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Cytological Evaluation During Intraoperative Consultation

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Rapid On-site Evaluation (ROSE)

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Abstract

This chapter illustrates the utility of cytological approach for intraoperative pathology consultation, exampled by intraoperative evaluation of sentinel lymph nodes, lymphoproliferative disorders, and indeterminate thyroid nodules. The diagnostic tips and pitfalls for cytological evaluation of these lesions are discussed. The chapter also provides information about slide preparation and stains used for intraoperative cytological evaluation.

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References

  1. Acs G, Baloch ZW, LiVolsi VA. Intraoperative consultation: an historical perspective. Semin Diagn Pathol. 2002;19(4):190–1.

    PubMed  Google Scholar 

  2. Gal AA, Cagle PT. The 100-year anniversary of the description of the frozen section procedure. JAMA. 2005;294(24):3135–7.

    Article  CAS  PubMed  Google Scholar 

  3. Taxy JB. Frozen section and the surgical pathologist: a point of view. Arch Pathol Lab Med. 2009;133(7):1135–8.

    PubMed  Google Scholar 

  4. St John ER, Al-Khudairi R, Ashrafian H, Athanasiou T, Takats Z, Hadjiminas DJ, Darzi A, Leff DR. Diagnostic accuracy of intraoperative techniques for margin assessment in breast cancer surgery: a meta-analysis. Ann Surg. 2017;265(2):300–10.

    Article  PubMed  Google Scholar 

  5. Esbona K, Li Z, Wilke LG. Intraoperative imprint cytology and frozen section pathology for margin assessment in breast conservation surgery: a systematic review. Ann Surg Oncol. 2012;19(10):3236–45.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Gupta PK, Baloch ZW. Intraoperative and on-site cytopathology consultation: utilization, limitations, and value. Semin Diagn Pathol. 2002;19(4):227–36.

    PubMed  Google Scholar 

  7. Soo V, Shen P, Pichardo R, Azzazy H, Stewart JH, Geisinger KR, Levine EA. Intraoperative evaluation of sentinel lymph nodes for metastatic melanoma by imprint cytology. Ann Surg Oncol. 2007;14(5):1612–7.

    Article  PubMed  Google Scholar 

  8. van der Noordaa MEM, Vrancken Peeters MTFD, Rutgers EJT. The intraoperative assessment of sentinel nodes – standards and controversies. Breast. 2017;34(Suppl 1):S64–9.

    Article  PubMed  Google Scholar 

  9. Kolte SS, Satarkar RN. Role of scrape cytology in the intraoperative diagnosis of tumor. J Cytol. 2010;27(3):86–90.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Rakha EA, Haider A, Patil S, Fourtan H, Chaudry Z, Soomro IN. Evaluation of touch preparation cytology during frozen-section diagnoses of pulmonary lesions. J Clin Pathol. 2010;63(8):675–7.

    Article  CAS  PubMed  Google Scholar 

  11. Kaba S, Tokoro Y, Washiya K, Tokairin T, Ono I, Tsuchida S, Kojima M, Koshikawa T. Cytology of pulmonary marginal zone B-cell lymphoma of MALT type: lessons learned for intra-operative diagnosis. Cytopathology. 2011;22(5):346–9.

    Article  CAS  PubMed  Google Scholar 

  12. Roychoudhury S, Souza F, Gimenez C, Glass R, Cocker R, Chau K, Kohn N, Das K. Utility of intraoperative frozen sections for thyroid nodules with prior fine needle aspiration cytology diagnosis. Diagn Cytopathol. 2017;45(9):789–94.

    Article  PubMed  Google Scholar 

  13. Bui MM, Smith P, Agresta SV, Cheong D, Letson GD. Practical issues of intraoperative frozen section diagnosis of bone and soft tissue lesions. Cancer Control. 2008;15(1):7–12.

    Article  PubMed  Google Scholar 

  14. Rahman K, Asif Siddiqui F, Zaheer S, Sherwani MK, Shahid M, Sherwani RK. Intraoperative cytology—role in bone lesions. Diagn Cytopathol. 2010;38(9):639–44.

    Article  PubMed  Google Scholar 

  15. Sezak M, Doganavsargil B, Kececi B, Argin M, Sabah D. Feasibility and clinical utility of intraoperative consultation with frozen section in osseous lesions. Virchows Arch. 2012;461(2):195–204.

