A biosafety algorithm for the protection of pathology staff during intraoperative examinations of pulmonary lesions

We aimed to propose a biosafety algorithm for the protection of pathology staff during intraoperative examinations of pulmonary lesions when working with cytological imprints and/or frozen sections for the intraoperative diagnosis of pulmonary lesions. We examined 148 pulmonary surgical tissues obta...

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Bibliographic Details
Published in:Pathology international 2019-04, Vol.69 (4), p.211-218
Main Authors: Sugiyama, Tomoko, Tajiri, Takuma, Fujita, Hirotaka, Hiraiwa, Shinichiro, Toguchi, Suguru, Nomura, Nozomi, Machida, Tomohisa, Suga, Atsushi, Nakamura, Yusuke, Nakagawa, Tomoki, Yamada, Shyunsuke, Iwazaki, Masayuki, Nakamura, Naoya
Format: Article
Language:English
Subjects:
algorithm
Algorithms
Biosafety
caseous necrosis
Cytology
Diagnosis
Diagnostic systems
Granuloma
imprint cytology
intraoperative diagnosis
Lungs
Necrosis
Pathology
pulmonary lesion
Pulmonary lesions
Sectioning
Surgeons
Surgery
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Summary:We aimed to propose a biosafety algorithm for the protection of pathology staff during intraoperative examinations of pulmonary lesions when working with cytological imprints and/or frozen sections for the intraoperative diagnosis of pulmonary lesions. We examined 148 pulmonary surgical tissues obtained intraoperatively for imprint cytology (IC) and for frozen sectioning and compared the diagnoses against the final pathological diagnoses. We analyzed concordance and non‐concordance rates and then used the data to produce a biosafety algorithm. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scratch‐IC were 91%, 100%, 100%, 50% and 92%, respectively, and those of frozen sectioning were 99%, 100%, 100%, 96% and 99%, respectively. Our data indicate that frozen sectioning is unnecessary if scratch‐IC yields a ‘malignant’ diagnosis but recommended with a ‘benign’ diagnosis. When a scratch‐IC preparation deemed inadequate for a diagnosis or an abscess, the pathologist must consult the surgeon concerning the possibility of granuloma with caseous necrosis and should ask the surgeon to be prepared for a frozen section. If granuloma with caseous necrosis is found in the frozen section, the pathologist must immediately communicate the information to entire staff and perform a PCR test before making a permanent section.
ISSN:1320-5463
1440-1827
DOI:10.1111/pin.12789