Pathology consultation during surgery
CPT4 code
Name of the Procedure:
Pathology Consultation During Surgery, also known as Intraoperative Consultation or Frozen Section.
Summary
In layman's terms, a pathology consultation during surgery involves a pathologist quickly examining tissue samples taken during an operation to provide the surgeon with immediate information about the findings. This helps in making real-time decisions about the surgery.
Purpose
This procedure addresses the need to identify whether tissue being removed during surgery is cancerous or benign. The goal is to provide immediate, accurate information to guide surgical decisions, potentially avoiding the need for a second operation.
Indications
- Suspicion of cancer during surgery.
- Need to confirm margins are clear of disease in cancer surgeries.
- Uncertainty about the nature of a mass or tissue detected during surgery.
- Situations where immediate pathology results could alter the surgical approach.
Preparation
- No special preparation is required from the patient specifically for the pathology consultation portion.
- Standard surgical preparation as guided by the surgeon and surgical team.
- Preoperative imaging and diagnostic tests might be conducted before the surgery.
Procedure Description
- Tissue Sample Collection: During the surgery, the surgeon collects tissue samples and sends them immediately to the pathology lab.
- Cryostat Freezing: The tissue sample is quickly frozen using a cryostat.
- Sectioning: Thin slices of the frozen tissue are cut.
- Staining: The slices are stained to highlight cellular details.
- Microscopic Examination: The pathologist examines the stained slices under a microscope.
- Reporting: The pathologist communicates the findings directly to the surgical team in the operating room.
Tools/Equipment: Cryostat, microscopes, staining reagents. Anesthesia: The patient is under general anesthesia for the primary surgery.
Duration
The consultation typically takes about 15-30 minutes, depending on the complexity of the tissue sample.
Setting
This procedure is performed in a hospital operating room, with the pathology lab nearby to facilitate quick analysis.
Personnel
- Surgeon
- Surgical Nurses
- Anesthesiologist
- Pathologist
- Pathology Technicians
Risks and Complications
- Minimal to no direct risks from the pathology consultation itself.
- Potential for inaccuracies or inconclusive results, necessitating further testing.
Benefits
- Immediate identification of cancerous tissues.
- Ability to ensure complete removal of cancerous tissues in one operation.
- Potentially avoid the need for a second surgery.
Recovery
- Recovery instructions pertain to the primary surgery.
- Normal post-operative care includes pain management, wound care, and activity restrictions as advised by the surgical team.
- Follow-up pathology reports might be provided after detailed analysis of additional tissue samples.
Alternatives
- Preoperative biopsies and imaging studies.
- Postoperative pathology examination of removed tissue (delayed results).
- Each alternative has its own timing, accuracy, and impact-related considerations.
Patient Experience
- The patient is under general anesthesia and will not feel anything during the pathology consultation.
- Post-operative pain management and comfort measures are similar to those provided after any major surgery.
- Patients will be informed of the preliminary findings once they are awake and stable, usually later on the day of surgery.