Difference between revisions of "Intraoperative consultation"
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===List of specimens=== | ===List of specimens=== | ||
====Gynecologic==== | ====Gynecologic==== | ||
*Pelvic mass - diagnosis. | *Pelvic mass - diagnosis (benign/borderline/malignant). | ||
*Ovarian mass - diagnosis. | *Ovarian mass - diagnosis (benign/borderline/malignant). | ||
*Uterine mass - diagnosis. | *Uterine mass - diagnosis (benign/borderline/malignant). | ||
*[[Sentinel lymph node]] - staging. | *[[Sentinel lymph node]] - staging. | ||
**[[Vulva]]r melanoma. | **[[Vulva]]r melanoma. | ||
Revision as of 01:35, 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]
- Determine diagnosis & appropriate extent of operation ~ 50%.
- Margin status - 15%.
- Triage tissue ~ 10%.
- Inform family ~ 8%.
- 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 |
List of specimens
Gynecologic
- Pelvic mass - diagnosis (benign/borderline/malignant).
- Ovarian mass - diagnosis (benign/borderline/malignant).
- Uterine mass - diagnosis (benign/borderline/malignant).
- Sentinel lymph node - staging.
- Vulvar melanoma.
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:
- Bronchus - margins.
- Lymph nodes - staging.
Neurologic
- Brain tumour - diagnosis.
- Spinal tumour - diagnosis.
Thyroid gland
- Thyroid nodule - diagnosis.
Prosthetic joint
- Query prosthetic joint infection.
Surgeon-pathologist dialog
It should include:
- Identification:
- Pathology is calling - Dr. X is speaking.
- Patient identifiers - full name.
- Part(s) submitted.
- Diagnosis.
- Repeat of diagnosis from surgeon.
- Additional requests?
See also
References
- ↑ 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.
- ↑ URL: http://www.adasp.org/papers/position/QualityAssurance.htm. Accessed on: 2 March 2012.