|
Interinstitutional comparison of frozen section turnaround time. A College
of American Pathologists Q-Probes study of 32868 frozen sections in
700 hospitals.
Novis DA, Zarbo RJ.
Department of Pathology, Wentworth-Douglass Hospital, Dover,
NH 03820, USA.
|
Arch Pathol Lab Med 1997 Jun;121(6):559-67 Abstract quote
OBJECTIVES: To study the intraoperative turnaround time for performing
a frozen section (FS) and to examine pathology practice variables that
influence it.
DESIGN: Over a 4-month period in 1995, participants in the College
of American Pathologists Q-Probes laboratory quality improvement program
prospectively collected data on up to 30 FS procedures performed on
elective inpatient surgical cases and completed questionnaires profiling
their FS practice characteristics.
SETTING: Surgical pathology laboratories serving private and public
hospitals.
PARTICIPANTS: Seven hundred institutions located in North America (667),
Australia (12), New Zealand (1), the United Kingdom (3), Hong Kong (1),
Mexico (1), and Norway (1).
MAIN OUTCOME MEASURES: The 90% FS block completion time defined as
the time interval, in minutes, within which the fastest 90% of all FS
blocks were completed, measured from the time pathologists received
FS specimens to the time they communicated FS results to the surgeon.
RESULTS: Participants submitted data on 32868 FS blocks. Ninety percent
of FS procedures were completed within 20 minutes. Frozen section turnaround
times exceeding 20 minutes, termed outlier turnaround times, were more
likely to occur when more than one pathologist participated in the FS
diagnosis, pathology residents and medical students participated in
the FS procedure, the pathologist had to retrieve and review previous
case material during the FS procedure, the pathologist simultaneously
received additional specimens from other FS cases, the pathologist was
unable to reach a final FS diagnosis, and when technical problems occurred
during the FS procedure. Seventy percent of all participating hospitals
completed 90% of their frozen sections within 20 minutes. The institutional
90% completion times were shorter for hospitals containing 300 or fewer
occupied beds than for those containing more than 300 occupied beds.
CONCLUSIONS: The data suggest that 90% of FS block turnaround times
can be performed within 20 minutes, measured from the time that pathologists
receive FS specimens to the time that pathologists return FS diagnoses
to surgeons. |
|
Interinstitutional comparison of frozen section consultations. A college
of American Pathologists Q-Probes study of 90,538 cases in 461 institutions.
Gephardt GN, Zarbo RJ.
Department of Pathology, Kennestone Hospital, Marietta, GA
30060, USA.
|
Arch Pathol Lab Med 1996 Sep;120(9):804-9 Abstract quote
OBJECTIVE: To assess concordant, discordant, and deferred diagnosis
rates from frozen sections; to determine reasons for discordance; to
identify pathologic processes associated with discordant diagnoses;
to determine false-positive or false-negative rates for neoplasms; and
to identify anatomic sites associated with discordant frozen section
diagnoses.
DESIGN: Q-Probes study of the College of American Pathologists.
PARTICIPANTS: Four hundred sixty-one institutions participating in
the Q-Probes program from November 1, 1990, through March 31, 1991.
MAIN OUTCOME MEASURES: Concordant and discordant diagnosis rates.
RESULTS: The frozen section concordance rate for diagnoses from the
aggregate group was 98.58% and the discordance rate was 1.42%, when
uncorrected for deferred diagnoses. During the study period, participating
institutions accessioned 1,693,331 surgical pathology cases; 90,538
of these cases were evaluated by frozen section consultation, resulting
in the examination of 121,668 specimens and 148,506 frozen section blocks.
The majority of the frozen section discordances occurred because of
misinterpretation of the original frozen section (31.8%), presence of
diagnostic tissue in permanent sections of the frozen block when the
frozen section was negative (30.0%), and presence of diagnostic tissue
in the portion of the specimen not sampled by the frozen section (31.4%).
Of the discordant diagnoses, 67.8% had false-negative diagnoses for
neoplasm. The pathology processes and anatomic sites represented in
discordant diagnoses are also evaluated.
CONCLUSIONS: High diagnostic accuracy of frozen section consultations
was demonstrated. Frozen sections are used to evaluate a variety of
pathologic processes and anatomic sites. |
|
Indications and immediate patient outcomes of pathology intraoperative
consultations. College of American Pathologists/Centers for Disease
Control and Prevention Outcomes Working Group Study.
Zarbo RJ, Schmidt WA, Bachner P, Howanitz PJ, Meier FA, Schifman
RB, Boone DJ, Herron RM Jr.
Department of Pathology, Henry Ford Hospital, Detroit, MI 48202,
USA. |
Arch Pathol Lab Med 1996 Jan;120(1):19-25 Abstract quote
OBJECTIVE--To evaluate the reasons (indications) for and immediate
intraoperative surgical results (outcomes) associated with pathology
intraoperative consultation.
DESIGN--In 1992 and 1993, surgeons collaborated with pathologists in
472 voluntarily participating institutions from the United States (462),
Canada (7), Australia (2), and New Zealand (1) in a study jointly sponsored
by the College of American Pathologists and the Centers for Disease
Control and Prevention. Pathologists selected 20 consecutive intraoperative
consultations and assembled a cover letter, a checklist questionnaire,
and a copy of the corresponding surgical pathology report, all of which
were sent to the surgeon(s) for retrospective evaluation.
PARTICIPANTS--The study was distributed to participants in the College
of American Pathologists voluntary Q-Probes quality improvement and
Surgical Pathology Performance Improvement programs and to Canadian
and Australian hospitals with more than 200 beds.
RESULTS--Evaluation of 9164 cases established the five most common
indications for intraoperative consultation: (1) establish or confirm
diagnosis to determine type or extent of operation (51%), (2) confirm
adequacy of margins (16%), (3) confirm nature of tissue to direct sampling
for immediate culture or other laboratory study (10%), (4) expedite
obtaining diagnosis to inform family or patient (8%), and (5) confirm
sufficient tissue submitted to secure diagnosis in permanent section
(8%). The information provided by the intraoperative consultation resulted
in changed surgical procedures that were either modified, terminated,
or newly initiated in 47%, 30%, 6%, 9%, and 28% of cases, corresponding
respectively to each of the above five common indications. Rarely cited
reasons for intraoperative consultation were to expedite obtaining diagnosis
for surgeon's knowledge (3%), to facilitate patient management, other
professional communication or discharge planning prior to permanent
section availability (3%), academic protocol (< 1%), and consultation
not needed or no reason for request (< 1%).
CONCLUSIONS--This multi-institutional, interdisciplinary database confirms
that pathology intraoperative consultations, regardless of the initial
indications, influence immediate patient care decisions, resulting in
changed surgical procedures in an average of 39% of all operative cases. |
