Common traps in intraoperative frozen diagnosis and countermeasures

DONG Fang; SHANG Jian-feng; FANG Wei; TENG Fei; LIAN Guo-liang; HAN Li-yuan; CHEN Dong

doi:10.3969/j.issn.1007-8096.2023.10.010

Abstract：Objective To collect cases with diagnostic traps in intraoperative frozen diagnosis,and to analyze the reasons and corresponding strategies for these cases.Methods Eleven typical cases with difficulty in diagnosis at frozen HE sections were selected from June 2020 to June 2023.The pathological characteristics of these frozen sections were observed and compared with their postoperative paraffin sections to analyze the reasons for diagnostic traps.The literature was also reviewed to summarize the key points of pathologic diagnosis and differentiated diagnosis.And the corresponding strategies were proposed to avoid such diagnostic traps.Results Influenced by the quality of frozen sections and artificial artifacts,pulmonary sclerosing pneumocytoma was easily misdiagnosed as invasive adenocarcinoma and carcinoid,bronchiolar adenoma was easily misdiagnosed as mucinous adenocarcinoma,and apocrine adenosis was easily misdiagnosed as invasive cancer.Additionally,the limitations of frozen sections could lead to insufficient diagnosis of breast lesions.Conclusion By analyzing 11 typical cases that are prone to misdiagnosis in work,it is suggested that clinical pathologists should pay attention to the diagnosis of such cases.Before diagnosing such cases,it is necessary to have a detailed understanding of the patients'medical history and to obtain multiple points of tissue specimens timely;Consciously analyzing the diagnostic and differential diagnostic points of cases with similar pathological changes,we could avoid diagnostic traps.In addition,the application of intraoperative immunohistochemistry in frozen diagnosis will help improve the accuracy of frozen diagnosis.