The Diagnostic Properties of Frozen Sections in Suspected Intracranial Tumors: A Study of 578 Consecutive Cases

Overview

Journal Surg Neurol Int

Specialty Neurology

Date 2015 Jan 17

PMID 25593754

Citations 10

Authors

Kathrine Tofte

Cathrine Berger

Sverre Helge Torp

Ole Solheim

Affiliations

Soon will be listed here.

Abstract

Background: Intraoperative frozen section (FS) diagnostics is an important diagnostic tool in neurosurgery, but agreement with final histopathology diagnoses may vary. In the present study we assess the diagnostic properties of intraoperative FSs in suspected intracranial tumors.

Methods: Retrospective single-center review of consecutive patients with suspected intracranial brain tumors from January 2008 to December 2012. We included all cases were both an intraoperative FS and a formalin-fixed paraffin-embedded (FFPE) section had been acquired. Agreement with final diagnosis, sensitivity, specificity, and predictive values were explored. Time between date of surgery and first final diagnosis based on FFPE section, whether the patients had undergone previous brain surgery and/or prior cerebral radiotherapy were also registered.

Results: Agreement between FS diagnoses and final FFPE section diagnoses was seen in 504/558 (90.3%), while there was lack of agreement in 54/558 (9.7%). In 20 cases, agreement was not classifiable. Agreement was lower in low-grade gliomas (82.5%) than in high-grade gliomas (93.2%). Agreement between FS and FFPE was significantly higher in primary operations (92.1%) than in re-do operations (81.5%) (P = 0.001). Sensitivity of FS ranged from 30.8% in lymphomas to 94.6% in meningiomas.

Conclusions: Intraoperative FS diagnoses demonstrate high diagnostic accuracy. However, agreement varies among histopathological entities and is lower in low-grade tumors than in high-grade tumors. Sensitivity for diagnosing CNS lymphomas is low. A variable degree of reservation is always necessary when interpreting and communicating FS diagnoses.

Citing Articles

Cryopreservation of brain cell structure: a review.

McKenzie A, Thorn E, Nnadi O, Wrobel B, Kendziorra E, Farrell K Free Neuropathol. 2025; 5():35.

PMID: 39844781 PMC: 11753176. DOI: 10.17879/freeneuropathology-2024-5883.

Tumor-Promoted Changes in Pediatric Brain Histology Can Be Distinguished from Normal Parenchyma by Desorption Electrospray Ionization Mass Spectrometry Imaging.

Seidinger A, Silva F, Euzebio M, Krieger A, Meidanis J, Gutierrez J Biomedicines. 2024; 12(11).

PMID: 39595159 PMC: 11592165. DOI: 10.3390/biomedicines12112593.

Fast intraoperative detection of primary CNS lymphoma and differentiation from common CNS tumors using stimulated Raman histology and deep learning.

Reinecke D, Maroouf N, Smith A, Alber D, Markert J, Goff N medRxiv. 2024; .

PMID: 39252932 PMC: 11383472. DOI: 10.1101/2024.08.25.24312509.

A multicenter proof-of-concept study on deep learning-based intraoperative discrimination of primary central nervous system lymphoma.

Zhang X, Zhao Z, Wang R, Chen H, Zheng X, Liu L Nat Commun. 2024; 15(1):3768.

PMID: 38704409 PMC: 11069536. DOI: 10.1038/s41467-024-48171-x.

Brain tumor grading diagnosis using transfer learning based on optical coherence tomography.

Hsu S, Lin M, Lin C, Hsiao T, Wang Y, Sun C Biomed Opt Express. 2024; 15(4):2343-2357.

PMID: 38633066 PMC: 11019689. DOI: 10.1364/BOE.513877.

References

McGirt M, Mukherjee D, Chaichana K, Than K, Weingart J, Quinones-Hinojosa A . Association of surgically acquired motor and language deficits on overall survival after resection of glioblastoma multiforme. Neurosurgery. 2009; 65(3):463-9. DOI: 10.1227/01.NEU.0000349763.42238.E9. View

Hagen T, Nieder C, Moringlane J, Feiden W, Konig J . [Correlation of preoperative neuroradiologic with postoperative histologic diagnosis in pathological intracranial processes]. Radiologe. 1995; 35(11):808-15. View

Mittler M, Walters B, Stopa E . Observer reliability in histological grading of astrocytoma stereotactic biopsies. J Neurosurg. 1996; 85(6):1091-4. DOI: 10.3171/jns.1996.85.6.1091. View

