Frozen sections are performed for the purpose of rapid diagnosis while a patient is undergoing
surgery usually under general anesthesia as a basis for making immediate treatment decisions.
Therefore frozen section diagnosis is often a highly demanding situation for the pathologist
who must render a diagnosis quickly and a crucial determination for the patient and surgeon. In
addition to the need for rapid recall of differential diagnoses there are many pitfalls and
artifacts that add to the risk of frozen section diagnosis that are not present with permanent
sections of fully processed tissues that can be examined in a more leisurely fashion. Most
standard pathology textbooks both general and subspecialty largely ignore the topic of frozen
section. Few textbooks have ever focused exclusively on frozen section diagnosis and those
textbooks that have done so are now out-of-date and have limited numbers of black and white
figures. None has emphasized the education of the surgeon in terms of frozen section benefits
limitations or proper utilization. The Frozen Section Library series will provide convenient
user-friendly handbooks for each organ system to expedite use in the hurried frozen section
situation. These books will be small and light-weight copiously color illustrated with images
of actual frozen sections highlighting pitfalls artifacts and differential diagnosis. These
books will also include perspectives for the surgeon and for communication with the surgeon and
suggest ancillary procedures (for example when to take tissue for microbiology cultures). Each
5 X 8 book is estimated to be about 200 to 250 pages in toto with 100 to 150 color figures
each. As a handbook for practicing pathologists these books will be indispensable aids to
diagnosis and avoiding dangers in one of the most challenging situations that pathologists
encounter. Problems such as differentiation of benign processes from malignant neoplasms which
may be more difficult on frozen section than permanent section and which have a serious impact
on the surgeon's immediate treatment decisions will be emphasized. Rapid consideration of
differential diagnoses and how to avoid traps caused by frozen section artifacts will be
readily accessible to the users of the handbooks. A series of concise easy-to-use
well-illustrated handbooks alleviates the often frustrating and time-consuming sometimes
futile process of searching through bulky textbooks that are unlikely to illustrate or discuss
pathologic diagnoses from the perspective of frozen sections in the first place. Tables and
charts will provide guidance for differential diagnosis of various histologic patterns. The
advantages of a series of organ-specific handbooks in addition to the ease-of-use and
manageable size is that (1) it allows more comprehensive coverage of more diagnoses both
common and rare than a single volume that tries to highlight a limited number of diagnoses for
each organ and (2) it allows more detailed insight by permitting experienced authorities to
emphasize the peculiarities of frozen section for each organ system. Although some differences
in practice of frozen section exist between different institutions such as differing policies
regarding whether or not to perform frozen section on specific types of specimens these
differences are generally not significant and can be discussed ( an organ-specific handbook by
an expert in that organ system permits more opportunity for this type of discussion). Touch
preparations which are used for some organs such as central nervous system or thyroid more
often than others will be appropriately emphasized and illustrated according to the need for
each specific organ. This series will be highly valuable to practicing surgical pathologists
both community and academic and to pathology residents and fellows. The perspectives provided
will also be valuable to surgeons and especially to surgery residents and fellows who must
answer questions about pathology and frozen section on their board examinations. These
handbooks will be easily portable by the individual but it is envisioned that many departments
will want to also keep a series readily available in the frozen section laboratory.
