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We describe 14 resected cases of thyroid tumor diagnosed as Class Ⅲ by fine needle aspiration cytology(FNA). Of these, 13 cases were diagnosed as: malignant tumor(1 case), suspicion of malignant tumor(5 cases), or were hard to distinguish from benign or malignant(7 cases). The operative methods used were total or near total thyroidectomy plus D1 or D2a in 4 cases; hemithyroidectomy plus D1 in 3 cases; subtotal thyroidectomy in 3 cases; and lobectomy of the thyroid in 4 cases. The final pathological diagnoses were papillary adenocarcinoma(6 cases, all were pStage Ⅰ), follicular adenocarcinoma(1 case, pStage Ⅲ), malignant lymphoma(1 case), follicular adenoma(2 cases), and adenomatous goiter(4 cases). The results of preoperative examination and intraoperative frozen section diagnosis did not accord with the final pathological results in 2 cases(follicular adenocarcinoma: 1, adenomatous goiter: 1). FNA Class Ⅲcases should be treated surgically, because 8 of 14 FNA Class Ⅲ cases were malignant thyroid tumor. The operation method should be selected cautiously.

Case 1: A 38-year-old man was referred to our hospital because of a chest nodular shadow found on a medical check-up. Chest CT showed a mass about 2 cm in diameter with a sharp margin in the right S6 segment. Right lower lobectomy was performed by video-assisted thoracoscopic surgery, because the mass was thought to be a peripheral lung carcinoid by intraoperative frozen section examination. However, the postoperative histopathological diagnosis was pulmonary sclerosing hemangioma with lymph node metastasis. Case 2: An 81-year-old woman was referred to our hospital because of a chest nodular shadow found on a medical check-up. Chest CT showed a mass about 1.5 cm in diameter with a sharp margin in the right S. Partial lung resection was performed by video-assisted thoracoscopic surgery, because the mass was thought to be an inflammatory lymph node on intraoperative frozen section examination. However, the postoperative histopathological diagnosis was peripheral lung carcinoid. Then, a right middle lobectomy was performed. These cases suggest that it may be difficult to diagnose peripheral lung carcinoid or pulmonary sclerosing hemangioma by intraoperative frozen section examination because of their pathological diversity.

One hundred twenty-six cases of resected lung adenocarcinoma of 2 cm in size or less were studied about intra and postoperative Noguchi's classification, high-resolution computed tomography (HRCT) findings and lymph node metastases in cases of lobectomy. Intentional limited resection for lung adenocarcinoma of 2 cm in size or less was recommended for selected patients with tumors of type A of Noguchi's classification diagnosed by intraoperative frozen diagnosis or tumors of intraoperative type B of 0.5 in ground-glass opacity (GGO) diameter ratio or more of HRCT. These patients are almost equal to patients of 0.5 in GGO diameter ratio or more with any type of Noguchi's classification. This GGO diameter ratio of 0.5 is easily available as a criteria of intentional limited resection for lung adenocarcinoma of 2 cm in size or less.

Sixty-two cases of peripheral lung adenocarcinoma 2 cm or less in diameter were diagnosed as type A, B, or C according to Noguchi classifications by intraoperative frozen section diagnosis. Four of 19 type A were changed finally to type B by postoperative pathologic examination. Likewise 10 of 34 type B were changed finally to 1 type A, 8 type C, and 1 type D. Three of 9 type C were changed finally to 2 type B and 1 type D. Frozen section diagnosis for small peripheral lung adenocarcinoma has some special problems and limitations. Only cases of type A diagnosed by frozen section diagnosis should be permitted to undergo limited surgical resection.

A 59-year-old man was admitted to our hospital for hemoptysis. Chest X-ray films showed a mass shadow in the left lower lobe. Any definitive diagnosis could not be made after examinations including sputum culture and bronchial cytology. Exploratory thoracotomy was performed since malignancy was not excluded. During the operation, mucosa-associated lymphoid tissue (MALT) lymphoma was suspected based on the pathological findings of the frozen section. The permanent section of the resected specimen contained colonies of actinomycetes in the bronchus, and the peripheral region demonstrated marked infiltration of lymphocytes and plasma cells through the interstitium of alveolar walls and peri-bronchovascular sheath, with many lymphoid follicles. This case revealed pulmonary actinomycosis coexisted with lymphocytic interstitial pneumonia (LIP). We concluded that lymphoproliferative disease should be considered another candidate for the differential diagnosis from pulmonary actinomycosis.

