The Accuracy of Frozen Section Histopathology in the Rapid Diagnosis of Severe Cutaneous Adverse Reactions: A Systematic Review and Meta‐Analysis

BACKGROUND: Frozen section analysis enables rapid diagnosis, but its diagnostic accuracy in the setting of severe cutaneous adverse reactions (SCARs) remains poorly defined. METHODS: A systematic review and meta-analysis were performed to evaluate the diagnostic performance of frozen sections in the rapid identification of SCARs, with a focus on Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), compared to paraffin-embedded sections. Studies were identified from MEDLINE, EMBASE, the Cochrane Library, ISI Web of Science, and SCOPUS. Random-effects models were used for meta-analysis, and study quality was evaluated using the QUADAS-2 and STARD tools. RESULTS: Three diagnostic accuracy studies, comprising 134 patients, were eligible for meta-analysis. For SJS/TEN, pooled sensitivity was 0.91 (95% CI 0.83-0.96) and pooled specificity was 0.90 (95% CI 0.79-0.95), with a diagnostic odds ratio of 91.3 (95% CI 18.1-460.6). The area under the summary receiver operative characteristic (sROC) curve was 0.957. Data for other SCAR subtypes were insufficient for pooled analysis. Turnaround times were inconsistently reported, and risk-of-bias assessments identified high risk in two studies. CONCLUSION: Frozen sections demonstrate high diagnostic accuracy for the rapid evaluation of SJS/TEN, but the evidence is confined to a limited number of small, heterogeneous studies.