Utility of intraoperative frozen section examination in thoracic surgery. A review of 721 cases.
OBJECTIVE
Intraoperative frozen section examination (FSE) is an important tool for determining how extensive a surgical procedure needs to be. In this study we reviewed the indications for FSE, the correlation between FSE and postoperative histopathology, and the contribution of intraoperative FSE in determining the extent of the surgical procedure.


METHODS
A total of 744 FSE performed in 721 patients between January 1995 and January 2004 were reviewed retrospectively. The FSE were divided into 7 groups according to the indications of the request for frozen section. False positivity and false negativity were evaluated.


RESULTS
The indications for FSE included intraoperative diagnosis of pulmonary masses (311, 41.8%), determination of N2 status with mediastinoscopy and mediastinotomy (153, 20.6%), staging of pulmonary carcinomas during the operation (86, 11.6%), assessment of the margin of bronchial surgical resection following pulmonary resection (54, 7.2%), presence of solitary pulmonary nodules (75, 10.1%), presence of mediastinal masses (39, 5.2%), and pleural thickening (26, 3.5%). When compared to postoperative paraffin sections, FSE was found to have a 1.9% (8) rate of false negatives and a 0.2% (1) rate of false positives (P < 0.001).


CONCLUSIONS
Intraoperative FSE in thoracic surgery is a rather reliable method. When FSE indicates malignancy, it is a valuable guide in directing the extent of the ongoing surgical procedure. However, when FSE indicates a benign lesion, surgeons should interpret this in the light of the patient's clinical and radiological features and the lesion's macroscopic nature when deciding how extensive an operation needs to be.
Sirmali
M
M
Department of Thoracic Surgery Atatürk Training and Research Hospital for Chest Disease and Chest Surgery, Ankara, Turkey. mehmetsirmali@yahoo.com
Demirağ
F
F
Türüt
H
H
Gezer
S
S
Topçu
S
S
Kaya
S
S
Taştepe
I
I
D005629:Frozen Sections; D006801:Humans; D007432:Intraoperative Period; D008171:Lung Diseases / Q000473:pathology; D008175:Lung Neoplasms / Q000473:pathology*; D008481:Mediastinoscopy; D010994:Pleura / Q000473:pathology; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures