Frozen Section Biopsy

An intraoperative diagnostic method in which the tissue sample taken during surgery is rapidly frozen, sectioned into thin slices, stained, and evaluated by a pathologist under the microscope, guiding the course of the operation.

Indication

• Distinguishing malignant from benign in suspicious masses (e.g., breast, thyroid, lung)
• Evaluating whether surgical margins (resection margins) contain tumor
• Determining lymph node metastasis during surgery (sentinel lymph node)
• Situations requiring a change in the surgical plan (decision for extended resection)
• Preliminary diagnosis of unexpected intraoperative lesions
• Rapid confirmation of tissue type (tumor / normal / inflammatory)

Preparation

• Pre-operative communication and planning between surgeon and pathologist regarding the need for a frozen section
• The frozen section laboratory should be near the operating room and well-equipped
• During the consent process, the patient should be informed that the frozen section result may change treatment options
• Sharing previous imaging and pathology findings with the pathologist

How it's performed

1. The surgeon obtains the tissue sample and quickly delivers it to the pathology laboratory
2. The pathologist performs a macroscopic examination and selects the most appropriate sampling site
3. The tissue is placed in a special gel (OCT) and frozen in a cryostat at -20 to -30°C
4. Sections of 5-10 microns thickness are cut with a microtome and mounted on slides
5. Rapid H&E or toluidine blue staining is performed (usually within 5-10 minutes)
6. The pathologist makes a microscopic evaluation and reports the result to the surgeon by telephone or intraoperative communication system

Post-procedure

• Based on the frozen section result, the course of surgery may be modified (extended resection, additional lymph node dissection, etc.)
• The intraoperative result is preliminary in nature; for the definitive diagnosis, the remaining tissue undergoes routine paraffin processing
• The final pathology report is completed within 3-7 working days
• When there is a discrepancy between the frozen section and final results, the clinical decision is reassessed
• All findings are added to the patient's file and may be reviewed in multidisciplinary meetings

Risks

• Difficulty in morphological evaluation in some diagnoses due to freezing artifact
• Section quality may be limited in fatty, cartilage- or bone-containing tissues
• Rare diagnostic revisions due to rapid evaluation (differences in the final report)
• Need to reassess the treatment plan in cases of frozen-final discordance

FAQ

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