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Ma. Minda Luz Meneses-Manuguid, M.D.
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˜ iopsies are small samples of tissue taken from a
mass or tumor that are examined under a
microscope to make a diagnosis.
˜ iopsies are used most often to determine whether
cancer cells are present, although certain infections
and other diseases can be diagnosed as well.
˜
specific type of biopsy procedure called the
frozen section was developed in order to make a
rapid diagnosis of a mass during surgery.
˜ he frozen section is a laboratory procedure to
perform rapid microscopic analysis of a specimen. It
is used most often in oncological surgery. he
technical name for this procedure is cryosection.
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˜ he surgeon removes a portion of the tissue mass. his
biopsy is then given to a pathologist.
˜ he pathologist freezes the tissue in a cryostat machine, cuts
it with a microtome, and then stains it with various dyes so
that it can be examined under the microscope. he
procedure usually takes only minutes.
˜ he quality of the slides produced by frozen section is of
lower quality than formalin-fixed, wax-embedded tissue
processing. While diagnosis can be rendered in many cases,
fixed tissue processing is preferred in many conditions for
more accurate diagnosis.
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˜ he key instrument for cryosection is the cryostat, which is
essentially a microtome inside a freezer.
˜ he microtome is a very accurate "deli" slicer, capable of
slicing sections as thin as 1 micrometer. he usual histology
slide is cut at 5 to 10 micrometers.
˜ he surgical specimen is placed on a metal hold and frozen
rapidly to about ñ20 to -30 èÿ.
t this temperature, most
tissues become rock-hard. Usually, colder temperature is
required for fat or lipid-rich tissue, and cooler temperature
for skin. Each tissue has a preferred temperature for
processing.
˜ he specimen is embedded in a gel-like media known as
Optimum ÿutting emperature (Oÿ compound.
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˜ tissue must be sufficiently cold & hard to prevent
compression & displacement of cell & tissue
structures as the knife passes through. (if not cold
enough, tissue melts & becomes adherent to the
knife; if too cold, tissue becomes brittle, its
resistance to cutting is increased, & it fragments
upon cutting
˜ the knife must also be chilled & maintained at low
temp.he cutting blade must be sharp and set at the
correct angle.
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˜ ecommended emperatures for ÿutting Unfixed Frozen
issues
˜ issue ype Working emperature
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˜ ubsequently the frozen tissue is cut with the
microtome portion of the cryostat, the
section is picked up on a glass slide and
stained (usually with H & E
˜ he preparation of the sample is much more
rapid than with traditional histology
technique (around 10 minutes vs 16 hours.
However, the technical quality of the
sections is much lower.
˜ he intraoperative consultation is the name given
to the whole intervention by the pathologist:
frozen section, gross evaluation, examination
of cytology preparations taken on the specimen
(e.g. touch imprints, and aliquoting of the
specimen for special studies (e.g. molecular
pathology techniques, flow cytometry.
˜ he report given by the pathologist is usually
limited to a "benign" or "malignant" diagnosis, and
communicated to the surgeon

.
˜ he principal use of the frozen section procedure is
the examination of tissue while surgery is taking
place.
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˜ Mohs surgery - a simple method for 100% margin-
control of a surgical specimen.
˜ a sample of the suspected metastasis is sent for
cryosection. his will help the surgeon decide
whether there is any point in continuing the
operation. Usually, aggressive surgery is performed
only if there is a chance to cure the patient. If the
tumor has metastasized, surgery is usually not
curative, and the surgeon will choose a more
conservative surgery, or no resection at all.
˜ Evaluation if surgical margin is free of tumor, an
intraoperative consultation is requested to assess
the need to make a further resection for clear
margins.
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˜ In a sentinel node procedure: a sentinel node
containing tumor cells prompts a further lymph
node dissection, while a benign node will avoid
such a procedure.
˜ If surgery is explorative, rapid examination of a
lesion might help identify the possible cause of a
patient's symptoms.
˜ It is important to note, however, that the
pathologist is very limited by the poor technical
quality of the frozen sections.
final diagnosis is
rarely offered intraoperatively.
˜ arely, cryosections are used to detect the presence
of substances lost in the traditional histology
technique, for example lipids. hey can also be used
to detect some antigens masked by formalin.
 
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˜ If more tissue is needed to make an accurate diagnosis, the
surgeon is able to obtain an additional sample, avoiding a
second operation.
˜ ˜ If the tissue is determined to be cancerous and is amenable
to surgery, the mass can be removed at that time.
˜ ˜ If the tissue is determined to be benign (not cancerous,
then the mass may not always need to be removed and the
surgery can end.
˜ ˜ he frozen section biopsy can help ensure that the mass
being removed is the intended tissue for removal.
˜ ˜ It can help ensure that the entire mass and its surrounding
borders are removed.
˜ ˜ It allows for the collection of proper tissue samples for
further scientific research.
˜ ˜ he surgeon and pathologist are able to collaborate to
care for the patient.
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ometimes pathologists are not able to determine the
diagnosis based on the frozen section and instead
must rely on the permanent section.

lthough this takes longer than a frozen section
(usually 1 day, the permanent section leads to
better-quality microscope slides.

ll biopsies are limited by the sample taken. ÿancer
or other diseases may be so small that they are not
present in the tissue sample but may still be present
elsewhere. Multiple biopsies may be needed to
make a diagnosis