Difference between revisions of "Intraoperative consultation"
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*Tissue is the issue - not enough of it. | *Tissue is the issue - not enough of it. | ||
*Infectious case. | *Infectious case. | ||
*Management - it won't make a | *Management - it won't make a difference. | ||
**Diagnosis won't make a difference. | **Diagnosis won't make a difference. | ||
**Cannot make the diagnosis. | **Cannot make the diagnosis. | ||
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*Ovarian mass - diagnosis. | *Ovarian mass - diagnosis. | ||
*Uterine mass - diagnosis. | *Uterine mass - diagnosis. | ||
*Sentinel lymph node - staging. | *[[Sentinel lymph node]] - staging. | ||
**[[Vulva]]r melanoma. | **[[Vulva]]r melanoma. | ||
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*Pneumonectomy: | *Pneumonectomy: | ||
**Bronchus - margins. | **Bronchus - margins. | ||
**Lymph nodes - staging. | **[[Lymph nodes]] - staging. | ||
Neurologic: | Neurologic: | ||
*Brain tumour - diagnosis. | *[[Brain tumour]] - diagnosis. | ||
*Spinal tumour - diagnosis. | *Spinal tumour - diagnosis. | ||
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It should include: | It should include: | ||
# Identification: | # Identification: | ||
#* Pathology is calling - Dr. X is speaking. | #* [[Pathology]] is calling - Dr. X is speaking. | ||
#* Patient identifiers - full name. | #* Patient identifiers - full name. | ||
#* Part(s) submitted. | #* Part(s) submitted. | ||
# Diagnosis. | # [[Diagnosis]]. | ||
# Repeat of diagnosis from surgeon. | # Repeat of diagnosis from surgeon. | ||
# Additional requests? | # Additional requests? | ||
Revision as of 10:03, 9 August 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%.
- Margin 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 difference.
- Diagnosis won't make a difference.
- Cannot make the diagnosis.
- Bone tumours.
Frozen section permanent section concordance
Main article: Quality
Categories by the Association of Directors of Anatomic and Surgical Pathology (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.
Surgeon-pathologist dialog
It should include:
- Identification:
- Pathology is calling - Dr. X is speaking.
- Patient identifiers - full name.
- Part(s) submitted.
- Diagnosis.
- Repeat of diagnosis from surgeon.
- Additional requests?
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.