FROZEN SECTION UNDER MICROSCOPE: AUDITING DIAGNOSTIC PITFALLS IN INTRAOPERATIVEPATHOLOGY

Abstract

Sometimes there is a disagreement between the frozen section (FS) and the histopathological diagnosis because of significant limitations in FS processing and reporting, such as poor morphology and freezing artifact. A medical audit of FS reports was conducted to identify the cause of diagnostic limitations in FS reporting and formulating preventive measures to overcome these limitations.

Objectives: To identify the cause of diagnostic limitations in FS reporting and formulating preventive measures to overcome these limitations

Material and Methods: This retrospective medical audit done in the Department of Pathology in a tertiary hospital. The study was done from January 2024 to June 2024. The records of 48 FS and the corresponding final formalin fixed paraffin embedded (FFPE) histopathology reports during the study period of 6 months were compared and analyzed. The results were categorized into concordant, discordant. The slides of the discordant cases were reviewed and the causes of discrepancy were noted.

Results: 70% FS referral were by Surgical oncology team. Percentage of discordance was seen in 8.6 % cases (4 cases out of 48). 94.5% FS consultations had average turnaround time of 25 min. In the remaining cases (5.5%) the turnaround time (TAT) was around 30-35 min.

Conclusion: FS is a valuable intraoperative diagnostic tool with high concordance to final histopathology, supporting critical surgical decisions. While accuracy may be affected by sampling, technical, and interpretative factors, most discrepancies are preventable through standardization, quality control, and ongoing education. Targeted training for surgeons and continuous auditing are essential to maintain diagnostic accuracy, enhance patient safety, and optimize frozen section services.