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Intraoperative consultation (view source)
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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'''. | [[Image:Tissue for frozen section in cryostat.JPG|thumb|right|Tissue within a cryostat, as seen during an intraoperative consultation. (WC/000jaw)]] | ||
'''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'''. Frozen section is often abbreviated '''FS'''. | |||
==Why intraoperative consultations are done== | ==Why intraoperative consultations are done== | ||
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#Inform family ~ 8%. † | #Inform family ~ 8%. † | ||
#Sufficient tissue? ~ 8%. | #Sufficient tissue? ~ 8%. | ||
#Treatment planning ~ 3%. | #Treatment planning, e.g. insert a portacath ~ 3%. | ||
Note: | Note: | ||
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| Ovarian mass | | Ovarian mass | ||
| diagnosis | | diagnosis | ||
| gynecologic pathology | | [[gynecologic pathology]] | ||
|- | |- | ||
| Uterine mass | | Uterine mass | ||
| diagnosis | | diagnosis | ||
| gynecologic pathology | | [[gynecologic pathology]] | ||
|- | |- | ||
| [[Sentinel lymph node]] | | [[Sentinel lymph node]] | ||
| staging in [[vulva]]r melanoma | | staging in [[vulva]]r melanoma | ||
| gynecologic pathology | | [[gynecologic pathology]] | ||
|- | |- | ||
| Squamous cell carcinoma | | [[Squamous cell carcinoma]] | ||
| [[margins]] | | [[margins]] | ||
| [[head and neck pathology]] | | [[head and neck pathology]] | ||
|- | |- | ||
| Whipple procedure | | [[Whipple procedure]] | ||
| margins | | margins | ||
| [[gastrointestinal pathology]] | | [[gastrointestinal pathology]] | ||
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| Thyroid nodule | | Thyroid nodule | ||
| diagnosis | | diagnosis | ||
| [[ | | [[endocrine pathology]] | ||
|- | |- | ||
| Prosthetic joint | | Prosthetic joint | ||
| query [[prosthetic joint infection]] | | query [[prosthetic joint infection]] | ||
| [[joints|joint pathology]] | | [[joints|joint pathology]] | ||
|- | |||
| Parathyroid gland | |||
| identify parathyroid gland | |||
| [[endocrine pathology]] | |||
|} | |} | ||
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====Genitourinary tract==== | ====Genitourinary tract==== | ||
* | *Cystoprostatectomy/cystectomy - ureteral margins. | ||
====Pulmonary==== | ====Pulmonary==== | ||
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#* Part(s) submitted. | #* Part(s) submitted. | ||
# [[Diagnosis]]. | # [[Diagnosis]]. | ||
# Repeat of diagnosis from surgeon. | # Repeat of diagnosis from surgeon (known as ''read-back confirmation''<ref name=pmid22032564>{{Cite journal | last1 = Nakhleh | first1 = RE. | title = Quality in surgical pathology communication and reporting. | journal = Arch Pathol Lab Med | volume = 135 | issue = 11 | pages = 1394-7 | month = Nov | year = 2011 | doi = 10.5858/arpa.2011-0192-RA | PMID = 22032564 | URL = http://www.archivesofpathology.org/doi/full/10.5858/arpa.2011-0192-RA }}</ref>). | ||
# Additional requests? | # Additional requests? | ||
==Specific specimens - checklists== | |||
===Ovarian mass=== | |||
:Covers ''adnexal mass'' and ''pelvic mass''. | |||
====Checklist==== | |||
General: | |||
*Specimen integrity: fragmented/intact/ruptured. | |||
*Dimensions: ___ x ___ x ___ cm. | |||
*Mass: ___ grams. | |||
*Surface involvement: absent/present. | |||
*Consistency: solid/cystic/solid and cystic. | |||
Cystic: | |||
