Evaluating Diagnostic Accuracy: Frozen and Permanent Sections

Context: Frozen section (FS) analysis is an intraoperative diagnostic approach that provides surgeons with timely information to guide immediate clinical decisions. Aims: The aim of this study was to evaluate the diagnostic accuracy, turnaround time (TAT), and causes of discrepancies between FS and permanent section analysis results in a tertiary care setting in Saudi Arabia. Settings and Design: In this retrospective cross-sectional study, we analyzed intraoperative FS consultations between January 2018 and December 2022. Subjects and Methods: We reviewed 781 FS cases and collected information on patient demographics, specimen type, FS and final diagnoses, TAT, number of blocks per case, pathologist subspecialty, and the level of experience of the technologists. Discordant cases were analyzed to determine the causes and clinical impact of discrepancies. Statistical Analysis Used: Data were analyzed using SPSS version 30.0 (IBM Corp., Armonk, NY, USA). Categorical variables are reported as frequency and percentage. Comparisons between the groups were conducted using the Chi-square test, t -test, or Mann–Whitney U -test. Results with P < 0.05 were considered statistically significant. Results: The FS and permanent section concordance rate was 93.3%. FS was most often used to distinguish benign from malignant pathology and evaluate sentinel lymph nodes (SLNs). Discordance (6.7%) was noted mainly in SLN cases. The mean TAT was 17.43 min, faster in concordant cases. Errors were mostly due to sampling and interpretation, with 51.9% of errors affecting clinical decisions. Conclusions: The FS analysis demonstrated high accuracy and timely results. Most diagnostic errors occurred in SLN cases. Better sampling, protocol adherence, and digital tools could improve outcomes.