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.

Why intraoperative consultations are done

Reasons why IC are done:[1]

  1. Determine diagnosis & appropriate extent of operation ~ 50%.
  2. Margins status - 15%.
  3. Triage tissue ~ 10%.
  4. Inform family ~ 8%.
  5. 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

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.

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:

Surgeon-pathologist dialog

It should include:

  1. Identification:
    • Pathology is calling - Dr. X is speaking.
    • Patient identifiers - full name.
    • Part(s) submitted.
  2. Diagnosis.
  3. Repeat of diagnosis from surgeon.
  4. Additional requests?

See also

References

  1. 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.
  2. URL: http://www.adasp.org/papers/position/QualityAssurance.htm. Accessed on: 2 March 2012.