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Intraoperative consultation (view source)
Revision as of 16:15, 15 December 2023
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[[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'''. | '''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'''. | ||
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| [[head and neck pathology]] | | [[head and neck pathology]] | ||
|- | |- | ||
| Whipple procedure | | [[Whipple procedure]] | ||
| margins | | margins | ||
| [[gastrointestinal pathology]] | | [[gastrointestinal pathology]] | ||
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====Head and neck==== | ====Head and neck==== | ||
*Squamous cell carcinoma - margins. | *Squamous cell carcinoma - margins. | ||
*Thyroid nodule - diagnosis. | |||
*Parathyroid - confirm it is parathyroid. | |||
====Gastrointestinal tract==== | ====Gastrointestinal tract==== | ||
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====Genitourinary tract==== | ====Genitourinary tract==== | ||
* | *Cystoprostatectomy/cystectomy - ureteral margins. | ||
====Pulmonary==== | ====Pulmonary==== | ||
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*[[Brain tumour]] - diagnosis. | *[[Brain tumour]] - diagnosis. | ||
*Spinal tumour - diagnosis. | *Spinal tumour - diagnosis. | ||
====Prosthetic joint==== | ====Prosthetic joint==== | ||
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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? | ||
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*Myometrial involvement - after sectioning bivalving and sectioning (with a 5 mm interval). | *Myometrial involvement - after sectioning bivalving and sectioning (with a 5 mm interval). | ||
===Parathyroid gland=== | ===Parathyroid gland and thyroid gland=== | ||
{{Main|Parathyroid gland}} | {{Main|Parathyroid gland}} | ||
Possibilities: | Possibilities: | ||
*Parathyroid gland: | *Parathyroid gland: | ||
**Benign parathyroid gland. | **Benign parathyroid gland. | ||
**[[Parathyroid adenoma]]. | **[[Parathyroid adenoma]]. † | ||
**[[Parathyroid hyperplasia]]. | **[[Parathyroid hyperplasia]]. † | ||
**[[Parathyroid carcinoma]]. | **[[Parathyroid carcinoma]]. | ||
*Thyroid gland. | *Thyroid gland. | ||
**Thyroid usually follicular - though parathyroid occasionally is pseudofollicular. | |||
**Thyroid often has birefringent (calcium oxalate) crystals (60 of 80 cases) whereas parathyroid less often does (2 or 20 cases).<ref name=pmid24618617>{{cite journal |authors=Wong KS, Lewis JS, Gottipati S, Chernock RD |title=Utility of birefringent crystal identification by polarized light microscopy in distinguishing thyroid from parathyroid tissue on intraoperative frozen sections |journal=Am J Surg Pathol |volume=38 |issue=9 |pages=1212–9 |date=September 2014 |pmid=24618617 |doi=10.1097/PAS.0000000000000204 |url=}}</ref> | |||
*[[Lymph node]]. | *[[Lymph node]]. | ||
*Fibroadipose tissue. | *Fibroadipose tissue. | ||
*[[Paraganglioma]]. | *[[Paraganglioma]]. | ||
Notes: | |||
* † It is ''not'' possible to determine which one without history ''or'' all parathyroid glands. | * † 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==== | ====Checklist==== | ||
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====Sign out==== | ====Sign out==== | ||
<pre> | |||
Query Parathyroid Gland: | |||
- Hypercellular parathyroid tissue. | |||
</pre> | |||
<pre> | <pre> | ||
QUERY PARATHYROID GLAND: | QUERY PARATHYROID GLAND: | ||
- PARATHYROID GLAND. | - PARATHYROID GLAND. | ||
</pre> | </pre> | ||
===Whipple specimen=== | |||
====Sign out==== | |||
<pre> | |||
BILE DUCT MARGIN: | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
===Skin specimens=== | |||
{{Main|Oriented skin ellipse grossing}} | |||
{{Main|Unoriented skin ellipse grossing}} | |||
{{Main|Grossing separately received oriented margins for a skin ellipse}} | |||
[[Cut-up]] at frozen section depends on how the specimen is received and its size. | |||
*Small skin specimens: the standard grossing procedure for fixed specimens. | |||
*Large skin specimens: inking is typically as per the routine process. It is useful to mark non-margin if the nearest margin is taken [[en face margin|en face]]. | |||
*Oriented margins should be grossed in a way that allows orientation by [[ink]]. Ideally, ink should allow one to identify the different specimens. See ''[[Grossing separately received oriented margins for a skin ellipse|grossing separately received oriented margins for a skin ellipse]]''. | |||
==See also== | ==See also== | ||