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Confounders of intraoperative frozen section pathology during glioma surgery

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Abstract

Although frozen section pathology (FSP) is commonly performed during surgery for glioma-suspicious lesions, confounders of accuracy are largely unknown. FSP and final diagnosis were compared in 398 surgeries for glioma-suspicious lesions. Diagnostic accuracy, risk factors for diagnostic shift from neoplastic to non-neoplastic tissue and vice versa according to the final diagnosis, and the impact on intraoperative and postoperative decision-making were analyzed. Diagnostic shift occurred in 70 cases (18%), and sensitivity, specificity, and the positive (PPV) and negative (NPV) predictive value of FSP were 82.5%, 77.8%, 99.4%, and 9.3%, respectively. No correlations between shift and patients‘ age and sex, sample fluorescence or volume, tumor location, correct information on the pathology form, final high- or low-grade histology, or molecular alterations were found (p > .05, each). Shift was more common after irradiation (25% vs 15%; p = .025) or chemotherapy (26% vs 15%; p = .022) than in treatment naïve cases and correlated with the type of surgery (p = .002). FSP altered intraoperative decision-making in 25 cases (6%). Postoperative shift led to repeated surgery in 12 patients (3%). In 45 cases, in which FSP and final diagnosis based on the same tissue, shift occurred in only 5 patients (11%), and sensitivity, specificity, PPV, and NPV for FSP were 77.4%, 78.6%, 88.9%, and 61.1%, respectively. No correlations between diagnostic shift and any of the analyzed variables were found (p > .05, each). Although accuracy of FSP during glioma surgery is sufficient, moderate NPV should be considered during intraoperative decision-making. While confounders are sparse, accuracy might be increased by repeated sampling. Diagnostic shift rarely alters postoperative treatment strategy.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Münster, Münster, Germany

    Johanna Waltraud Anita Harms, Eileen Maria Susanne Streckert, Nora Maren Kiolbassa, Walter Stummer & Benjamin Brokinkel

  2. Institute of Neuropathology, University Hospital Münster, Münster, Germany

    Christian Thomas, Werner Paulus & Benjamin Brokinkel

  3. Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany

    Oliver Grauer

  4. Department of Radiation Oncology, University Hospital Münster, Münster, Germany

    Michael Oertel & Hans Theodor Eich

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  1. Johanna Waltraud Anita Harms
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  2. Eileen Maria Susanne Streckert
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Contributions

JWAH: data collection, manuscript draft, statistical analyses, and interpretation of the results; EMSS: data acquisition and manuscript draft; NMK: data acquisition and manuscript draft; CT: manuscript draft and interpretation of the results; OG: manuscript draft and interpretation of the results; MÖ: data collection; manuscript draft, and interpretation of the results; HTE: manuscript draft and interpretation of the results; WS: conception and manuscript draft; WP: manuscript draft; BB: statistical analyses, manuscript draft, and conception.

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Correspondence to Benjamin Brokinkel.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethikkommission der Ärztekammer Westfalen-Lippe und der Westfälischen Wilhelms-Universität, Az.: 2021-733-f-S.

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Harms, J.W.A., Streckert, E.M.S., Kiolbassa, N.M. et al. Confounders of intraoperative frozen section pathology during glioma surgery. Neurosurg Rev 46, 286 (2023). https://doi.org/10.1007/s10143-023-02169-z

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