Frozen Section Fundamentals
Freeze spray should be avoided on these specimen for this reason
What is identified or unidentified lung specimens and to prevent aerosolization of infectious agents
(objective 3)
This responsibility is describe as outside of the Pathologists' Assistant scope of practice
What is delivering a rendered diagnosis to the requesting surgeon
(Objective 11)
These are studies that should not be performed on the remaining tissue that has thawed for FS blocks
What is IHC and special studies
(Objective 3)
This definition explains turn-around time and the prior, and current, mandates behind it
What is a term to describe the time it takes for a frozen section to be prepared and reviewed by a pathologist. This requirement used to be mandated by CAP to be within 15-20 minutes but is now determined by individual laboratories based on their goals and efficiency targets
(objective 4)
Cancerous lesions
Research tissue
POCs
What are products of conception (POCs)
This technique involves rapidly freezing fresh tissue to prepare an H&E slide, allowing pathologists to make a preliminary diagnosis while the patient is still under anesthesia in the operating room.
What is a frozen section?
(Objective 1,2)
These responsibilities can be described as within the pathologists' assistant scope of practice
What is specimen handling, sampling, and processing tissue specimens for intraoperative consultations and permanent sections and relaying those results to the pathologist
(objective 11)
The OR brings you lymph nodes, brain bx, and a thyroid bx. This is the most likely Intraop you should perform
What is cytology slides for touch prep smears
(Objective 2)
This is the rate of accuracy of FS evaluation agreement to permanent section evaluation
What is 97% to 99.5%
(Objective 8)
These are examples special study triages that will be highlighted on the requisition form
What are flow cytometry, immunophenotyping, cytogenetics, and karyotyping
(Objective 2)
These are common specimens that may be requested for an FS
What are sentinel lymph nodes, skin, complex resections, and unexpected lesions and masses
(Objective 2)
These are the errors that contribute to discrepancies and whose responsibility it falls under
What are
Interpretive error (Pathologist)
Sampling error (Pathologists' Assistant)
Technical errors (Pathologists' Assistant)
Communication errors (Pathologist)
(Objective 10, Objective 11)
Theses are the findings reported from a CAP Q-Probe study on FS
What are that 6% of all surgery cases at any given institution request/necessitate FS, and of those cases 10% are done unnecessarily
(Objective 5)
This is the acceptable rate of discordant results between FS and permanent section evaluations as permitted by CAP/ADASP
What is 3%
(Objective 9)
These are three reasons that "Intraops" are done
What is
1) Provide rapid gross or microscopic diagnosis which helps to guide intraoperative patient management (explain bullet points on slide 8)
2)Optimally process tissue for special studies for procedures
3) To confirm that lesional tissue is present for diagnosis on permanent section or after special studies
(Objective 1,2)
This is the reason diagnostic information provided by frozen sections is limited when compared to permanent sections
What is final diagnoses require permanent section processing for QA/QC purposes. Limited testing can be done on FS, therefore the scope of information that they can provide is limited, hence why they re used as preliminary diagnoses that must be compared to the primary diagnoses
(Objective 6)
This is why how turn around time relates to QA/QC
What is efficient turn around time ensures a minimized risk for patients who are still under anesthesia in the OR and allows the surgeon to make quicker decisions in regards to the route of patient care based on the results of accurate and timely preliminary diagnosis
(Objective 4, Objective 12)
Scenario: During surgery, a you perform a FS intraop to provide a preliminary diagnosis. After completing the FS, the surgeon asks you to relay the preliminary diagnosis directly to the patient’s family, who are anxiously waiting in the hospital lobby for any news. This is the reason you would decline.
What is it is inappropriate to provide FS results in this context
(objective 5)
This is the protocol for documenting discordant FS results
What is documenting TAT, who communicated the results (Pathologists'), who received the results (surgeon), and the comparison between the FS diagnosis and permanent diagnosis for QA/QC
(Objective 4,Objective 12)
This is describe as the steps involved in prepping slides for cytology
What is
Review the OR schedule
Accession the case
Document the start time
Gross the specimen similar to how a routine specimen would be handled
Select a tissue sample for cytology slides and section the tissue. Excess moisture should be blotted away
Directly press tissue against the slide to transfer cells (touch prep) or use an edge to collect cells and transfer them onto a separate slide (smear)
Allow the slide to air dry then use Diff quick, Romanowosky, or H&E to stain the slide
Mount the slide with cystoseal and remove excess mounting medium with xylene
Give to the pathologist to render a diagnosis
Once the diagnosis has been communicated to the requesting surgeon, the sign out time should be documented
(Objective 7)
This is describe as the steps involved in performing a FS
What is:
Review OR schedule
Accession the case
Document the start time and gross the specimen routinely
Select tissue sample for FS sample
Embed tissue in OCT compound using either the chuck or well system
Freeze the tissue
Cut the tissue at the appropriate temperature. Use tools to decrease freezing time, if applicable
Face the block at 20 microns
Cut tissue at 4-6 microns
Place sections on a (+)-charged slide
Stain the slide using modified H&E method
Submit prepared slide to pathologist
Document completion time for QA/QC
(Objective 3)
Scenario: You receive a bowel resection for intraoperative consultation, and determine that an en face margin because the tumor 1 cm away from the margin. The pathologists determines and communicates that no tumor is present at the margin, so the patient is closed up and sent back home. 2 months later, the patient has to return for a complete bowel resection because the tumor was actually still present within the patient. What type of discrepancy, outlined in lecture, does this fall under?
What is major disagreement with serious impact on patient care?(Objective 10)
Scenario: You receive a fresh specimen from the OR and immediately place it in formalin because you are busy with a complex case.
This answer is what should have been done upon retrieval of the specimen.
this answer describes what could have been compromised as a result of the specimen going into formalin.
What is the requisition should always be checked upon accession for special study triage cases; What is the results for flow cytometry and/or cytogenetics could have been compromised as specimens submitted for those consultations are received fresh and are required to be cultured in RPMI media yo aid in classification of diseases, diagnosis and prognosis
(Objective 2)
These are the pre-analytic, analytic, and post-analytic errors that PAs contribute in QA
What are
Pre-analytic: failing to check containers against requisitions, and failure to properly orient specimens
Analytic: incorrect inking, prosection, embedding, sectioning, slide labeling, etc.
Post-analytic: improper FS and permanent slide preparation resulting in discrepancies
(Objective 11, Objective 12)
Gross only consultations are important for assessing margin and lymph node status, but it is also important for this third point
What is to confirm the presence of chorionic villi during the removal of conceptive tissue, which is crucial for diagnosing ectopic pregnancies and ensuring the safety of the patient.
(Objective 1, Objective 2)