Cytology sucks

[AngryTesticle]

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I think it's easy for surgeons to lose touch with reality. Give us one specimen for frozen...then comes more and more and more! It's like they want us to solve the entire case via frozen section...sorry, it doesn't work that way.

I felt bad for this one surgeon though. The guy was convinced that his patient had mesothelioma and was doing pleural biopsies. Specimen #1 had no tumor. Specimen #2 didn't either. Specimens #3 - 10 didn't have any tumor. Then I started to feel bad for the patient...he's gonna be s/p total pleurectomy by the time this operation is over!

 

[pathdawg]

I think it's easy for surgeons to lose touch with reality. Give us one specimen for frozen...then comes more and more and more! It's like they want us to solve the entire case via frozen section...sorry, it doesn't work that way.

I felt bad for this one surgeon though. The guy was convinced that his patient had mesothelioma and was doing pleural biopsies. Specimen #1 had no tumor. Specimen #2 didn't either. Specimens #3 - 10 didn't have any tumor. Then I started to feel bad for the patient...he's gonna be s/p total pleurectomy by the time this operation is over!

Its easy to bash surgeons (and fun too!). Seriously, not to turn this into a surgeon-trashing thread, but I find that they tend to live in a very black and white world. Not alot of space for nuiance. Its part of that whole "cold steel cures" mentality.
I really believe that our role as consultatnts is to help them. Sometimes, we have to save them from themselves.

 

[Doctor B.]

That's true. It seems like most of our surgeons understand the limitations of frozen and don't get too out of sorts. We do get a lot of thyroid frozens despite prior diagnosis by FNA. I'm not sure how that would change intraop management either. I sometimes wonder if they do a frozen just so they can report to the family that they did indeed remove the cancer.

 

[yaah]

I sometimes wonder if they do a frozen just so they can report to the family that they did indeed remove the cancer.

I wonder this too. Like doing a lobectomy for a lung mass, and then asking what the mass was on frozen. Duh, you already did the definitive surgery.

 

[AngryTesticle]

I wonder this too. Like doing a lobectomy for a lung mass, and then asking what the mass was on frozen. Duh, you already did the definitive surgery.

Seriously, man . Hell, if the surgeon did a whole "lung-ectomy" the most important thing that should be evaluated on a frozen section is the bronchial resection margin. That's it! The rest can be evaluated on permanents such as type of tumor, immunoprofile, lymphovascular invasion, lymph node mets, etc.

 

[pathdawg]

Seriously, man . Hell, if the surgeon did a whole "lung-ectomy" the most important thing that should be evaluated on a frozen section is the bronchial resection margin. That's it! The rest can be evaluated on permanents such as type of tumor, immunoprofile, lymphovascular invasion, lymph node mets, etc.

Right, and usually is done for a periphral tumor that is about a yard away from the damn bronchial reaection margin.

I have done a ton of bronchial resection margin frozens for lobectomies. I have yet to see a positive one.

 

[AngryTesticle]

Right, and usually is done for a periphral tumor that is about a yard away from the damn bronchial reaection margin.

I have done a ton of bronchial resection margin frozens for lobectomies. I have yet to see a positive one.

Hee hee...so true.

I too have yet to see a positive BRM but my sample size is likely much smaller than yours. 🙂

 

[happyhour06]

Speaking of the emperor's new clothes phenomenon, how about hemepath? Can we make up some more new and unnecessary immuno stains? I am working up a lymphoma case and the hemepath guy says to get a CD21 stain on top of the other 8 stains I am getting. I ask "what does it tell us" and the response is, "it'll highlight dentritic cells in the follicle." And that tells us..........NOTHING!!! Do they just do that to up the billing, or is it just mental masterbation?

Well, hempath just does things better than surg path. CD21 can tell you a lot about the follicles- if they're hypoplastic, if they're regressed, and where the malignant cells are. The bottom line is hempath actually has a big role in treatment planning, and the reason that it's so thorough is that minor differences in diagnosis can have major impacts in treatment. There certainly are pathologists who would rather isolate themselves from the clinical environment and just "mentally mastUrbate" about whether something is low-grade or high-grade dysplasia or "minimally invasive" carcinoma... or those who have radiology syndrome, completely unwilling to commit to a diagnosis. If you're that sort of person, hempath isn't for you.