All authors are affiliated with the Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Dermatol Surg. 2021 Feb 1;47(2):194-199. doi: 10.1097/DSS.0000000000002473.
Treatment of nonmelanoma skin cancer (NMSC) by Mohs surgery has traditionally relied on previous pathologic evaluation of paraffin-embedded tissue. Tissue processing by frozen sections allows for expedited diagnosis and treatment; however, data on its accuracy are limited.
To measure the accuracy and outcomes of biopsy via frozen sections for clinical NMSC.
Biopsies of clinical NMSCs processed via frozen sections with in-office diagnosis rendered by one Mohs surgeon were retrospectively reviewed by one board-certified dermatopathologist. Discordant diagnoses were re-read in blinded fashion by both physicians. If still discordant, final diagnosis was determined by consensus discussion. Inter-rater reliability was calculated using Cohen's kappa statistic.
Two hundred ninety-seven lesions from 208 patients were included. Correlation between in-office and final diagnosis was 0.876 indicating "almost perfect" concordance. Sensitivity and specificity of in-office diagnosis for detecting malignancy were 98.1% and 94.4%. Seven cases (2.0%) had a clinically relevant change in final diagnosis, but appropriate treatment had been rendered. Two benign lesions (0.7%) initially diagnosed as malignant underwent excision.
In-office biopsy via frozen sections is highly accurate in confirming NMSC. This practice may speed diagnosis and treatment thus improving outcomes and patient satisfaction.
传统上，Mohs 手术治疗非黑色素瘤皮肤癌（NMSC）依赖于石蜡包埋组织的先前病理评估。通过冷冻切片进行组织处理可以加快诊断和治疗速度；然而，关于其准确性的数据有限。
测量通过冷冻切片对临床 NMSC 进行活检的准确性和结果。
对一位 Mohs 外科医生进行的冷冻切片处理的临床 NMSC 活检进行回顾性研究，由一位经过董事会认证的皮肤科病理学家进行。对存在分歧的诊断以盲法由两位医生重新阅读。如果仍然存在分歧，则通过共识讨论确定最终诊断。使用 Cohen's kappa 统计量计算组内一致性。
共纳入 208 名患者的 297 个病变。办公室诊断与最终诊断的相关性为 0.876，表明“几乎完美”一致。办公室诊断检测恶性肿瘤的敏感性和特异性分别为 98.1%和 94.4%。7 例（2.0%）最终诊断有临床相关的变化，但已进行了适当的治疗。2 例良性病变（0.7%）最初诊断为恶性，行切除术。
通过冷冻切片进行的现场活检在确认 NMSC 方面具有高度准确性。这种做法可以加快诊断和治疗速度，从而改善结果和患者满意度。
