1%) was initially read as benign fibroblastic proliferation and was later found to have a positive margin for infiltrating squamous cell carcinoma originating from the sinuses, and 2 (22.2%) were initially read as normal muscle and were later found to have positive margins for infiltrating breast carcinoma.
This study suggests that intraoperative frozen sections are generally correlated to the final tissue diagnosis in orbital and oculoplastic cases. Of note, amyloidosis, lymphoid hyperplasia, and surgical margins of infiltrative carcinoma were among those that were not diagnosed on frozen sectioning, and the ultimate diagnosis was made on permanent sections.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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