Retrospective Review of Emergent Frozen Sections at a Large Teaching Hospital
Martin D Hyrcza, Nicholas E Sunderland, C Blake Gilks. University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada
Background: Unexpected, emergency frozen section is one the anatomic pathologist's most demanding and stressful tasks, yet residency training programs do not systematically prepare young pathologists for this difficult task. Emergency frozen sections are infrequent and tend to involve a distinct set of conditions, different from the usual types of specimens received for frozen section analysis. Review of literature reveals a dearth of published data on this topic. Specifically, the frequency and types of specimens submitted for emergent frozen sections are have not been reported in recent publications.
Design: We retrospectively analyzed the emergency frozen sections performed on weekends for non-neuropathology cases at Vancouver General Hospital, a large metropolitan teaching hospital, between June 2010 and Aug 2012. Eighteen cases were identified for which the on-call pathologist was requested to perform emergent frozen section analysis.
Results: The indications for the emergent frozen sections were: diagnosis (lesion identification) in 13/18 cases (72%), margin assessment in 2/18 cases (11%), and transplant tissue quality assessment in 4/18 cases (22%) (one case involved both margin and diagnosis). Of the eighteen cases, six (33%) were performed for emergent general surgery cases such as perforated or obstructed viscus, severe bleeding from a mass, and one case of VIPoma causing severe hypokalemia. Four cases (22%) involved assessment of liver biopsies for steatosis prior to a cadaveric liver transplant. Four cases (22%) involved mediastinal lesions causing either superior vena cava syndrome or acute cardiac symptoms. Three cases (17%) involved orbital or base of skull masses. The final case involved acute spinal cord compression (6%).
Conclusions: The review of emergent frozen sections revealed a distinct set of situations for which emergent frozen section analysis is called for. These include: 1) acute presentations of gastrointestinal mass lesions causing obstruction, perforation, bleeding or other symptoms requiring same day surgery; 2) mediastinal masses causing SVC syndrome or acute cardiac symptoms; 3) orbital or skull base masses presenting with acute vision loss or other neurological deficits; 4) spinal cord compression syndrome; and 5) assessment of liver biopsies for steatosis prior to a liver transplant. Identifying these classes is the first step to development of an educational program to specifically prepare pathology residents for this challenging responsibility.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 308, Monday Morning