Difference between revisions of "Intraoperative consultation"
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'''Intraoperative consultation''', also '''quick section''' and '''frozen section''', is when a surgeon requests an opinion during an operation so that they can appropriately manage a patient. It is abbreviated '''IC'''. | '''Intraoperative consultation''', also '''quick section''' and '''frozen section''', is when a surgeon requests an opinion during an operation so that they can appropriately manage a patient. It is abbreviated '''IC'''. | ||
==Why | ==Why intraoperative consultations are done== | ||
Reasons why IC are done:<ref>{{Cite journal | last1 = Zarbo | first1 = RJ. | last2 = Schmidt | first2 = WA. | last3 = Bachner | first3 = P. | last4 = Howanitz | first4 = PJ. | last5 = Meier | first5 = FA. | last6 = Schifman | first6 = RB. | last7 = Boone | first7 = DJ. | last8 = Herron | first8 = RM. | title = Indications and immediate patient outcomes of pathology intraoperative consultations. College of American Pathologists/Centers for Disease Control and Prevention Outcomes Working Group Study. | journal = Arch Pathol Lab Med | volume = 120 | issue = 1 | pages = 19-25 | month = Jan | year = 1996 | doi = | PMID = 8554440 }} | Reasons why IC are done:<ref>{{Cite journal | last1 = Zarbo | first1 = RJ. | last2 = Schmidt | first2 = WA. | last3 = Bachner | first3 = P. | last4 = Howanitz | first4 = PJ. | last5 = Meier | first5 = FA. | last6 = Schifman | first6 = RB. | last7 = Boone | first7 = DJ. | last8 = Herron | first8 = RM. | title = Indications and immediate patient outcomes of pathology intraoperative consultations. College of American Pathologists/Centers for Disease Control and Prevention Outcomes Working Group Study. | journal = Arch Pathol Lab Med | volume = 120 | issue = 1 | pages = 19-25 | month = Jan | year = 1996 | doi = | PMID = 8554440 }} | ||
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#Inform family ~ 8%. | #Inform family ~ 8%. | ||
#Sufficient tissue? ~ 8%. | #Sufficient tissue? ~ 8%. | ||
===Why intraoperative consultations may be refused=== | |||
*Tissue is the issue - not enough of it. | |||
*Infectious case. | |||
*Management - it won't make a different. | |||
**Diagnosis won't make a difference. | |||
**Cannot make the diagnosis. | |||
***Bone tumours. | |||
==Frozen section permanent section concordance == | ==Frozen section permanent section concordance == | ||
Revision as of 22:49, 14 March 2012
Intraoperative consultation, also quick section and frozen section, is when a surgeon requests an opinion during an operation so that they can appropriately manage a patient. It is abbreviated IC.
Why intraoperative consultations are done
Reasons why IC are done:[1]
- Determine diagnosis & appropriate extent of operation ~ 50%.
- Margins status - 15%.
- Triage tissue ~ 10%.
- Inform family ~ 8%.
- Sufficient tissue? ~ 8%.
Why intraoperative consultations may be refused
- Tissue is the issue - not enough of it.
- Infectious case.
- Management - it won't make a different.
- Diagnosis won't make a difference.
- Cannot make the diagnosis.
- Bone tumours.
Frozen section permanent section concordance
Main article: Quality
Categories by ADASP:[2]
- Agreement
- Deferral - appropriate.
- Deferral – inappropriate
- Recommendation <=10% threshold.
- Disagreement – Minor.
- Disagreement – Major.
- Recommendation <=3% threshold.
Common specimens
Gynecologic:
- Pelvic mass - diagnosis.
- Ovarian mass - diagnosis.
- Uterine mass - diagnosis.
- Sentinel lymph node - staging.
- Vulvar melanoma.
Head and neck:
- Squamous cell carcinoma - margins.
Gastrointestinal tract:
- Whipple procedure - margins.
- Liver resection - margins.
- Lower anterior resection - distal margin.
Genitourinary tract:
- Cystectomy - ureteral margins.
Pulmonary:
- Pneumonectomy:
- Bronchus - margins.
- Lymph nodes - staging.
Neurologic:
- Brain tumour - diagnosis.
- Spinal tumour - diagnosis.
Thyroid gland:
- Thyroid nodule - diagnosis.
Prosthetic joint:
- Query prosthetic joint infection.
See also
References
- ↑ Zarbo, RJ.; Schmidt, WA.; Bachner, P.; Howanitz, PJ.; Meier, FA.; Schifman, RB.; Boone, DJ.; Herron, RM. (Jan 1996). "Indications and immediate patient outcomes of pathology intraoperative consultations. College of American Pathologists/Centers for Disease Control and Prevention Outcomes Working Group Study.". Arch Pathol Lab Med 120 (1): 19-25. PMID 8554440.
- ↑ URL: http://www.adasp.org/papers/position/QualityAssurance.htm. Accessed on: 2 March 2012.