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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31326
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Doc.. followup to previous post. Brother had polyp surgically

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Doc.. followup to previous post. Brother had polyp surgically removed today. I assumed they would check pathology on the margins removed while he was still under. and then decide to take more. Wife says Doc told her they would get path back on Monday.
I'm wondering if they do a quick test while he's under and send it our for a more involved test?
Hello and welcome,

A quick pathology test (called as frozen section) is not done for the polyps. The reason is, that if it is benign (non cancerous), nothing further has to be done. If it is malignant; a surgical resection (5 cms of intestines on either side) has to be performed, which has to be done in a separate anesthesia and surgery session. That cannot be performed immediately. So the polyp is sent for pathology / biopsy for the paraffin section, where pathologist can give a detailed report later on. The paraffin sections (which gives report in 3-5 days) are far better than the frozen sections (which give report immediately during the procedure), as this has better staining and thus more specific and sensitive.

“My goal is to provide you with excellent service today. If there’s anything else I can do, let me know – it’s been a pleasure working with you and I hope to assist you again soon!”

Dr. Arun
Customer: replied 3 years ago.



As this was a followup to previous post.. a biopsy was done during colonoscopy and came back cancer. His previous colonoscopy was only 3 years ago so the chance of spread is small. They removed polyp and did the resection you described. I assumed a frozen section would be done on the margins removed since we already knew the polyp was cancer.. and if came back positive they would remove a larger section right then. Then send everything out for paraffin section. no?

Okay JR. The margins of the resected intestines are usually not sent for the frozen sections. There are two reasons for it;

1) the gross examination by the naked eye during the resection usually is quite confirmatory that adequate margins are taken. This eliminates the chance of the residual cancer being left out.

2) the paraffin sections are far more sensitive and specific to see the subtle changes (very minor changes, if at all anything has been left out which is almost one in hundred thousand chance).

It is privilege assisting you.
Customer: replied 3 years ago.

Doc.. Are you saying a surgeon can tell just by looking if it spread to the margins?

Yes. The naked eye exam can see the changes in the intestines which are suspicious. That would warrant for further increase the margin of the resection.

Even during colonoscopy (which was done previously and when polyp was removed); they could have seen that the rest of the intestine was normal. This is further confirmed during the surgery.

There is another criteria too; if the cancer was confined to the distal part of the polyp (which is not attached to the intestine); the chance of caner spread to the intestine is negligible or zero.
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