Document Detail

Root cause analysis of problems in the frozen section diagnosis of in situ, minimally invasive, and invasive adenocarcinoma of the lung.
MedLine Citation:
PMID:  23194044     Owner:  NLM     Status:  In-Data-Review    
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.
Ann E Walts; Alberto M Marchevsky
Related Documents :
19364614 - Parasitological diagnosis of canine visceral leishmaniasis: is intact skin a good target?
11775764 - Neurotic excoriations.
23550704 - Atypical pilar leiomyomatosis: an unusual presentation of multiple atypical cutaneous l...
3722474 - An unusual dermal collagen disorder in a dog.
837044 - Primary malignant lymphoma of the testis associated with sclerosis and nodularity.
557714 - Co2 laser as a clinical tool in otolaryngology.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of pathology & laboratory medicine     Volume:  136     ISSN:  1543-2165     ISO Abbreviation:  Arch. Pathol. Lab. Med.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7607091     Medline TA:  Arch Pathol Lab Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1515-21     Citation Subset:  AIM; IM    
From the Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Screening for lung cancer: who should be screened?
Next Document:  A unique, histopathologic lesion in a subset of patients with spontaneous pneumothorax.