Frozen Section Analysis in Surgical Pathology: A Comprehensive Review
Author(s):
Angela S. Rezende, Teresa CF. Gutman , Karin SG. Cunha, Fabiana R. Rodrigues and Vânia GS. Lopes
Background: Frozen section (FS) analysis is an indispensable intraoperative diagnostic tool in surgical pathology, enabling realtime histological assessment to guide surgical decision-making. Despite its widespread use, its diagnostic accuracy varies, and a comprehensive synthesis of its indications, limitations, and organ-specific performance is warranted.
Objective: This comprehensive review aims to evaluate the technical principles, clinical applications, diagnostic accuracy, and inherent limitations of intraoperative frozen section consultation across various surgical specialties.
Methods: A comprehensive narrative review was conducted, recognizing the broad and multidisciplinary scope of the topic. A systematic search of PubMed, Scopus, and Web of Science databases was performed for English-language articles up to October 2025. Keywords included "frozen section," "intraoperative consultation," "surgical pathology," "diagnostic accuracy," and specific organ systems. Studies reporting on FS techniques, accuracy metrics, or diagnostic challenges were included. Given the heterogeneity of study designs and the aim to provide a clinically oriented synthesis, a narrative rather than systematic meta-analytic approach was chosen.
Results: FS demonstrates a variable but generally high diagnostic accuracy, with reported concordance rates with final paraffin histopathology ranging from 84% to 100% (average ~93%). Its utility is paramount for assessing surgical margins, evaluating sentinel lymph nodes, and diagnosing unexpected lesions. However, significant limitations exist, including tissue freezing artifacts, sampling constraints, and diagnostic challenges in specific contexts such as low-grade tumors, post-neoadjuvant therapy specimens, and certain anatomical sites (e.g., central nervous system, ovary, pancreas). Organ-specific analyses reveal distinct patterns of utility and difficulty.
Conclusion: Intraoperative frozen section consultation remains a critical, time-sensitive tool that significantly impacts surgical management. Its optimal use requires technical proficiency, a clear understanding of its capabilities and constraints, and robust interdisciplinary communication. Pathologists and surgeons must recognize it as a preliminary modality, with definitive diagnosis relying on comprehensive paraffin section analysis.