A Retrospective Study on Turnaround Time for Frozen Sections-A Tertiary Care Centre Experience from Southern India

Introduction: Intraoperative consultation by frozen sections is an integral and essential part of surgical pathology to provide critical real-time information and guide in further intraoperative management. Diagnostic accuracy and Turnaround Time (TAT) have been considered as essential parameters which decide its effectiveness. Although diagnostic accuracy has been studied extensively, very few studies have assessed TAT of frozen sections. Aim: To assess the TAT for frozen sections in a tertiary center and identifying the various practical factors determining it. Materials and Methods: This retrospective study was conducted in Department of General Pathology at Christian Medical college, Vellore, Tamil Nadu, India, on 615 frozen section samples obtained during the time period of June 2020 to June 2021. The TAT was defined as the time interval between receipt of sample and the time at which report was conveyed to the surgeon. The TAT for frozen sections should not exceed 30 minutes as per the criteria proposed by National Accreditation Board for Testing and Calibration Laboratories (NABL). Further details such as number of sites per frozen, number of pathologists involved, number of tissue blocks and slides made, requirement of deeper sections and special stains were documented and the factors influencing TAT were analysed based upon their subspecialty. Results: A total of 35,175 specimens were received during the study period, of which 615 cases had frozen sections. Out of 615, 16.9% had TAT of more than 30 minutes, however when only one tissue block was submitted (n=221), 90% were within TAT. The delay in TAT was likely to occur when more than two pathologists participated in the FS diagnosis, more number of sections/tissue blocks were required, the pathologist had to retrieve and review previous case material during the FS procedure, simultaneously receiving additional specimens and requirement of special stains. Conclusion: Turnaround time for frozen sections depends on several pre-analytical and analytical reasons. An overall TAT that includes these factors cannot be taken as a standalone quality indicator of the laboratory. Therefore, a checklist that includes specimen receiving time, slide receiving time and time at which the diagnosis was conveyed to the surgeon needs to be documented to help understand where the delay happens. A periodic assessment of intraoperative frozen section TAT should be an integral part of an ongoing quality assurance program.