Frozen Section Request
Evaluate appropriateness of request
All Pathways
PathologyDiagnostic
Frozen Section Decision Making Algorithm (CAP)
Frozen Section Decision Making Algorithm (CAP): Frozen Section Request → Indication Assessment → Appropriate Indications → Specimen Handling → Interpret...
Pathway Overview
10 steps
Algorithm Steps
10 total
01Start 02Decision Indication Assessment
Will result change surgery?
- Margin assessment
- Lymph node status
- Tissue identification
- Presence of malignancy
- Resectability determination
03Action Appropriate Indications
Frozen section likely helpful
- Sentinel lymph node (breast, melanoma)
- Surgical margins
- Tumor resectability
- Identification of parathyroid tissue
- Ovarian tumor assessment
04Action Specimen Handling
Optimize tissue processing
- Fresh tissue only (no fixative)
- Appropriate sampling (gross exam)
- Thin sections (5 microns)
- Adequate staining
- Save tissue for permanent
05Decision Interpretation Confidence
Can definitive diagnosis be made?
06Action Definitive Diagnosis
Communicate to surgeon
- Clear benign or malignant
- Margin positive or negative
- Document findings
- Verbal communication
- Include limitations noted
07Action Surgeon Communication
Critical step
- Direct verbal communication
- Document who was called and when
- Explain limitations clearly
- Follow up with permanent correlation
- Report discrepancies for QA
08Action Frozen-Permanent Correlation
Quality assurance
- Compare frozen to permanent diagnosis
- Document any discrepancy
- Major discrepancy: different management
- Minor: same management category
- Root cause analysis if needed
09Action Defer to Permanent
When uncertain
- Atypical cells, cannot exclude malignancy
- Need IHC for diagnosis
- Inadequate tissue quality
- Rare/unusual entity
- Document reason for deferral
- Path rejoins step 07Shared downstream outcome
10Warning Not Recommended
Defer to permanent sections
- Lymphoma suspected (need flow/IHC)
- Thyroid follicular lesions
- Mesenchymal tumors (need IHC)
- Small specimens (may exhaust tissue)
- Fat-rich tissue (poor sections)
Guideline Source
CAP Guidelines for Frozen Section
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Frozen section has limitations vs permanent
- Some lesions not suitable for frozen
- Deferral is appropriate option
- Communication with surgeon critical
- Sample selection affects accuracy
Applicable Regions
USAUUKEU
AU: RCPA standards
UK: RCPath guidance
US: CAP frozen section guidelines
Version 1Next review: 2028-01-01
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Related Resources
Frequently Asked Questions
What is the Frozen Section Decision Making Algorithm (CAP)?
The Frozen Section Decision Making Algorithm (CAP) is a diagnostic clinical algorithm for Pathology. It provides a structured decision tree to guide clinical decision-making, based on CAP Guidelines for Frozen Section.
What guideline is the Frozen Section Decision Making Algorithm (CAP) based on?
This algorithm is based on CAP Guidelines for Frozen Section (DOI: 10.5858/arpa.2016-0234-CP).
What are the limitations of the Frozen Section Decision Making Algorithm (CAP)?
Known limitations include: Frozen section has limitations vs permanent; Some lesions not suitable for frozen; Deferral is appropriate option; Communication with surgeon critical; Sample selection affects accuracy. Individual patient factors may require deviation from these recommendations.
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