Telepathology is the performance of pathology at distance using available telecommunication links such as optic fiber, communication satellite, and integrated services digitized network (ISDN). The main applications of telepathology are to provide frozen section service, consultation between pathologists at a distance, and conducting conferences using displays. These activities are required due to the shortage and disproportional distribution of pathologists. Telepathology for frozen section service is fairly effective in providing indications for surgical procedures by discriminating malignant tumor from benign tumor, confirming metastasis to distant organs or lymph nodes, and decisions regarding the surgical margin. However, there are several public insurance problems in the spread and practice of telepathology. To solve these problems, not only from a medical approach but also from the development of mechanical engineering, economic and legal issues must be considered.

A retrospective study is presented comparing the results of 167 frozen section diagnoses of surgical extirpated parotid gland tumors with permanent-section diagnoses. Percentages of correct diagnosis for malignancy (cases correctly classified as benign or malignant tumors) and of correct diagnosis for histopathology (cases in which frozen section diagnosis and permanent-section diagnosis were identical) were calculated. Percentages of correct diagnosis for malignancy in all cases, benign cases, and malignant cases were 98.8%, 99.3%, and 95.8%, respectively. Percentages of correct diagnosis for histopathology in all cases, benign cases, and malignant cases were 94.0%, 97.2%, and 75.0%, respectively. These results are superior to the previous reports both of frozen section diagnosis and of fine-needle aspiration biopsy diagnosis although the data for histopathological diagnosis in malignant tumors are average compared to previous reports. We conclude that diagnoses of most parotid gland tumors based on frozen section examination are reliable and accurate, but caution should be exercised in malignant tumors diagnosis.

From March 1988 to December 1990, we detected estrogen receptor (ER) from breast cancer tissues with the dextran-coated charcoal (DCC) method. From September 1990 to March 1998, we repeated the above with the frozen section method (cloneH222; DAINABOT). With the paraffin-embedded section method using two antibodies of anti-ER (clone6F11; NOVOCASTRA and clone 1D5; MBL), we examined the ER of the same 185 primary breast cancer tissues. We had already detected these tissues with the frozen section method, and we also applied the same procedure for the 43 primary breast cancer tissues which had already been detected with the DCC method. We compared these data. The positive rates of ER with DCC, H222, 6F11 and 1D5 were 49%, 53%, 53% and 52% respectively, which were within the reported range. The accuracy between H222 and 6F11 which was calculated as the percentage that were in positive and negative concordance by the two methods, was 88%. The accuracies between H222 and 1D5, between 6F11 and 1D5, between DCC and 6F11, between DCC and 1D5 were respectively 89%, 96%, 79%, and 77%. Although the accuracy between DCC and the paraffin-embedded section was not necessarily high, we obtained a higher concordance between the frozen and paraffin-embedded sections. The highest concordance existed between 6F11 and 1D5. The 30% of negative cases with DCC were positive with paraffin-embedded section. Among these methods of ER detection from breast cancer tissues, the paraffin-embedded section method seemed to be the most useful.

Purpose: To improve the diagnostic accuracy of computed tomography (CT)-guided biopsy of small lung nodules., Materials and Methods: The usefulness of fine-needle core biopsy combined with immediate frozen-section diagnosis by pathologists was prospectively studied. Forty-six biopsies of small lung nodules (less than 3 cm in greatest diameter) were performed under CT guidance in 46 patients with 31 malignant and 15 benign processes. Initial biopsy was always attempted with a 20 or 21G histological needle; tissue samples were sent to the pathology department immediately after biopsy for pathologic diagnosis of the frozen sections., Results: In 41 of 46 lesions (89.1%), sufficient material was obtained for diagnosis, permitting a correct final diagnosis. For malignancy, the sensitivity was 100%, whereas 81.8% of the benign lesions were diagnosed as specifically benign. Pneumothorax occurred in 41.3%., Conclusion: Histological diagnosis using frozen sections is a useful adjunct for CT-guided biopsy of the chest.

The indications for and limitations of rapid cytology were discussed, and intraoperative cytology in combination with frozen section histology was reviewed. During the past 14 years, intraoperative cytology and frozen section histology were simultaneously performed in 1,987 cases of various diseases and organs. A discrepancy between the cytologic and the frozen section diagnoses was noted in 39 (2.0%) instances, and the combined use of cytology and histology was concluded to be useful for correct intraoperative diagnosis owing to their supplementary effect. A rapid preparation and staining technique for intraoperative cytology was described.

