Fixation artefact in an intra-operative frozen section: a potential cause of misinterpretation
© Thomson and Wallace; licensee BioMed Central Ltd. 2007
Received: 22 August 2007
Accepted: 25 October 2007
Published: 25 October 2007
The intra-operative histological assessment of fresh tissue can provide valuable diagnostic information and guide surgical management, however, even a limited exposure to standard fixation agents can potentially compromise analysis. Defined handling strategies should exist to facilitate the receipt of all specimens, in their optimal state, by the laboratory.
Sir: The intra-operative histological assessment of fresh tissue can provide valuable diagnostic information and guide surgical management [1–4]. However, the production of stained sections from frozen tissue is a technically demanding procedure which is associated with a variety of artefacts that limit interpretation and restrict subsequent clinical impact . As the following example illustrates, it is important that the tissue received by the laboratory is fresh and has not been inadvertently exposed to standard fixation agents prior to analysis.
We received a small biopsy, from an incidental lung lesion found in an 81-year-old male undergoing coronary artery bypass surgery, with a request to perform an intra-operative frozen-section. The tissue had been placed in a standard specimen container to facilitate transport; as a consequence, upon arrival, it had been exposed to formalin-buffered saline for approximately 5–10 minutes. Following consultation with the surgical team, and in light of the limited period of exposure to fixative, it was decided to proceed with analysis.
This case illustrates that even transient tissue fixation can potentially compromise frozen-section analysis. Defined handling strategies should exist to facilitate the receipt of all specimens, in their optimal state, by the laboratory; when these protocols are not followed, extreme care should be taken in interpreting the histology.
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