European Journal of Cardio-Thoracic Surgery, Vol 4, 584-586, Copyright © 1990 by European Association for Cardio-thoracic Surgery
Pitfalls in intraoperative frozen section histology of mediastinal neoplasms
FM Juttner, C Fellbaum, H Popper, K Arian, H Pinter and G Friehs
Department of Thoracic and Hyperbaric Surgery, University Medical School of Graz, Austria.
We evaluated the reliability of intraoperative frozen section histology in
149 mediastinal tumours of which 106 lesions were localized in the
anterior, 18 in the central and 25 in the posterior mediastinum. Gross
non-resectability was ruled out by preoperative imaging. No preoperative
cytological or histological diagnosis was obtained in any case. At
thoracotomy, 3 biopsies from 3 different sites of the tumour were processed
for frozen section as well as for paraffin histology and
immunohistochemistry. In 67 of 73 benign lesions (91%), the intraoperative
diagnosis was correct, 5 cases could not be classified by frozen section
and 1 case had to be revised. Only 28 of 76 malignant lesions (36.8%) were
diagnosed correctly by intraoperative frozen section. In 27 cases (35.5%),
no intraoperative classification was possible and in 21 patients (27.6%),
the diagnosis was wrong with the consequence of surgical overtreatment for
lymphoma misinterpreted as thymic cancer in 3 cases. In patients in whom
preoperative investigations suggest borderline resectability, a staged
procedure to obtain histology prior to definitive surgery could prevent
overtreatment.