The "Quick Return Service" of laboratory information would be the service for patients and clinicians that supply the laboratory information the instance that the specimens and the requests of laboratory examinations are accepted by the laboratory on the basis of the hospital information system (HIS) and the high-speed hospital transportation system of the specimens. Is the "Quick Return Service" of the pathological diagnosis possible and necessary? This question led the author to review the technical environments of the pathological diagnosis, especially of the frozen section diagnosis through our experience at the surgical pathology division of the Department of Laboratory Medicine of National Defense Medical College (NDMC) Hospital. Through the review, it appears that the supporting system for surgical pathologists to frozen section diagnosis ("Quick Return Service") is essential. Pathologists often need clinical and radiological information at the pathological diagnosis. For quick gaining of the information by surgical pathologists on the "Quick Return Service", the efficient HIS including hospital PACS (picture archiving and communication system) is necessary. Standardization and quality assurance of images of frozen section are also necessary. The technical environments of telepathology are developing. The interinstitution consultation through the telepathology will be the indispensable help for the "general" surgical pathologists confronting the problematic cases in the small hospitals that are deficient of pathologists. With the help of staff of the surgical pathology division of the NDMC hospital and the technologists of Mitsubishi Electronics, Co, the author has tried to develop the archiving system of frozen section pictures on the digital image management system.(ABSTRACT TRUNCATED AT 250 WORDS)

On immunohistochemical detection of estrogen receptor in the breast cancer tissue, we examined whether ER1D5 [Anti-estrogen receptor monoclonal antibody, clone ER1D5(MBL)] using routinely fixed paraffin-embedded section may take the place of ERICA [Estrogen receptor immunocytochemical assay kit (DAINABOT)] using frozen one or not. With 63 breast cancer cases, estrogen receptor was positive in 63.4% of the cases by ERICA, while in 25.4% and 28.6% by ER1D5 in which enhancement of the antigen with microwave heating (high frequency power 500W 5 minutes) and autoclave heating (121 degrees C, 20 minutes) had been carried out. At present, it is unreasonable for ER1D5 to take the place of ERICA. However, it is noteworthy that estrogen receptor is detectable with paraffin-embedded section although the rate of positivity is low. It is desirable that further development of the antibody for estrogen receptor in the breast cancer tissue with paraffin-embedded section will be continued.

To evaluate the importance of epidermal growth factor receptors (EGFR) in the growth and progression of human gastric cancer, we immunohistochemically stained EGFR in specimens of gastric cancer and compared the results with histopathological findings. Fresh frozen sections obtained from 65 cases of gastric cancer were stained by indirect immunostaining technique using Oncogene Scince Inc. Cat. No. GR01 (528 IgG reported by Kawamoto et al.) as anti-EGFR monoclonal antibody. Of the 65 cases of gastric cancer, 17 (26.2%) were EGFR-positive. In differentiated cancer, EGFR was positive in 15 of 28 cases (53.6%) of advanced cancer, and 1 of 14 (7.1%) of early stage cancer. In undifferentiated cancer, 1 of 15 cases (6.7%) of advanced cancer was positive, but all 8 cases of early stage cancer were negative. In differentiated cancer, EGFR was more frequently positive in cases of advanced cancer than in those of early stage cancer (p < 0.05). These results suggest that EGFR are expressed or increase in the transition process from early to advanced stage cancer in differentiated gastric cancer. In addition, the lower EGFR-positive rate in cases of undifferentiated cancer than in those of differentiated cancer suggests that an increase in EGFR is not needed for cancer growth in most cases of undifferentiated cancer.

We studied immunohistochemically estrogen receptors (ER) in 25 meningiomas removed from 20 patients using formalin-paraffin sections. Estrogen and progesterone receptors were studies in three case of meningiomas using frozen sections, also. Only two cases show positive reactions for estrogen receptor using formalin-paraffin sections. No correlation was found between estrogen receptor state and histological type, or biological behavior except for sex. Frozen sections failed to show the positive reaction for estrogen or progesterone receptors at all. The data suggest that estrogen receptors are detected in a few of the case with meningioma. Immunohistochemical analysis for estrogen receptor do not offer the useful informations in histopathological diagnosis or estimation of biological behaviors for meningioma on routine laboratory works.

The crush cytology perform during the surgery for 22 cases with brain tumors at Surugadai Nihon University Hospital, being compared with frozen and permanent histology sections. Crush cytology, which was generally and less damaged by artefacts than frozen sections. Immunocytochemistry used crush cytology were useful tools for differential diagnosis between undifferentiated glioma and carcinoma. Crush cytology were thought to be useful using together with the frozen sections for intraoperative diagnosis.