    Article  PubMed  Google Scholar 

  16. Tathe SP, Parate SN, Jaiswal KN, Randale AA. Intraoperative crush smear cytology of vertebral chondroblastoma: a diagnostic challenge. Diagn Cytopathol. 2018;46(1):79–82.

    Article  PubMed  Google Scholar 

  17. Adhya AK, Mohanty R. Utility of touch imprint cytology in the preoperative diagnosis of malignancy in low resource setting. Diagn Cytopathol. 2017;45(6):507–12.

    Article  PubMed  Google Scholar 

  18. Lyman GH, Somerfield MR, Bosserman LD, Perkins CL, Weaver DL, Giuliano AE. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017;35(5):561–4.

    Article  PubMed  Google Scholar 

  19. Lisa Attebery M, Sieling BA, Ciocca R, Grujic E, Smink R, Frazier TG. Touch prep cytology as a preferred approach for evaluating sentinel lymph nodes in breast cancer. Breast J. 2007;13(1):106–7.

    Article  CAS  PubMed  Google Scholar 

  20. Upender S, Mohan H, Handa U, Attri AK. Intraoperative evaluation of sentinel lymph nodes in breast carcinoma by imprint cytology, frozen section and rapid immunohistochemistry. Diagn Cytopathol. 2009;37(12):871–5.

    Article  PubMed  Google Scholar 

  21. Liu LC, Lang JE, Lu Y, Roe D, Hwang SE, Ewing CA, Esserman LJ, Morita E, Treseler P, Leong SP. Intraoperative frozen section analysis of sentinel lymph nodes in breast cancer patients: a meta-analysis and single-institution experience. Cancer. 2011;117(2):250–8.

    Article  PubMed  Google Scholar 

  22. Howard-McNatt M, Geisinger KR, Stewart JH 4th, Shen P, Levine EA. Is intraoperative imprint cytology evaluation still feasible for the evaluation of sentinel lymph nodes for lobular carcinoma of the breast? Ann Surg Oncol. 2012;19(3):929–34.

    Article  PubMed  Google Scholar 

  23. Bruzzone M, Saro F, Bruno S, Celiento T, Mazzarella G, Lanata S, Aquilano MC, Parmigiani G, Pollone M, Gandolfo F, Costigliolo G, Sironi M. Synergy of cytological methods in the pathological staging of breast cancer: axillary fine-needle aspiration and intraoperative scrape cytology of the sentinel lymph node. Diagn Cytopathol. 2018;46(11):919–26.

    Article  PubMed  Google Scholar 

  24. Mannell A, Wium B, Thatcher C. Intraoperative examination of sentinel lymph nodes using scrape cytology. S Afr J Surg. 2014;52(3):75–8.

    Article  PubMed  Google Scholar 

  25. Llatjós M, Castellà E, Fraile M, Rull M, Julián FJ, Fusté F, Rovira C, Fernández-Llamazares J. Intraoperative assessment of sentinel lymph nodes in patients with breast carcinoma: accuracy of rapid imprint cytology compared with definitive histologic workup. Cancer. 2002;96(3):150–6.

    Article  PubMed  Google Scholar 

  26. Dabbs DJ, Fung M, Johnson R. Intraoperative cytologic examination of breast sentinel lymph nodes: test utility and patient impact. Breast J. 2004;10(3):190–4.

    Article  PubMed  Google Scholar 

  27. Cox C, Centeno B, Dickson D, Clark J, Nicosia S, Dupont E, Greenberg H, Stowell N, White L, Patel J, Furman B, Cantor A, Hakam A, Ahmad N, Diaz N, King J. Accuracy of intraoperative imprint cytology for sentinel lymph node evaluation in the treatment of breast carcinoma. Cancer. 2005;105(1):13–20.

    Article  PubMed  Google Scholar 

  28. Jain P, Kumar R, Anand M, Asthana S, Deo SV, Gupta R, Bhutani M, Karak AK, Shukla NK. Touch imprint cytology of axillary lymph nodes after neoadjuvant chemotherapy in patients with breast carcinoma. Cancer. 2003;99(6):346–51.

    Article  PubMed  Google Scholar 

  29. Elliott RM, Shenk RR, Thompson CL, Gilmore HL. Touch preparations for the intraoperative evaluation of sentinel lymph nodes after neoadjuvant therapy have high false-negative rates in patients with breast cancer. Arch Pathol Lab Med. 2014;138(6):814–8.

