Frozen Section Collection (Pathology Consultation)
NAME OF PROCEDURE
Frozen Section Collection (Pathology Consultation)
CPT CODE
- 88329 – Pathology Consultation during surgery
- 88331 – first tissue block, with frozen section(s), single specimen
- 88332 – each additional tissue block with frozen section(s)
SYNONYMS
Frozen; Frozen Section, Frozen Tissue Section; FS; Intraoperative Consultation; Surgical Pathology Consultation; Surgical Pathology Consultation @Operation
TEST INCLUDES
Gross examination, frozen section interpretation, followed by routine histopathology report. Imprints may be made on fresh tissue and material saved for future studies.
SPECIAL INSTRUCTIONS
For all out-patient frozen sections in the Brunswick area call Southeastern Pathology Associates (SEPA) @912-261-2669. To request a pathologist for a frozen section for off-site hospital laboratory, complete a <Request for Pathologist for Frozen Section of Special Procedures> form. The request should be made at least forty-eight (48) hours in advance of the scheduled surgery.
SPECIMEN
Fresh tissue with NO added fixative or fluid, submitted in a sterile container or towel as soon as possible following surgical removal.
CONTAINER
Sterile towel, sterile petri dish, or sterile container.
COLLECTION
Label container or towel with patient’s name, type of specimen, date, time of collection, and operating room phone number for frozen section report. Specimen must be placed in the hands of transporting personnel or Pathologist as soon as possible.
REQUEST
Complete a <Anatomical Pathology Requisition>.
CAUSES FOR REJECTION
Specimen container not properly labeled.
Specimen submitted in fixative, water or saline.
LIMITATIONS
Bone or heavily calcified tissue cannot be frozen. Tissues dominated by fat are technically difficult and may not be amendable to frozen section. Sampling errors occur, leading to false-negative diagnosis. Some lesions require permanent sections for definitive diagnosis, such as occasional problematic breast lesions (papillary lesions, atypical lobular, and some intraductal hyperplasias). In some cases, diagnosis must be delayed for permanent sections. By virtue of sampling problems, negative margins in tumor resections may be of very limited value, especially when such margins are of substantial size. Patients usually should not be kept anesthetized while multiple frozen blocks are processed, cut, stained, and examined, when paraffin sections would serve as well, or better. Frozen sections are enormously more useful in providing diagnosis of visible lesion, then trying to rule out a possibility of an entity of microscopic proportions such as lobular carcinoma in situ (LCIS). LCIS, in fact, should not be diagnosed on frozen section but only on good quality paraffin sections. Certain tissues demand cytologic as well as histologic evaluation for proper diagnosis and are therefore best examined on permanent section only; these include cone biopsies of the cervix, endometrial curetting, lymph nodes when lypmphoma is suspected, pigmented skin lesion, etc.
METHODOLOGY
Frozen section, gross and microscopic exam
CONTRAINDICATIONS
Tissue is consumed in the process of frozen section. Tiny critical specimens (for example, possible breast carcinoma less than 1cm in diameter) are best not risked.
Breast specimens not grossly suspicious should not be frozen.
The freezing process may distort lymphoid as well as other tissues; therefore, for suspected lymphoma, it is advisable to await proper fixation of the lymph node and paraffin sections for definitive diagnosis.
Specimens removed for microcalcification should not be frozen.
ADDITIONAL INFORMATION
Written and verbal communication between the pathologist and surgeon occur at the time of the frozen section diagnosis, according to requirements both of regulatory agencies and of good patient care. A report is issued within 30 minutes of completion of frozen section. O.R. personnel must always place the specimen in the hands if a histotechnologist or pathologist. Cultures of tissue are best taken in the O.R., where a sterile field exists. A piece of tissue (e.g. a curetting of a fistulous tract) should be placed in a sterile container with the request for appropriate bacteriology studies. If the surgeon wishes the pathologist to culture the tissue, the specimen should be fresh and sterile. Place the specimen in the hands of a histotechnologist or pathologist (never leave it unattended).