Speed with consequences
Intraoperative frozen section gives the surgical team an answer in minutes, but the technique has inherent limits that every pathologist must weigh.
The classic pitfalls
- Freezing (ice-crystal) artefact distorts nuclear detail, especially in water-rich tissue.
- Sampling error — a small frozen piece may miss the diagnostic focus.
- Fatty tissue sections poorly at frozen temperatures (relevant for breast, lymph nodes).
- No deferral for special stains or IHC at the moment of decision.
Good practice
Communicate uncertainty plainly to the surgeon, correlate with gross findings, and do not hesitate to defer to permanent sections when morphology is equivocal — an honest "defer" is safer than a forced call.
Equipment matters
A cryostat that holds a stable chamber temperature and a consistently sharp blade reduces avoidable artefact, giving cleaner sections when the clock is running.