Frozen Section and Intraoperative Consultation in Hematopathology

Diagnosis, treatment, and prognosis of hematolymphoid neoplasms not only require careful morphologic review but increasingly rely on ancillary testing such as flow cytometry, immunohistochemistry, cytogenetics, and molecular testing. Traditional frozen sections can often limit such evaluation if additional fresh tissue is not obtained. A touch preparation should strongly be considered as a first step for intraoperative evaluation of lymph nodes, mediastinal masses, or other tissue where a potential hematolymphoid process may be considered. These are rapid, can be readily interpreted by the surgical pathologist, and may add key morphologic data to subsequent detailed review. Nonetheless, frozen section, squash preparations, and other techniques provide valuable information in many circumstances, particularly lesions with extensive fibrosis. Intraoperative evaluation also creates an opportunity to allocate material to appropriate ancillary testing and request additional fresh material when cytogenetic, flow cytometric, or microbial culture data may significantly inform diagnosis.