Name of the Procedure:

Pathology Consultation During Surgery; Cytologic Examination (e.g., touch prep, squash prep)

Summary

This procedure involves the rapid examination of cells taken from a surgical site while the surgery is ongoing. Techniques like touch prep or squash prep are used to prepare cell samples for immediate microscopic examination by a pathologist.

Purpose

This procedure aims to provide rapid diagnostic information during surgery to guide the surgeon. It can confirm if a tumor is malignant or benign, check if the surgical margins are clear of disease, and help decide the next steps in the surgery.

Indications

• Suspicion of malignancy during surgery
• Need to determine tumor type quickly
• Ensuring complete removal of cancerous tissue
• Immediate tissue diagnosis to guide surgical decisions

Patient criteria:

• Undergoing surgery where rapid diagnosis can influence the surgical outcome
• Suspected cancer or unclear tissue pathology that needs quick evaluation

Preparation

• Patient undergoes standard surgical preparation, which could include fasting and medication adjustments.
• Pre-surgical imaging or biopsy might be done to guide the surgery.

Procedure Description

1. A sample of tissue is taken from the surgical site.
2. The tissue is gently touched or squashed onto a glass slide (touch/squash prep).
3. The slide is quickly stained to highlight cellular details.
4. A pathologist examines the slides under a microscope in the operating room or a nearby lab.
5. The pathologist communicates the findings to the surgical team.

Tools and equipment:

• Glass slides, staining solutions, microscope.

Anesthesia:

• General or regional anesthesia as part of the ongoing surgery.

Duration

The cytologic examination itself takes approximately 15-30 minutes.

Setting

Performed in an operating room with immediate access to a pathology lab.

Personnel

• Surgeons
• Surgical nurses
• Pathologist
• Anesthesiologists (if applicable)

Risks and Complications

• Minimal risks directly related to the cytology procedure itself.
• Standard surgical risks include infection, bleeding, and anesthesia complications.

Benefits

• Rapid diagnosis can guide immediate surgical decision-making.
• Helps in achieving clear surgical margins, reducing the need for repeat surgeries.
• Can provide peace of mind by confirming diagnoses quickly.

Recovery

• No specific recovery process related to the cytologic examination.
• Recovery follows the standard post-surgical care plan.
• Follow-up appointments to discuss pathology results and next steps.

Alternatives

• Frozen section analysis, which is another rapid diagnostic procedure but involves freezing and slicing tissue.
• Waiting for postoperative pathology results, which can delay further treatment plans.

Patient Experience

• The patient will be under anesthesia during the procedure.
• Post-surgery, the patient might not directly experience the cytologic examination but will benefit from the immediate diagnostic information it provides.
• Pain management will follow standard postoperative care practices.