Intraoperative consultation

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%.
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):

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

Common specimens

Gynecologic:

• Pelvic mass - diagnosis.
• Ovarian mass - diagnosis.
• Uterine mass - diagnosis.
• 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:

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

• Basics.