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Intraoperative Consultation During Pancreato-Biliary Surgery

Introduction Intraoperative/frozen section consultations on pancreaticobiliary surgeries are mainly performed for the assessment of resection margins of the specimens and to rule out the possibility of metastatic disease at sites such as liver, peritoneum, omentum, mesentery, and lymph nodes. Only rarely a core biopsy of the pancreas is received for frozen section to help make the intraoperative diagnosis of a mass lesion because most often the…

Intraoperative Consultation During Intestinal, Appendiceal, and Proximal Colonic Surgery, Including Neuroendocrine Tumors

Introduction Endoscopy and imaging modalities provide an easy access to lesions located within the small bowel, appendix, and proximal colon. As a result, the surgeon is typically well equipped with the preoperative diagnosis of the lesion in question, and intraoperative consultations are restricted to very specific issues. In contrast to intraoperative consultations performed for limited resections in organ systems such as head and neck, thoracic, kidney,…

Intraoperative Consultation During Colonic and Rectal Surgery

Introduction With rare exceptions, the primary role of intraoperative consultation (IOC) during colorectal surgery is to determine the extent of disease prior to primary resection, to evaluate the adequacy of tumor resection (margin evaluation), and to diagnose unusual or unexpected intraoperative findings ( Table 11-1 ). The questions that need to be answered during IOC are usually straightforward and specific ( Table 11-2 ). As a…

Intraoperative Consultation During Gastric and Esophageal Surgery

Introduction Intraoperative pathology consultation with or without frozen section analysis is commonly used during surgery performed for a variety of diseases involving the upper gastrointestinal (GI) tract. It can be requested to determine completeness of cancer resection (margin status), assess extent of cancer, diagnose a mass or lesion when preoperative mucosal biopsy is inconclusive, or diagnose incidental lesions encountered intraoperatively. Timely and direct communication with the…

Intraoperative Consultation in Frozen Section of Intrathoracic Lesions

Thoracic surgeons routinely rely on intraoperative consultations with frozen section to help determine the appropriate surgical procedure best indicated for a particular patient (Aijaz et al, 1993; Cohen and Flinner, 1960; Gal and Cagle, 2005; Gal, 2005; Sakai et al, 1994). The goals of intraoperative consultations during thoracic surgery vary according to the clinical problem, and it is important that pathologists and their surgical colleagues communicate…

Intraoperative Consultation During Salivary Gland Surgery

Introduction Salivary gland tumors represent 2% to 6% of all head and neck neoplasms (Ellis and Auclair, 2008). Though uncommon, they present with unique challenges in diagnosis and effective treatment (Silva and Kraemer, 1987). The vast majority (60% to 80%) of these neoplasms arise in the parotid gland, up to 11% in the submandibular gland, less than 1% in the sublingual gland, and approximately 23% in…

Intraoperative Consultation During ENT and Laryngeal Surgery

Ear, nose, and throat (ENT) surgeons perform a variety of surgical procedures that require intraoperative consultation (IOC) with frozen section (FS). Surgical pathologists can receive biopsies or resection specimens from a variety of locations, including the oral cavity, floor of mouth, oropharynx, tonsil, nasopharynx, hypopharynx, larynx, parotid gland and neck lymph nodes. These specimens can exhibit a large variety of neoplastic and nonneoplastic conditions, some unusual,…

Intraoperative Consultation of Thyroid and Parathyroid Lesions

Intraoperative Consultation of Thyroid Lesions General Clinical Introduction Thyroid nodules are frequent in the general population and can be detected by ultrasound in up to 50% of adults. They are also often incidentally found on other imaging studies of the neck such as computed tomography (CT) scans and magnetic resonance imaging (MRI). Only 5% to 10% of these nodules are clinically palpable and less than 5% of…

Intraoperative Consultations During Skin Surgery

Introduction Frozen section is rarely used for primary diagnosis in dermatopathology but is often requested for management of skin cancer. The principal treatment for most skin malignancies consists of primary excision with negative margins. The operative procedure may include use of flaps or grafts following margin clearance, depending on the size of the defect needed to clear margins. Accordingly, a false positive result may potentially lead…

Intraoperative Consultation During Neurosurgery

Neuropathologists have been close allies of neurosurgeons for decades. Confirmation of diagnostic tissue can herald the end of a surgery if the purpose of surgery is a biopsy. Identification of certain preliminary pathologies can change the course of a surgical case, determining whether an attempt at gross total resection is reasonable or foolhardy. A pathologic diagnosis is the gold standard and at times settles disputes between…

Guide to the Preparation of Frozen Sections

Introduction The intraoperative consultation (IOC) is a multifaceted procedure that requires adequate preparation by the surgical pathology and other laboratory personnel and adequate communication with nursing and other operating room (OR) staff. The procedure includes the timely request for a frozen section, delivery of the specimen to the pathologist in the OR or transportation of a specimen and requisition sheets to a centralized IOC laboratory, preparation…

Guide to the Preparation of Intraoperative Touch Preparations and Other Cytologic Preparations

Introduction Cytologic imprints, scrape preparations, and smears (collectively called cytopreps ) have been used for intraoperative diagnosis for over 80 years (Dudgeon and Patrick, 1927). In the current era of subspecialty ascendancy, the demonstrated value of cytopreps (Sakai and Lauslahti, 1969; Kontozoglou and Cramer, 1991; Sidawy and Silverberg, 1991) as an extension of surgical pathology may be underappreciated by noncytopathologists. Rapid fixation of cells without introduction…

General Guidelines for Intraoperative Consultations with Frozen Section

Historical Background Although the frozen section technique was first used for routine intraoperative consultations in the late 19th century at Johns Hopkins Hospital and in the early 20th century at the Mayo Clinic, various methodologies to harden tissues for sectioning had been described almost a century earlier (Gal and Cagle, 2005; Wright, 1985). For example, a Dutch anatomist Pieter de Riemer developed a cold salt-and-water solution…

Guidelines for Ordering Blood for Elective Surgery

Also Referred to as Maximum Surgical Blood Order Schedule (MSBOS) These guidelines present a range in numbers of units of blood to be ordered as practiced at three different institutions: University Hospital State University of New York Upstate Medical Center at Syracuse, New York; Virginia Commonwealth University Medical Center, Richmond, Virginia; and University of Michigan Hospitals, Ann Arbor, Michigan. Each institution should set its own guidelines…

Disease/Organ Panels

Anemia CBC with indices, reticulocyte count, and microscopic examination Microcytic: Iron studies , ∗ ferritin, ESR Normocytic: ESR, hemolysis profile Macrocytic: B 12 , folate, TSH Arterial Blood Gas pH P a co 2 O 2 saturation P a o 2 CO 2 content P A–a o 2 Arthritis ESR (sedimentation rate) Uric acid ANA (antinuclear antibody) C-reactive protein Rheumatoid factor Cyclic citrullinated peptide antibody Bone/Joint…