    Article  PubMed  Google Scholar 

  30. Pétursson HI, Kovács A, Mattsson J, Olofsson Bagge R. Evaluation of intraoperative touch imprint cytology on axillary sentinel lymph nodes in invasive breast carcinomas, a retrospective study of 1227 patients comparing sensitivity in the different tumor subtypes. PLoS One. 2018;13(4):e0195560.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Creager AJ, Geisinger KR, Perrier ND, Shen P, Shaw JA, Young PR, Case D, Levine EA. Intraoperative imprint cytologic evaluation of sentinel lymph nodes for lobular carcinoma of the breast. Ann Surg. 2004;239(1):61–6.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Caudle AS. Intraoperative pathologic evaluation with targeted axillary dissection: editorial for “intraoperative touch imprint cytology in targeted axillary dissection after neoadjuvant chemotherapy among breast cancer patients with initial axillary metastasis”. Ann Surg Oncol. 2018;25(11):3112–4.

    Article  PubMed  Google Scholar 

  33. Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, Guild V, Grant-Kels JM, Halpern AC, Johnson TM, Sober AJ, Thompson JA, Wisco OJ, Wyatt S, Hu S, Lamina T. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol. 2019;80(1):208–50.

    Article  PubMed  Google Scholar 

  34. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Nieweg OE, Roses DF, Hoekstra HJ, Karakousis CP, Puleo CA, Coventry BJ, Kashani-Sabet M, Smithers BM, Paul E, Kraybill WG, McKinnon JG, Wang HJ, Elashoff R, Faries MB, MSLT Group. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370:599–609.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Belli F, Lenisa L, Clemente C, Tragni G, Mascheroni L, Gallino G, Cascinelli N. Sentinel node biopsy and selective dissection for melanoma nodal metastases. Tumori. 1998;84(1):24–8.

    Article  CAS  PubMed  Google Scholar 

  36. Gipponi M, Solari N, Lionetto R, Di Somma C, Villa G, Schenone F, Queirolo P, Cafiero F. The prognostic role of the sentinel lymph node in clinically node-negative patients with cutaneous melanoma: experience of the Genoa group. Eur J Surg Oncol. 2005;31(10):1191–7.

    Article  CAS  PubMed  Google Scholar 

  37. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, Nieweg OE, Roses DF, Hoekstra HJ, Karakousis CP, Reintgen DS, Coventry BJ, Glass EC, Wang HJ, MSLT Group. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355(13):1307–17.

    Article  CAS  PubMed  Google Scholar 

  38. Alkhatib W, Hertzenberg C, Jewell W, Al-Kasspooles MF, Damjanov I, Cohen MS. Utility of frozen-section analysis of sentinel lymph node biopsy specimens for melanoma in surgical decision making. Am J Surg. 2008;196(6):827–33.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Badgwell BD, Pierce C, Broadwater JR, Westbrook K, Korourian S, Davis D, Hiatt K, Lee J, Cheung WL, Klimberg VS. Intraoperative sentinel lymph node analysis in melanoma. J Surg Oncol. 2011;103(1):1–5.

    Article  PubMed  Google Scholar 

  40. Fahy AS, Grotz TE, Keeney GL, Glasgow AE, Habermann EB, Erickson L, Hieken TJ, Jakub JW. Frozen section analysis of SLNs in trunk and extremity melanoma has a high false negative rate but can spare some patients a second operation. J Surg Oncol. 2016;114(7):879–83.

    Article  PubMed  Google Scholar 

  41. Gibbs JF, Huang PP, Zhang PJ, Kraybill WG, Cheney R. Accuracy of pathologic techniques for the diagnosis of metastatic melanoma in sentinel lymph nodes. Ann Surg Oncol. 1999;6(7):699–704.

    CAS  PubMed  Google Scholar 

  42. Koopal SA, Tiebosch AT, Albertus Piers D, Plukker JT, Schraffordt Koops H, Hoekstra HJ. Frozen section analysis of sentinel lymph nodes in melanoma patients. Cancer. 2000;89(8):1720–5.

    Article  CAS  PubMed  Google Scholar 

  43. Stojadinovic A, Allen PJ, Clary BM, Busam KJ, Coit DG. Value of frozen-section analysis of sentinel lymph nodes for primary cutaneous malignant melanoma. Ann Surg. 2002;235(1):92–8.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Scolyer RA, Thompson JF, McCarthy SW, Gershenwald JE, Ross MI, Cochran AJ. Intraoperative frozen-section evaluation can reduce accuracy of pathologic assessment of sentinel nodes in melanoma patients. J Am Coll Surg. 2005;201(5):821–4.

