Since the appearance of the First Edition of this book, the practice of frozen section has continued to change. As part of the broader spectrum of intraoperative consultation, the clinical requests continue to be implemented in various ways. A visit to the operating room by the pathologist, a gross examination, an imprint with or without an actual frozen section is executed singly or in combination. The number of requests and the organ system distribution as well as the subject matter at stake in a particular case continue to be institutionally driven. Our own experience over the last several years largely forms the basis for this second edition, as it did for the first, and has shown a modest decrease in overall numbers by about 10%. As might be expected, breast samples have all but disappeared; however, there has also been a substantial decline in the intraoperative examination of sentinel lymph nodes. Thyroid frozen section has also diminished, probably rightly so, since the overwhelming majority of thyroid malignancies are papillary carcinoma, a tumor more easily appreciated by preoperative fine needle aspiration. Total or subtotal thyroidec- tomy for benign disease is also being debated in the clinical literature, making a frozen section moot. In urologic cancer, margins for partial nephrectomy, ureteral margins for radical cystectomy and lymph node frozen sections in radical prostatectomy have all decreased in number. All these changes directly reflect alterations in clinical thinking, the necessity for immediate therapy decisions and uncertainties prevalent for the respective diseases current in American medicine.
The appearance of a second edition of a focused volume such as this should contain new or additional information. And this one does. The organ system-based chapters have been updated. New illustrations have been added. The former pediatric pathology chapter has been revised and split to accommodate a new chapter on hematopathology. Frozen section remains a topic of great interest among all practitioners of pathology irrespective of venue. The various informative observations are shared using publication as an established vehicle of communication. Therefore, a new chapter dealing with the published literature related to intraoperative consultation/frozen section has been added. We note that the subject of frozen section does not deal per se with "new disease," with a newly discovered or adapted immunohisto chemical stain, nor with a novel molecular analysis. Fundamentally, this is H&E surgical pathology. And this technique, now well into its second century of use, is unlikely to disappear in the foreseeable future. Perhaps its continued relevance will be fueled and guided by the increasing use of telepathology.
The reception of the first edition has been most gratifying. Perhaps most significant is the informal communication we have received from colleagues elsewhere indicating the appearance of the book in their frozen section suites. This is as good a review as any author could anticipate. The need for an immediate intraoperative diagnosis, actually consulting the pathologist, was the impetus for the idea of a frozen section more than 100 years ago. This has not changed. The clinical algorithms have changed and our service along with them. We hope that this edition, like its predecessor, will assist colleagues who will use it in the care of the patients who ultimately justify its existence. Jerome B. Taxy, MD; Aliya N. Husain, MD; Anthony G. Montag, MD

Contributors vii

Preface ix

Preface to the Second Edition xi

1.The Frozen Section: Historical Background, Technique, and Quality Assurance 1

ANTHONY G. MONTAG

2.A Survey of Frozen Section Literature 16

JIE SONG

3.Hematopoietic Tissues 26

M. KAMRAN MIRZA AND JOHN ANASTASI

4.Bone and Soft Tissue 43

MICHELLE O'LEARY AND ANTHONY G. MONTAG

5.Female Genital Tract 69

REBECCA J. WOLSKY AND ANTHONY G. MONTAG

6.Lung, Mediastinum, and Pleura 89

ILYSSA O. GORDON AND ALIYA N. HUSAIN

7.Pediatric Frozen Section 126

AJIT S. PAINTAL AND ALIYA N. HUSAIN

8.Breast and Sentinel Node 147

REBECCA J. WOLSKY AND JEROME B. TAXY

9.Genitourinary System 164

GLADELL P. PANER, TATJANA ANTIC, AND JEROME B. TAXY

10.Head and Neck 211

ADRIANA ACURIO AND JEROME B. TAXY

11.Thyroid and Parathyroid 234

TATJANA ANTIC, ADRIANA ACURIO, AND JEROME B. TAXY

12.Gastrointestinal Tract 259

REBECCA WILCOX AND AMY NOFFSINGER

13.Liver, Extrahepatic Biliary Tree, Gallbladder, and Pancreas 297

RISH K. PAI, REBECCA WILCOX, AMY NOFFSINGER, AND JOHN HART

14.The Skin 343

CHRISTOPHER KINONEN AND VIJAYA B. REDDY

15.Central Nervous System 378

JACK RAISANEN AND CHARLES L. WHITE III

Index 415

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