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Intraoperative Schnellschnittdiagnostik

Intraoperative frozen section diagnosis

  • Themenschwerpunkt: Diagnostische Pathologie
  • Published:
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Zusammenfassung

Grundlagen

Die intraoperative Schnell (Gefrier)schnittdiagnostik stellt ein unterschiedlich häufig angewandtes Untersuchungsverfahren dar, dessen Indikationen und Leistungsfähigkeit unterschiedlich beurteilt werden. Es ist daher von praktischem Interesse, die Möglichkeiten, Schwierigkeiten und Grenzen dieser Methodik zu analysieren und zusammenzufassen.

Methodik:

Die intraoperative Schnell(Gefrier)schnittdiagnostik wird anhand wichtiger Literaturzitate und anhand eigener Ergebnisse und Erfahrungen besprochen.

Methodik:

Die intraoperative Schnell(Gefrier)schnittdiagnostik wird anhand wichtiger Literaturzitate und anhand eigener Ergebnisse und Erfahrungen besprochen.

Ergebnisse

Bei entsprechender Erfahrung des Pathologen ist die intraoperative Schnell(Gefrier)schnittdiagnostik ein hochverläßliches Diagnoseverfahren. Im allgemeinen kann mit einer definitiven intraoperativen und operationstaktisch richtungsweisenden Diagnose in 90 bis 95% der Fälle gerechnet werden. Dabei muß allerdings berücksichtigt werden, daß es organspezifisch beträchtliche Unterschiede in der diagnostischen Treffsicherheit und Aussagekraft gibt. Hauptindikation zur intraoperativen Schnellschnittuntersuchung ist die Tumordiagnostik. Neben Primärdiagnose von Läsionen haben das intraoperative Lymphknoten-Staging und die Radikalitätskontrolle in der Therapie maligner Tumoren an praktischer Bedeutung gewonnen. Weitern dient die intraoperative Gefrierschnittdiagnostik zur Sicherstellung der Repräsentativität von intraoperativ gewonnenen Biopsiematerial für die spätere definitive Diagnose im Paraffin eingebetteten Material.

Schlußfolgerungen:

Die intraoperative Schnell(Gefrier)schnittdiagnostik ist ein integraler Bestandteil der interdisziplinären Zusammenarbeit im Rahmen moderner Behandlungskonzepte geworden. Die Verläßlichkeit der Methode wird in hohem Maße bestimmt von der persönlichen Erfahrung des Pathologen, der technischen Qualität der Schnittpräparate und einer adäquaten Fragestellung. Unter diesen Voraussetzungen einer klinisch-pathologischen Kooperation stellt die intraoperative Schnell(Gefrier)schnittdiagnostik eine hochverläßliche und praktisch wichtige Untersuchungsmethode dar. Allgemein ist eine intraoperative Gefrierschnittdiagnostik dann gerechtfertigt, wenn von dieser Diagnose eine operationstaktische Entscheidung abhängt und die diesbezügliche Fragestellung auch im Gefrierschnitt lösbar ist.

Summary

Background:

The intraoperative frozen section diagnosis represents a diagnostic method, which is used with variable frequency and which indications and efficiency are discussed controversially. Therefore it is of practical interest to analyse and summarize the possibilities, difficulties and limitations of this method.

Methods:

The intraoperative frozen section diagnosis is discussed using important literature data as well as personal results and experiences.

Results:

Based on adequate experience of the pathologist the intraoperative frozen section diagnosis is a highly reliable diagnostic method. Generally a definite intraoperative and surgically relevant diagnosis can be achieved in about 90 to 95% of the cases. Substantial organ specific differences of the diagnostic accuracy and value have to be taken in account. The main indication for interoperative frozen section investigation is tumordiagnosis. In addition to the primary diagnosis of lesions the intraoperative lymph node-staging and the radicality control of the therapy of malignant tumors have got more practical impact. Additionally the intraoperative frozen section diagnosis is used to ascertain the adequacy of intraoperatively taken biopsy specimen for the later definite diagnosis in the paraffin embedded material.

Conclusions:

The intraoperative frozen section diagnosis has become an integral part of the interdisciplinary cooperation within modern therapeutic concepts. The value of this method highly depends on the personal experience of the pathologist, the technical quality of the histological slides and an adequate indication. Under these preconditions of a clinico-pathological cooperation the intraoperative frozen section diagnosis represents a highly reliable and practically important diagnostic method. In general an intraoperative frozen section diagnosis is primarily indicated if intraoperative decisions depend on its diagnosis and if the referring problem can be solved by frozen sections.

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  1. Institut für Pathologie, Universität Graz, Auenbruggerplatz 25, A-8036, Graz

    M. Klimpfinger

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Klimpfinger, M. Intraoperative Schnellschnittdiagnostik. Acta Chir Austriaca 28, 139–147 (1996). https://doi.org/10.1007/BF02625829

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