Frozen Section and the Surgical Pathologist: A Point of View (Report‪)‬

Surgical pathology as we currently recognize it was initially conceived and developed by surgeons. Concurrent with its development was the idea of a rapid intraoperative diagnosis, which was first attempted at The Johns Hopkins Hospital a little more than 100 years ago on a breast biopsy. (1) It took awhile for this new technique to gain popularity, but by the 1920s the use of frozen section as an intraoperative guide for the surgeon was deemed essential. (2) The technology has changed over the years: there are cryostats capable of rapid freezing, built-in microtomes sectioning at 5 [Am or less, better stains, and improved light microscope optics. The technical advances and the variations of implementation among present-day institutions notwithstanding, the essentials of the preparation and reporting of a frozen section would remain recognizable to our predecessors. This paper presents a personal statement on the contemporary use of frozen section based on my own experience in both university and community hospital settings. The examples cited are tumors, but the principles of examination and reporting are easily extrapolated to nonneoplastic and inflammatory conditions. The receipt of specimens varies, including direct pickup by the pathologist/pathology resident, delivery by operating room personnel, or a tube system. The physical space for performing frozen sections also varies, ranging from a dedicated room within the pathology laboratory to a separate space proximate to the operating rooms. The potential questions would primarily still be: what is it, where is it, and is there enough tissue? The communication of results may be by telephone or intercom, or it may require the pathologist to return to the operating room and verbally deliver the result. The clarity of this communication is obviously essential. Direct transmission of the microscopic field via closed-circuit television or intranet access from pathology to surgery is available but not universal. In any event, some hard copy record of the results of the intraoperative examination (with or without an actual frozen section) will enter the patient's record. The frozen section interpretation is also incorporated into the final surgical pathology report, including an acknowledgment of any discrepancies with the final diagnosis and the resolution of those discrepant issues.