    Article  PubMed  Google Scholar 

  45. Creager AJ, Geisinger KR, Shiver SA, Perrier ND, Shen P, Ann Shaw J, Young PR, Levine EA. Intraoperative evaluation of sentinel lymph nodes for metastatic breast carcinoma by imprint cytology. Mod Pathol. 2002;15(11):1140–7.

    Article  PubMed  Google Scholar 

  46. Hocevar M, Bracko M, Pogacnik A, Vidergar-Kralj B, Besic N, Zgajnar J. Role of imprint cytology in the intraoperative evaluation of sentinel lymph nodes for malignant melanoma. Eur J Cancer. 2003;39(15):2173–8.

    Article  CAS  PubMed  Google Scholar 

  47. Nejc D, Pasz-Walczak G, Piekarski J, Pluta P, Sek P, Bilski A, Durczynski A, Berner A, Jastrzebski T, Jeziorski A. 94% accuracy of intraoperative imprint touch cytology of sentinel nodes in skin melanoma patients. Anticancer Res. 2008;28(1B):465–9.

    PubMed  Google Scholar 

  48. Jonjić N, Rajković Molek K, Seili-Bekafigo I, Grbac Ivanković S, Girotto N, Jurišić D, Zamolo G, Pavlović Ružić I, Prpić Massari L. Predictive value of intraoperative sentinel lymph node imprint cytology analysis for metastasis in patients with melanoma. Acta Dermatovenerol Croat. 2017;25(2):99–106.

    PubMed  Google Scholar 

  49. Gupta R, Dastane A, McKenna RJ Jr, Marchevsky AM. What can we learn from the errors in the frozen section diagnosis of pulmonary carcinoid tumors? An evidence-based approach. Hum Pathol. 2009;40(1):1–9.

    Article  PubMed  Google Scholar 

  50. Subik MK, Gordetsky J, Yao JL, di Sant’Agnese PA, Miyamoto H. Frozen section assessment in testicular and paratesticular lesions suspicious for malignancy: its role in preventing unnecessary orchiectomy. Hum Pathol. 2012;43(9):1514–49.

    Article  PubMed  Google Scholar 

  51. Shahraki AD, Mohammadizadeh F, Zafarbakhsh A. Intraoperative diagnosis by frozen section study would prevent unnecessary surgery in ovarian Burkitt’s lymphoma. Adv Biomed Res. 2014;3:71.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Nishimura R, Tsujimoto M, Kurokawa K, Tsukiyama A, Okuda T, Uraoka T, Gunji Y, Taki I, Yamanishi H, Nakahara M, Nakao K, Aozasa K. Usefulness of intraoperative cytology for the diagnosis of primary pancreatic lymphoma. Acta Cytol. 2001;45(1):104–6.

    Article  CAS  PubMed  Google Scholar 

  53. Bandyopadhyay A, Majumdar K, Gangopadhyay M, Khan K, Chakraborty S, Ghosh AK. Primary bilateral small lymphocytic lymphoma of ocular adnexal origin: imprint cytology suggests the intraoperative diagnosis. Saudi J Ophthalmol. 2013;27(1):61–3.

    Article  PubMed  Google Scholar 

  54. Singh C, Krigman HR, Pambuccian SE. Paranuclear and extracellular globules in intraoperative cytology preparations of anaplastic large cell lymphoma. Diagn Cytopathol. 2014;42(8):686–9.

    Article  PubMed  Google Scholar 

  55. Sugita Y, Terasaki M, Nakashima S, Ohshima K, Morioka M, Abe H. Intraoperative rapid diagnosis of primary central nervous system lymphomas: advantages and pitfalls. Neuropathology. 2014;34(5):438–45.

    Article  PubMed  Google Scholar 

  56. Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27(11):1341–6.

    Article  PubMed  Google Scholar 

  57. Tang AL, Falciglia M, Yang H, Mark JR, Steward DL. Validation of American Thyroid Association ultrasound risk assessment of thyroid nodules selected for ultrasound fine-needle aspiration. Thyroid. 2017;27(8):1077–82.

    Article  PubMed  Google Scholar 

  58. Berg RW, Yen TW, Evans DB, Hunt B, Quiroz FA, Wilson SD, Wang TS. Analysis of an institutional protocol for thyroid lobectomy: utility of routine intraoperative frozen section and expedited (overnight) pathology. Surgery. 2016;159(2):512–7.