Sughrue M, Kane A, Shangari G, Rutkowski M, McDermott M, Berger M . The relevance of Simpson Grade I and II resection in modern neurosurgical treatment of World Health Organization Grade I meningiomas. J Neurosurg. 2010; 113(5):1029-35. DOI: 10.3171/2010.3.JNS091971. View

Prayson R, Agamanolis D, Cohen M, Estes M, Kleinschmidt-DeMasters B, Abdul-Karim F . Interobserver reproducibility among neuropathologists and surgical pathologists in fibrillary astrocytoma grading. J Neurol Sci. 2000; 175(1):33-9. DOI: 10.1016/s0022-510x(00)00274-4. View

Rogers L, Gilbert M, Vogelbaum M . Intracranial meningiomas of atypical (WHO grade II) histology. J Neurooncol. 2010; 99(3):393-405. DOI: 10.1007/s11060-010-0343-1. View

Savargaonkar P, Farmer P . Utility of intra-operative consultations for the diagnosis of central nervous system lesions. Ann Clin Lab Sci. 2001; 31(2):133-9. View

Julia-Sape M, Acosta D, Majos C, Moreno-Torres A, Wesseling P, Acebes J . Comparison between neuroimaging classifications and histopathological diagnoses using an international multicenter brain tumor magnetic resonance imaging database. J Neurosurg. 2006; 105(1):6-14. DOI: 10.3171/jns.2006.105.1.6. View

Uematsu Y, Owai Y, Okita R, Tanaka Y, Itakura T . The usefulness and problem of intraoperative rapid diagnosis in surgical neuropathology. Brain Tumor Pathol. 2007; 24(2):47-52. DOI: 10.1007/s10014-007-0219-z. View

10.

Aldape K, Simmons M, Davis R, Miike R, Wiencke J, Barger G . Discrepancies in diagnoses of neuroepithelial neoplasms: the San Francisco Bay Area Adult Glioma Study. Cancer. 2000; 88(10):2342-9. View

11.

Morita N, Harada M, Otsuka H, Melhem E, Nishitani H . Clinical Application of MR Spectroscopy and Imaging of Brain Tumor. Magn Reson Med Sci. 2010; 9(4):167-75. DOI: 10.2463/mrms.9.167. View

12.

de Witt Hamer P, Robles S, Zwinderman A, Duffau H, Berger M . Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol. 2012; 30(20):2559-65. DOI: 10.1200/JCO.2011.38.4818. View

13.

Jakola A, Myrmel K, Kloster R, Torp S, Lindal S, Unsgard G . Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas. JAMA. 2012; 308(18):1881-8. DOI: 10.1001/jama.2012.12807. View

14.

Colbassani H, Nishio S, Sweeney K, Bakay R, Takei Y . CT-assisted stereotactic brain biopsy: value of intraoperative frozen section diagnosis. J Neurol Neurosurg Psychiatry. 1988; 51(3):332-41. PMC: 1032857. DOI: 10.1136/jnnp.51.3.332. View

15.

Clarke J, Chang S . Neuroimaging: diagnosis and response assessment in glioblastoma. Cancer J. 2012; 18(1):26-31. DOI: 10.1097/PPO.0b013e318244d7c8. View

16.

Shah A, Muzumdar G, Chitale A, Bhagwati S . Squash preparation and frozen section in intraoperative diagnosis of central nervous system tumors. Acta Cytol. 1998; 42(5):1149-54. DOI: 10.1159/000332104. View

17.

Reni M, Ferreri A . Therapeutic management of primary CNS lymphoma in immunocompetent patients. Expert Rev Anticancer Ther. 2002; 1(3):382-94. DOI: 10.1586/14737140.1.3.382. View

18.

Louis D, Ohgaki H, Wiestler O, Cavenee W, Burger P, Jouvet A . The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007; 114(2):97-109. PMC: 1929165. DOI: 10.1007/s00401-007-0243-4. View

19.

Regragui A, Amarti Riffi A, Maher M, El Khamlichi A, Saidi A . [Accuracy of intraoperative diagnosis in central nervous system tumors: report of 1315 cases]. Neurochirurgie. 2003; 49(2-3 Pt 1):67-72. View

20.

van den Bent M . Interobserver variation of the histopathological diagnosis in clinical trials on glioma: a clinician's perspective. Acta Neuropathol. 2010; 120(3):297-304. PMC: 2910894. DOI: 10.1007/s00401-010-0725-7. View