88331 Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen

Name of the Procedure:

Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen.
Common name(s): Intraoperative consultation, Frozen section biopsy.

Summary

During an operation, a small sample of tissue is quickly frozen, sliced, and examined under a microscope by a pathologist. This allows for an immediate evaluation of the tissue to help guide the surgeon's decisions.

Purpose

This procedure helps in identifying cancerous tissue, determining if all cancer is removed, or understanding other tissue abnormalities during surgery. The goal is to provide rapid and accurate diagnoses to assist in surgical decision-making.

Indications

• Suspicion of cancer or tumor.
• Need to confirm complete removal of malignant tissue.
• Determination of the type of tissue in question.
• Immediate intraoperative decisions concerning the surgical approach.

Preparation

• Patients may need to fast before surgery.
• Medication adjustments as advised by the surgical team.
• Pre-surgical diagnostic tests (e.g., imaging studies, blood tests).

Procedure Description

1. Surgical Sample Collection: A surgeon removes a small tissue sample from the patient during surgery.
2. Sample Freezing: The tissue is quickly frozen using a cryostat machine.
3. Sectioning: The frozen tissue block is sliced into thin sections.
4. Staining: The tissue sections are stained to highlight cellular details.
5. Microscopic Examination: The pathologist examines the stained tissues.
6. Report: The pathologist provides an immediate report to the surgical team.

Tools Used:

• Cryostat for freezing tissue.
• Microtome for slicing thin sections.
• Microscope for examination.

Anesthesia:

• General anesthesia for the patient, as part of the ongoing surgery.

Duration

• Typically, the pathology consultation takes about 15-30 minutes.

Setting

• Performed in a hospital operating room equipped with pathology laboratory capabilities.

Personnel

• Surgical team (surgeon, surgical assistants).
• Pathologist.
• Surgical nurses.

Risks and Complications

• Misdiagnosis due to technical limitations.
• Infection or bleeding at the biopsy site (rare as part of the larger surgery).

Benefits

• Immediate diagnosis and decision-making support.
• Helps ensure complete removal of malignant tissue.
• Guides further surgical steps without needing second operations.

Recovery

• No specific recovery from the biopsy itself; recovery depends on the overall surgery.
• Follow surgeon’s post-operative care instructions.
• Routine follow-up appointments to monitor recovery.

Alternatives

• Post-operative examination of tissue (delayed diagnosis).
• Imaging tests such as MRI or CT scan.
• Needle biopsy (less invasive but may not be suitable intraoperatively).

Comparison:

• Intraoperative consultation allows for immediate decisions but requires surgical intervention.
• Imaging and needle biopsies are less invasive but may require multiple procedures and delayed results.

Patient Experience

• The patient will not feel the biopsy procedure itself due to general anesthesia.
• Post-surgery pain managed by medical staff.
• Monitoring and care in a recovery area post-operation.