One hundred and nine cases of breast cancer were examined by immunoperoxidase staining of frozen section for their HLA expression. Sixty one cases (56%) were negative or very weak for HLA class I expression, while normal mammary ductal epithelia showed intense positivity in both class I and class II antigens. The extent of expression correlated well with the histopathological subtyping of invasive ductal carcinoma in Japan, which reflects the prognosis quite well. Degree of lymphoid cell infiltration was also proportional to HLA expression by tumor cells. It may be that lack of HLA antigen expression leads to failure of induction of cytotoxic T cells, thus modulating the immunological response and influencing prognosis.

To identify viral antigens, the types of infiltrating mononuclear cells and cytokine bearing cells, the frozen brain tissue sections form a patient with herpes simplex encephalitis who died on 12th hospital days, were examined by immunocytochemistry methods and combined immunocytochemistry and in situ hybridization. The avidin-biotin peroxidase complex (ABC) techniques were applied for the detection of antigens. All monoclonal antibodies to Leu series and polyclonal antisera to lymphotoxin (LT), interleukin-6 (IL-6) and interferon-gamma (IFN-gamma) were purchased form Becton Dickinson Co., and Genzyme Co., (USA) respectively. A large number of neurons and glial cells staining positively HSV-1 antigens were found in the gray matter. Moreover, although a moderate number of HLA-DR (Ia) positive cells were found in the parenchyma, there were few cells displaying positively for Leu-3a, Leu-2a and Leu-7 respectively. To evaluate the number of positive cells appeared in the brain tissues, Leu stain for 4, 2a, 3a, 7, 12 and HLA-DR demonstrated 1.6%, 0.4%, 0.9%, 0.7% and 10% respectively. In addition, numerous number of IFN-gamma positive cells were detected around the lesion and randomly distributed thoroughly the lesion. IL-6 positive cells and LT positive cells were also similar in distribution to IFN-gamma positive cells. Moreover, in simultaneous detection of HLA-DR and HSV-1 mRNA by the combined immunocytochemistry and in situ hybridization, there were seen glial cells staining positively for HLA-DR (Ia) and several cells with mRNA.(ABSTRACT TRUNCATED AT 250 WORDS)

Using Ki-67 monoclonal antibody to the nuclear antigen of proliferating cells, the squash preparations of 141 brain tumors and the 36 frozen sections from corresponding tumor tissues were stained with peroxidase-antiperoxidase method. The staining indices in squash preparations correlated well to those in the corresponding frozen sections. There were good correlations between the percentage of stained cells and the histologic grade in agreement with known biologic behavior. In order of decreasing malignancy, the averages of Ki-67 staining indices were 26.7% for metastatic carcinomas, 12.6% for glioblastomas, and less than 2.8% for benign mesodermal tumor groups. Ki-67 staining with squash preparations could be applied to small tissues obtained by transsphenoidal surgery and stereotactic surgery as valuable adjuncts to intraoperative histologic diagnosis and the estimation of histologic malignancy.

The rapid histological diagnosis of neurosurgical biopsy material is of prime importance for the neurosurgeon. Cryostat-cut sections of fresh frozen tissues have been used in our department. The surgical materials are rapidly frozen at - 150 degrees C, and serial sections, 10 microns thick, are cut in a cryostat at -18 degrees to -20 degrees C. The sections are adhered to cover glasses and stained with Metachrome solution (a mixture of 1% Azure A and 0.5% Erie Garnet B). The rapid and accurate diagnosis can be obtained within 5 minutes. The advantage of cryostat-cut frozen section is the preservation of cell density and tissue architecture, which is most important in the diagnosis of neurosurgical materials, especially in case of diffusely infiltrating glioma. The previously reported methods, such as smear technique and frozen sections by using freezing microtome are also reviewed and discussed.

To evaluate the accuracy in diagnosing breast lesions by frozen sections, 657 consecutive diagnostic biopsies seen during 1982 were reviewed. Of 559 lesions considered benign at frozen sections, 558 were also benign in paraffin sections, the remaining one being a papillary carcinoma (i.e. 1/559 or 0.2% false negative). All 78 cases diagnosed as malignant in frozen sections were also malignant in paraffin sections (i.e. 0% false positive). Of the 20 doubtful cases, in frozen sections, 15 showed a papillary lesions; 7 of them were malignant in paraffin sections and the rest 13 benign. It is concluded that the frozen sections are usefull in the diagnoses of mammary disorders except for those cases with papillary tumors.