*Type: unilocular, multilocular. | |||
*Cyst content: mucinous/serous/hemorrhagic/purulent/chylous/other. ‡ | |||
*Papillary excrescences: absent/present. | |||
*Necrosis: absent/present. | |||
*Hair: absent/present. | |||
Sections: | |||
*Sample morphologically distinct areas - esp. solid areas, papillary excrescences. | |||
Notes: | |||
*‡ Mucinous versus serous: | |||
**Serous: low viscosity (flows with ease threw the grates typically seen at the bottom of sinks<ref>{{Ref BITFS|33}}</ref>). | |||
**Mucinous: high viscosity (jello-like consistency). | |||
====DDx==== | |||
{| class="wikitable sortable" | |||
! Feature | |||
! Dx/DDx | |||
! Notes | |||
|- | |||
| Unilocular cysts | |||
| follicular cyst, epithelial cyst, very rarely [[granulosa cell tumour]] (not typically diagnosed at FS) | |||
| no excrescences or solid areas dx = "simple cyst"; "shag carpet" appearance = serous borderline tumour | |||
|- | |||
| Sebaceous material ''or'' hair | |||
| [[teratoma]] | |||
| ''Rokitansky nodule'' present -> submit section; neuroepithelium = fleshy appearance on gross;<ref>{{Ref BITFS|34}}</ref> | |||
''immature teratoma'' not typically diagnosed at FS | |||
|- | |||
| Chocolate cyst | |||
| [[endometriosis]] | |||
| solid elements (fibrosis vs. clear cell & endometrioid carcinoma | |||
|} | |||
===Endometrial carcinoma=== | |||
===General=== | |||
*Diagnosis usually known before the surgery. | |||
*The IC revolves around whether the lesion has a "high risk" of [[lymph node metastasis]]. | |||
Factors that increase the risk of lymph node metastases:<ref>{{Ref BITFS|43}}</ref> | |||
*Histology: | |||
**Serous or clear cell. | |||
**FIGO grade 3. | |||
*Staging parameters - involvement of: | |||
**Outer half of the myometrium. | |||
**Uterine cervix. | |||
**Adnexa. | |||
===Checklist=== | |||
Gross assessment: | |||
*Uterine cervix involvement (rare). | |||
*Adnexal involvement (rare). | |||
*Myometrial involvement - after sectioning bivalving and sectioning (with a 5 mm interval). | |||
===Parathyroid gland=== | |||
{{Main|Parathyroid gland}} | |||
Possibilities: | |||
*Parathyroid gland: † | |||
**Benign parathyroid gland. | |||
**[[Parathyroid adenoma]]. | |||
**[[Parathyroid hyperplasia]]. | |||
**[[Parathyroid carcinoma]]. | |||
*Thyroid gland. | |||
*[[Lymph node]]. | |||
*Fibroadipose tissue. | |||
*[[Paraganglioma]]. | |||
Notes: | |||
* † It is ''not'' possible to determine which one without history ''or'' all parathyroid glands. | |||
* Surgeons are pretty good at identifying parathyroid tissue ~ 94% accurate in one series.<ref name=pmid16360503>{{Cite journal | last1 = Dewan | first1 = AK. | last2 = Kapadia | first2 = SB. | last3 = Hollenbeak | first3 = CS. | last4 = Stack | first4 = BC. | title = Is routine frozen section necessary for parathyroid surgery? | journal = Otolaryngol Head Neck Surg | volume = 133 | issue = 6 | pages = 857-62 | month = Dec | year = 2005 | doi = 10.1016/j.otohns.2005.05.001 | PMID = 16360503 }}</ref> | |||
====Checklist==== | |||
*Weight. | |||
*Dimensions. | |||
*Appearance. | |||
====Sign out==== | |||
<pre> | |||
QUERY PARATHYROID GLAND: | |||
- PARATHYROID GLAND. | |||
</pre> | |||
===Whipple specimen=== | |||
====Sign out==== | |||
<pre> | |||
BILE DUCT MARGIN: | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
==See also== | ==See also== | ||
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==References== | ==References== | ||
{{Reflist| | {{Reflist|2}} | ||
[[Category:Basics]] | [[Category:Basics]] | ||