Name of the Procedure:

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

Summary

During a surgery, a pathologist may perform a cytologic examination using methods such as touch prep or squash prep to rapidly evaluate tissue samples. This procedure helps in diagnosing conditions immediately, influencing surgical decisions on the spot.

Purpose

This procedure addresses the need for rapid diagnosis of malignancies or other pathological conditions during surgery. The goal is to provide immediate information that can guide surgical treatment decisions, ensuring the best possible outcomes for the patient.

Indications

• Suspicion of cancer or other pathological conditions during surgery.
• Need for immediate diagnosis to decide on the extent of surgery.
• Verification of clear margins in tumor excision.
• Patient factors: A candidate undergoing surgery that may require immediate pathological assessment.

Preparation

• Patients typically follow fasting guidelines before surgery.
• Preoperative diagnostic tests such as imaging or biopsy may be performed to guide the surgery.
• Medication adjustments and cessation of certain drugs (e.g., blood thinners) as advised by the healthcare team.

Procedure Description

1. During surgery, the surgeon identifies areas for sampling.
2. Tissue samples are obtained from the surgical site.
3. For touch prep, the sample is touched to a glass slide to transfer cells. For squash prep, the tissue is squashed between two slides to spread cells thinly.
4. The slides are quickly stained and examined under a microscope by the pathologist.
5. The pathologist communicates findings to the surgical team immediately.
6. Based on findings, the surgical plan may be adjusted.

Equipment: Glass slides, staining agents, microscope.

Anesthesia: Typically, general anesthesia is used for the surgery, covering the sampling process as well.

Duration

The cytologic examination process itself typically takes about 20-30 minutes. The overall duration depends on the length of the surgery.

Setting

Performed in an operating room within a hospital or surgical center.

Personnel

• Surgeon
• Pathologist
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Common risks: Minimal, as it involves standard tissue sampling.
• Rare risks: Misinterpretation of results, which can affect surgical decisions.
• Management: Immediate intraoperative consultation and potential re-evaluation if needed.

Benefits

• Provides rapid diagnostic information.
• Allows immediate alterations to the surgical plan based on findings.
• Helps achieve clear margins in tumor removal, reducing the need for repeat surgeries.
• Benefits realized almost immediately during the same surgical procedure.

Recovery

• Recovery follows standard postoperative care instructions.
• No additional recovery time for the cytologic examination itself.
• Follow-up appointments as planned for the primary surgery.

Alternatives

• Preoperative biopsy, leading to a separate surgical session if pathology is confirmed.
• Frozen section analysis, which is another rapid diagnostic but more resource-intensive.
• Pros: Cytologic examination is faster and simpler.
• Cons: Less detailed than frozen section analysis.

Patient Experience

During the procedure: The patient will be under general anesthesia and unaware of the sampling process.

After the procedure: No additional discomfort from the cytologic examination. Pain management and comfort measures will be addressed for the primary surgery.