DIAGNOSTIC VALUE OF FROZEN SECTION COMPARED TO PERMANENT PATHOLOGY IN CAUSTIC INGESTION

Abstract

Introduction:-

Endoscopy is mandatory for assessment of severity of esophageal and gastric damage after corrosive burns. There are various mucosal damage classifications, which are unreliable for surgical decision making. Confirmation of endoscopic methods of burn depth estimation with pathologic findings is lacking. Faulty resection of burned esophagus and stomach based on mucosal damage also may be done.  Second look has its own problem, and diagnostic doubt may still remain because intra-operative findings have not enough validity for decision making. New modality for rapid an accurate assessment of injury depth may be frozen section.

Method and materials

This is a blinded prospective study to evaluate the accuracy of frozen section in estimation of burn depth.  Fifty one patients with grade 2 or 3 mucosal burn due to caustic injury underwent surgical exploration and biopsy taking. Samples reported by two pathologists.  Grading of samples either frozen section or permanent compared to each other. Intraoperative judgment of the surgeon compared with pathologic findings. Interrater reliability of examinations compared to each other by the kappa statistic. 

Results

Biopsy samples of fifty one patients with mean age of 33.4 years evaluated and compared to intra-operative findings .Thirty seven patients graded 2 and fourteen were in grade 3 endoscopy. At grade three, only 5 cases had the entire thickness of the stomach burn. Also, from 10 cases of gastrosophagectomy, 5 cases had mucous and under-mucous membranes burn. There were so many variations between pathologic diagnosis of burn depth and judgment of the surgeon (kappa<0.2).

Conclusion:

 Frozen section examination can be an accurate tool for final decision making in corrosive ingestion. Second look surgical exploration can be ignored from the management plan. Intraoperative opinion of a surgeon for estimating necrosis is not accurate. Futile resections are preventable, and Limited resection based on frozen section examination of burn margins will be possible. Limited resection probably made later reconstruction more feasible.