Qualitative Comparative Study of Frozen Section with Routine Histological Technique

Introduction: Intraoperative consultation by frozen section technique is an invaluable tool for immediate diagnosis. Its accuracy and limitations vary with different anatomical sites. Various studies comparing diagnostic accuracy are reported, however morphological quality of frozen section and its limitations have not been widely discussed. Aim: Qualitative morphological comparison between frozen section and routine formalin fixed paraffin embedded sections in different tissues, determine the diagnostic accuracy and study limitations of frozen section. Materials and Methods: 67 tissue specimens from 52 cases were studied over a period of 2 years. Diagnostic accuracy of frozen section and its morphological quality and reliability in comparison to histopathology was evaluated by 2 pathologists in a blinded fashion for the following parameters: cellular outline, nuclear and cytoplasmic features, staining pattern and overall morphology. The turnaround time and limitations in section preparation and problems encountered were assessed. Results: Diagnostic accuracy of frozen section was 96.2%. Statistical analysis showed that nuclear details, cellular outline and overall morphological quality of frozen section was slightly inferior to that of routine histopathology section, however, staining and cytoplasmic details were comparable. Most common limitation was freezing artifact. The average turnaround time was within 20 minutes in 76.9% cases. Conclusion: Frozen section is a reliable and accurate intra-operative consultation modality, but one needs to be aware of its indications and limitations. Avoiding technical errors in sectioning and staining, combination of knowledge about clinical presentation and experience in interpretation of morphological details can provide rapid diagnosis and subsequent patient management.