    Article  PubMed  Google Scholar 

  59. Abu-Ghanem S, Cohen O, Raz Yarkoni T, Fliss DM, Yehuda M. Intraoperative frozen section in “suspicious for papillary thyroid carcinoma” after adoption of the Bethesda System. Otolaryngol Head Neck Surg. 2016;155(5):779–86.

    Article  PubMed  Google Scholar 

  60. Bollig CA, Gilley D, Lesko D, Jorgensen JB, Galloway TL, Zitsch RP 3rd, Dooley LM. Economic impact of frozen section for thyroid nodules with “suspicious for malignancy” cytology. Otolaryngol Head Neck Surg. 2018;158(2):257–64.

    Article  PubMed  Google Scholar 

  61. Lumachi F, Borsato S, Tregnaghi A, Marino F, Polistina F, Basso SM, Koussis H, Basso U, Fassina A. FNA cytology and frozen section examination in patients with follicular lesions of the thyroid gland. Anticancer Res. 2009;29(12):5255–7.

    PubMed  Google Scholar 

  62. Zanocco K, Heller M, Elaraj D, Sturgeon C. Cost effectiveness of intraoperative pathology examination during diagnostic hemithyroidectomy for unilateral follicular thyroid neoplasms. J Am Coll Surg. 2013;217(4):702–10.

    Article  PubMed  Google Scholar 

  63. Kennedy JM, Robinson RA. Thyroid frozen sections in patients with preoperative FNAs: review of surgeons’ preoperative rationale, intraoperative decisions, and final outcome. Am J Clin Pathol. 2016;145(5):660–5.

    Article  CAS  PubMed  Google Scholar 

  64. Trosman SJ, Bhargavan R, Prendes BL, Burkey BB, Scharpf J. The contemporary utility of intraoperative frozen sections in thyroid surgery. Am J Otolaryngol. 2017;38(5):614–7.

    Article  PubMed  Google Scholar 

  65. Bollig CA, Lesko D, Gilley D, Dooley LM. The futility of intraoperative frozen section in the evaluation of follicular thyroid lesions. Laryngoscope. 2018;128(6):1501–5.

    Article  PubMed  Google Scholar 

  66. Furlan JC, Bedard YC, Rosen IB. Role of fine-needle aspiration biopsy and frozen section in the management of papillary thyroid carcinoma subtypes. World J Surg. 2004;28(9):880–5.

    Article  PubMed  Google Scholar 

  67. Baloch ZW, LiVolsi VA. Cytologic and architectural mimics of papillary thyroid carcinoma. Diagnostic challenges in fine-needle aspiration and surgical pathology specimens. Am J Clin Pathol. 2006;125(Suppl):S135–44.

    PubMed  Google Scholar 

  68. Basolo F, Ugolini C, Proietti A, Iacconi P, Berti P, Miccoli P. Role of frozen section associated with intraoperative cytology in comparison to FNA and FS alone in the management of thyroid nodules. Eur J Surg Oncol. 2007;33(6):769–75.

    Article  CAS  PubMed  Google Scholar 

  69. Miller MC, Rubin CJ, Cunnane M, Bibbo M, Miller JL, Keane WM, Pribitkin EA. Intraoperative pathologic examination: cost effectiveness and clinical value in patients with cytologic diagnosis of cellular follicular thyroid lesion. Thyroid. 2007;17(6):557–765.

    Article  PubMed  Google Scholar 

  70. Anila KR, Krishna G. Role of imprint cytology in intra operative diagnosis of thyroid lesions. Gulf J Oncolog. 2014;1(16):73–8.

    CAS  PubMed  Google Scholar 

  71. Pyo JS, Sohn JH, Kang G. Diagnostic assessment of intraoperative cytology for papillary thyroid carcinoma: using a decision tree analysis. J Endocrinol Investig. 2017;40(3):305–11.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pathology, Yale University School of Medicine, New Haven, CT, USA

    Guoping Cai

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  1. Guoping Cai
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Correspondence to Guoping Cai .

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Editors and Affiliations

  1. Department of Pathology, Yale University School of Medicine, New Haven, CT, USA

    Guoping Cai

  2. Department of Pathology, Yale University School of Medicine, New Haven, CT, USA

    Adebowale J. Adeniran

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Cai, G. (2019). Cytological Evaluation During Intraoperative Consultation. In: Cai, G., Adeniran, A. (eds) Rapid On-site Evaluation (ROSE). Springer, Cham. https://doi.org/10.1007/978-3-030-21799-0_14

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  • DOI: https://doi.org/10.1007/978-3-030-21799-0_14

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