Lauren V. Ackerman

The pathology of tumors, part three

FrozenSection Frozen section diagnosis has proved of great value in helping the surgeon determine the proper course of action while the patient is still in the operating room. This method of diagnosis origi nated in the United States where it is used more frequently than in any other country. There are two major indications for the performance of frozen sections: (1) to make a therapeutic decision on the basis of the diagnosis rendered; and (2) to be sure that diagnostic tissue has been obtained in cases where the pur pose of surgery is to obtain a biopsy, such as in a laparotomy done to confirm a suspected diagnosis of lymphoma. The responsibility for frozen section diagnosis should be in the hands of an expert pathologist, with conservative attitudes and good judgment. Before rendering a diagnosis, the pathologist should have all the clinical data pertain ing to the case. If the patient has had a previous biopsy or operation, the pathologist should obtain and review the slides in advance so a comparison

Part II: Biopsy and exfoliative cytology: The pathology of tumors

tract zone. At times, we have found needle biopsy of value in the diagnosis of lesions of the parotid salivary gland, but with adenoid cystic carcinomas a false negative diagnosis may be made. Occasionally, we use needle biopsy to determine the presence or absence of tumor within lymph nodes, and invari ably the diagnosis is accurate. It could be argued that the normal lymphoid tis sue was obtained from some other lymph node or from some other area in the involved node where tumor was not present; but we have never encoun tered such an error. If no tumor or lymphoid tissue is obtained, then the needle biopsy is of no value. Needle bi opsy is an expeditious method of ob taining a positive diagnosis in ad vanced cancer of the breast for which irradiation therapy is proposed (Fig. 1). We have also used needle biopsy for tumors of the liver, mediastinal masses, soft tissue sarcomas, and for the exten sions of primary malignant tumors of bone (Figs. 2, 3 and 15). Transrectal needle biopsy of the prostate gland will often provide a positive diagnosis, es pecially in the case of lesions which clinically appear large or extensive. Several writers have reported some success with needle biopsy of pulmo nary lesions. This procedure is appar ently not as hazardous as the prejudice against it would indicate. In any event, it would seem to be a useful method of investigating bilateral lesions of the lung (Fig. 16). We do not use needle bi opsy for possible tumors of the kidney because of the danger of possible tumor implantation. Biopsy Biopsy is essential in the treatment of cancer. There are three types of bi opsy for which there are different indi cations: needle biopsy, incisional biop sy, and excisional biopsy.