Tehran University Medical Journal

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Frozen section is a useful method in the diagnosis of different malignancies including those of thyroid origin. However, there are still controversies about its application, sensitivity and specificity for thyroid neoplasm. In this study, diagnostic value of frozen section (FS) was compared with permanent histopathologic and Fine Needle Aspiration (FNA). In this study, which was conducted in process research method, permanent sample, FNA, and frozen section results in 214 patients was compared. All of these 214 patients had been seeking medical evaluation for thyroid nodules between years 1997 and 1999 in Shariati hospital. All pathologic evaluations were performed by pathology staff of this hospital. Permanent pathology was considered as the gold standard so the specificity, sensitivity and diagnostic precision of FNA and FS were evaluated on the basis of its results. We use Macnemar test for this purpose. The number of patients during this period were 214 (160 women and 54 men). Mean age of our patients was 42.3±5.4 and their age ranged between 12 to 84 years. Pathologic results revealed that 163 of the patients (76 percent) had benign lesions, and 51 of them (24 percent) had malignant lesions. Thyroid malignancies comparised papillary carcinoma (70 percent), follicular carcinoma (13.5 percent), papilofollicular carcinoma (6 percent), medulary carcinoma (6 percent), Hurtle cell carcinoma (4 percent) and anaplastic carcinoma (5 percent). FNA was done in all of the patients before surgery and was able to determine the status of nodules in 150 patients. Sensitivity, specificity and precision of FNA in these 150 patients were 72, 96 and 90 percents respectively. When FNA was unable to determine the status of a nodule (64 remaining patients), FS was applied to do the job. A sensitivity of 36 percent, specificity of 85 percent and precision of 73 percent was found in this group of patients. Macnemar test showed that there is no significant difference between FNA and FS methods. This study showed: when FNA is not conclusive, FS will not bring any further benefit. It seems that only in suspicious cases of papillary, undifferentiated and medulary carcinomas, FS can be useful in certifying the results of FNA and choosing the appropriate surgical plan. We should wait for permanent sample reports in the case of follicular or Hurtle cell carcinoma.

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Background: It is well known that, at the time of the initial presentation of patients with non-small cell lung cancer, N-status is very important in accurate staging and avoiding inappropriate surgical procedures. Also, if mediastinal lymph node metastasis (N2) of non-small cell lung cancer (stage IIIA) is present, neoadjuvant (preoperative) chemora-diotherapy is indicated therefore a quick and accurate N-status determination is critical before thoracotomy. We compared the usefulness and accuracy of touch imprint and frozen section analysis for this purpose.

Methods: During 2006, fifty eight mediastinal lymph node specimens from 27 patients with lung cancer were excised. After touch imprint preparation, half of each lymph node was sent for frozen section and finally permanent histology.

Results: Frozen section and touch imprint had only one and two false negative results, respectively, but neither had false positive reports. The sensitivity, specificity and accuracy of the frozen section evaluation was 95.5%, 100% and 98.2%, respectively, and those of touch imprint were, 90.9%, 100% and 96.4%. The differences in the sensitivity, specificity and accuracy between the two methods were not significant (p>0.05).

Conclusion: Frozen section and touch imprint have similarly high accuracies for detecting mediastinal lymph node metastasis in lung cancer. However, since the touch imprint method is more rapid and simple, it maybe method of choice.

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Background: Endometrial carcinoma is considered the most common gynecological cancer in the world. Pelvic and para-aortic lymphadenectomy is widely advised based on FIGO staging system. Intra-operative frozen sections analysis is used to identify pa-tients at high risk for pelvic and para-aortic nodal metastasis evading lymphadenec-tomy in low-risk patients. However there is still some controversy concerning the effi-ciency of IFS. The aim of this study was to determine the validity and precision of fro-zen section diagnosis and gross examination of uterine specimen compared to the final histological results in patients with endometrial cancer. Methods: Patients diagnosed as endometrial cancer based on office biopsy using a Pipelle or D&C who underwent surgical staging were compared for frozen section anal-ysis and permanent diagnosis. Patients with the history of radiotherapy or other types of cancer or co existence malignancies were excluded. Results: There was no relation between the tumor size and lymph node involvement and the results were not significant (P= 0.1). Frozen section analysis was significantly accurate and correct in predicting final histopathological results (P< 0.0001). It has been shown that in more than 90% of patients the diagnosis made by frozen section analysis was in accordance with final pathology with considerable sensitivity and spec-ificity. Gross examination was also precise in determining myometrial microscopic in-vasions (P< 0.0001). Conclusion: Although the sample size of the studied population was small but our study results support the previous data and suggest that in early stages and low grade tumors, gross examination and frozen section diagnosis are conveniently predictive of lymph node metastasis. These data might be useful for prediction of tumor invasion using frozen section and gross examination in low grade tumors and early stages and for doing complete surgical staging and lymph node sampling. However the im-portance of surgical staging always must be considered in patients who need systemat-ic lymphadenectomy. In overall these data might help to come up with new guidelines for surgical risk assessment in endometrial cancer.