| Root cause analysis of problems in the frozen section diagnosis of in situ, minimally invasive, and invasive adenocarcinoma of the lung. | |
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MedLine Citation:
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PMID: 23194044 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Context.-Frozen sections can help determine the extent of surgery by distinguishing in situ, minimally invasive, and invasive adenocarcinoma of the lung. Objective.-To evaluate our experience with the frozen section diagnosis of these lesions using root-cause analysis. Design.-Frozen sections from 224 consecutive primary pulmonary adenocarcinomas (in situ, 27 [12.1%]; minimally invasive, 46 [20.5%]; invasive, 151 [67.4%]) were reviewed. Features that could have contributed to frozen section errors and deferrals were evaluated. Results.-There were no false-positive diagnoses of malignancy. Frozen section errors and deferrals were identified in 12.1% (27 of 224) and 6.3% (14 of 224) of the cases, respectively. Significantly more errors occurred in the diagnosis of in situ and minimally invasive adenocarcinoma than in the diagnosis of invasive adenocarcinoma (P < .001). Frozen section errors and deferrals were twice as frequent in lesions smaller than 1.0 cm (P = .09). Features significantly associated with errors and deferrals included intraoperative consultation by more than one pathologist (P = .003) and more than one sample of frozen lung section (P = .001). Inflammation with reactive atypia, fibrosis/scar, sampling problems, and suboptimal quality sections were identified in 51.2% (21 of 41), 36.6% (15 of 41), 26.8% (11 of 41), and 9.8% (4 of 41) of the errors and deferrals, respectively (more than one of these factors was identified in some cases). Frozen section errors and deferrals had significant clinical impact in only 4 patients (1.8%); each had to undergo completion video-assisted thoracoscopic lobectomy less than 90 days after the initial surgery. Conclusions.-The distinction of in situ from minimally invasive adenocarcinoma is difficult in both frozen and permanent sections. We identified several technical and interpretive features that likely contributed to frozen section errors and deferrals and suggest practice modifications that are likely to improve diagnostic accuracy. |
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Authors:
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Ann E Walts; Alberto M Marchevsky |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Archives of pathology & laboratory medicine Volume: 136 ISSN: 1543-2165 ISO Abbreviation: Arch. Pathol. Lab. Med. Publication Date: 2012 Dec |
Date Detail:
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Created Date: 2012-11-30 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7607091 Medline TA: Arch Pathol Lab Med Country: United States |
Other Details:
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Languages: eng Pagination: 1515-21 Citation Subset: AIM; IM |
Affiliation:
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From the Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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