A surgeon was suspicious during a biopsy procedure about the involvement of surrounding cells whether it's malignant or not. Which of the following would aid in quick diagnosis?

  # A surgeon was suspicious during a biopsy procedure about the involvement of surrounding cells whether it's malignant or not. Which of the following would aid in quick diagnosis?

A. Frozen section

B. Punch biopsy

C. Excisional biopsy

D. Incisional biopsy

The correct answer is A. Frozen section.

Clinical Rationale

In an intraoperative setting, the primary requirement for the surgeon is speed to decide the immediate course of action (e.g., whether to extend the surgical margin or perform a radical resection).

• Frozen Section (Cryosection): This technique involves rapidly freezing the tissue sample (usually with liquid nitrogen or a cryostat), slicing it with a microtome, and staining it for immediate microscopic examination. The entire process takes approximately 10 to 20 minutes, providing a "quick diagnosis" while the patient is still on the operating table.

• Punch, Excisional, and Incisional Biopsies: These are methods of obtaining tissue rather than a method of processing it for rapid diagnosis. These samples typically undergo Formalin-fixed paraffin-embedded (FFPE) processing, which takes 24 to 48 hours for a definitive report.

Comparison of Biopsy Techniques

Technique	Description	Clinical Utility
Frozen Section	Rapid freezing and sectioning of fresh tissue.	Intraoperative assessment of margins and malignancy.
Punch Biopsy	Uses a circular blade to remove a full-thickness "plug" of skin.	Commonly used for dermatological lesions (e.g., suspected melanoma or inflammatory conditions).
Excisional Biopsy	Removal of the entire lesion or tumor.	Used for small lesions where the procedure is both diagnostic and therapeutic.
Incisional Biopsy	Removal of only a portion of a large lesion.	Used when the lesion is too large for total excision without a prior diagnosis.

Note for MDS Residents

While frozen sections are highly efficient for identifying malignancy and checking margins (e.g., in Oral Squamous Cell Carcinoma), they have limitations compared to permanent sections:

1. Lower Resolution: Rapid freezing creates "freeze artifacts" (ice crystals) that can distort cellular morphology.

2. Thicker Sections: Cryosections are generally thicker than paraffin sections, making fine nuclear detail harder to appreciate.

3. Technician Dependent: The quality depends heavily on the skill of the pathologist and lab technician during the rapid processing window.