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Frozen section has limitations in its ability to provide real time description of analysed tissues. It is time consuming process where tissue samples are required to be studied by experienced pathologist. Despite this, often pathologists are not able to provide accurate results and outcome has to be deferred. This out-turn in increase operating time, wider resection of tissues and increases morbidity risk for patient. Hypothesis of this study is to explore the usefulness of frozen section in cancer surgeries in different specialities. We aim to map out the evidence for frozen section and study comparisons of frozen section with other intra-operative technologies.

Frozen section (FS) is a rapid histopathological assessment technique which involves snap freezing, staining and microscopic assessment of resected tissue of interest. It has been used as an intraoperative technique to determine the nature of tissue in question and to confirm clearance of margins in cancer resection. The technique has been shown to have potential in reducing rates of re-operative surgery and minimising disease and treatment related morbidity. FS is used in a variety of different surgical specialities with varying degrees of effectiveness. FS necessitates removing part of the tissue or specimen and rapid processing. The accuracy of FS depends on the question being asked of the pathologist, the type of organ or tissue and the type of assessment. Recently, there has been a move towards evaluating newer technological advances in imaging in the operating room as an alternative to FS assessment. This systematic scoping review will aim to answer the following questions: 1. What are the surgical scenarios in which FS has been studied in published literature? 2. What are the different types of FS techniques employed in literature, stratified by organ and tissue type? 3. What are the reported accuracy rates of FS compared to histopathological assessment and the reported improvement in clinical outcomes, stratified by organ and tissue type? 4. What novel technologies have been studied as an alternative or complementary technique to FS and what is their relative effectiveness? This review will enable an in-depth evaluation of the value of FS in surgical practice and provide an understanding of its evolution over the past few decades. It will explore the benefits and limitations of FS and provide a ‘state of the art’ synopsis of the place of FS in modern surgery.