Difference between revisions of "Intraoperative consultation"

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==Common specimens==
==Common specimens==
Gynecologic:
===Table of common FS specimens===
{| class="wikitable sortable"
! Specimen
! Indication
! Subspecialty
|-
| Pelvic mass
| diagnosis
| [[gynecologic pathology]]
|-
| Ovarian mass
| diagnosis
| gynecologic pathology
|-
| Uterine mass
| diagnosis
| gynecologic pathology
|-
| [[Sentinel lymph node]]
| staging in [[Vulva]]r melanoma.
| gynecologic pathology
|-
| Squamous cell carcinoma
| [[margins]]
| [[head and neck pathology]]
|-
| Whipple procedure
| margins
| [[gastrointestinal pathology]]
|-
| Liver resection (usu. metastatic disease)
| margins
| gastrointestinal pathology
|-
| Lower anterior resection
| distal margin
| gastrointestinal pathology
|-
| Cystectomy/cystoprostatectomy
| ureteral margins
| [[genitourinary pathology]]
|-
| Pneumonectomy (usu. cancer)
| bronchus margin, [[lymph nodes]] for staging
| [[pulmonary pathology]]
|-
| [[Brain tumour]]
| diagnosis
| [[neuropathology]]
|-
| Spinal tumour
| diagnosis
| [[neuropathology]]
|-
| Thyroid nodule
| diagnosis
| [[thyroid pathology]]
|-
| Prosthetic joint
| query [[prosthetic joint infection]]
| [[joints|joint pathology]]
|}
 
====Gynecologic====
*Pelvic mass - diagnosis.
*Pelvic mass - diagnosis.
*Ovarian mass - diagnosis.
*Ovarian mass - diagnosis.
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**[[Vulva]]r melanoma.
**[[Vulva]]r melanoma.


Head and neck:
====Head and neck====
*Squamous cell carcinoma - margins.
*Squamous cell carcinoma - margins.


Gastrointestinal tract:
====Gastrointestinal tract===
*Whipple procedure - margins.
*Whipple procedure - margins.
*Liver resection - margins.
*Liver resection - margins.
*Lower anterior resection - distal margin.
*Lower anterior resection - distal margin.


Genitourinary tract:
====Genitourinary tract====
*Cystectomy - ureteral margins.
*Cystectomy - ureteral margins.


Pulmonary:
====Pulmonary====
*Pneumonectomy:
*Pneumonectomy:
**Bronchus - margins.
**Bronchus - margins.
**[[Lymph nodes]] - staging.
**[[Lymph nodes]] - staging.


Neurologic:
====Neurologic====
*[[Brain tumour]] - diagnosis.
*[[Brain tumour]] - diagnosis.
*Spinal tumour - diagnosis.
*Spinal tumour - diagnosis.


Thyroid gland:
====Thyroid gland====
*Thyroid nodule - diagnosis.
*Thyroid nodule - diagnosis.


Prosthetic joint:
====Prosthetic joint====
*Query [[prosthetic joint infection]].
*Query [[prosthetic joint infection]].


Revision as of 01:26, 8 January 2013

Intraoperative consultation, also quick section and frozen section, is when a surgeon requests an opinion during an operation so that they can appropriately manage a patient. It is abbreviated IC.

Why intraoperative consultations are done

Reasons why IC are done:[1]

  1. Determine diagnosis & appropriate extent of operation ~ 50%.
  2. Margin status - 15%.
  3. Triage tissue ~ 10%.
  4. Inform family ~ 8%.
  5. Sufficient tissue? ~ 8%.

Why intraoperative consultations may be refused

  • Tissue is the issue - not enough of it.
  • Infectious case.
  • Management - it won't make a difference.
    • Diagnosis won't make a difference.
    • Cannot make the diagnosis.
      • Bone tumours.

Frozen section permanent section concordance

Main article: Quality

Categories by the Association of Directors of Anatomic and Surgical Pathology (ADASP):[2]

  • Agreement
  • Deferral - appropriate.
  • Deferral – inappropriate
    • Recommendation <=10% threshold.
  • Disagreement – Minor.
  • Disagreement – Major.
    • Recommendation <=3% threshold.

Common specimens

Table of common FS specimens

Specimen Indication Subspecialty
Pelvic mass diagnosis gynecologic pathology
Ovarian mass diagnosis gynecologic pathology
Uterine mass diagnosis gynecologic pathology
Sentinel lymph node staging in Vulvar melanoma. gynecologic pathology
Squamous cell carcinoma margins head and neck pathology
Whipple procedure margins gastrointestinal pathology
Liver resection (usu. metastatic disease) margins gastrointestinal pathology
Lower anterior resection distal margin gastrointestinal pathology
Cystectomy/cystoprostatectomy ureteral margins genitourinary pathology
Pneumonectomy (usu. cancer) bronchus margin, lymph nodes for staging pulmonary pathology
Brain tumour diagnosis neuropathology
Spinal tumour diagnosis neuropathology
Thyroid nodule diagnosis thyroid pathology
Prosthetic joint query prosthetic joint infection joint pathology

Gynecologic

Head and neck

  • Squamous cell carcinoma - margins.

=Gastrointestinal tract

  • Whipple procedure - margins.
  • Liver resection - margins.
  • Lower anterior resection - distal margin.

Genitourinary tract

  • Cystectomy - ureteral margins.

Pulmonary

  • Pneumonectomy:

Neurologic

Thyroid gland

  • Thyroid nodule - diagnosis.

Prosthetic joint

Surgeon-pathologist dialog

It should include:

  1. Identification:
    • Pathology is calling - Dr. X is speaking.
    • Patient identifiers - full name.
    • Part(s) submitted.
  2. Diagnosis.
  3. Repeat of diagnosis from surgeon.
  4. Additional requests?

See also

References

  1. ↑ Zarbo, RJ.; Schmidt, WA.; Bachner, P.; Howanitz, PJ.; Meier, FA.; Schifman, RB.; Boone, DJ.; Herron, RM. (Jan 1996). "Indications and immediate patient outcomes of pathology intraoperative consultations. College of American Pathologists/Centers for Disease Control and Prevention Outcomes Working Group Study.". Arch Pathol Lab Med 120 (1): 19-25. PMID 8554440.
  2. ↑ URL: http://www.adasp.org/papers/position/QualityAssurance.htm. Accessed on: 2 March 2012.
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