LEONIDA, Julyan Jazmine P.

4CMT

Difference of Rush Frozen Section and Routine Histopathology

There are a few differences in Rush Frozen Section and Routine

Histopathology ranging from sample to technique. The Rush Frozen Section or
RFS is used to provide gross or microscopic diagnosis to guide intra or
perioperative patient management. It is mainly for special studies to confirm
whether a particular mass is benign or malignant. This technique also takes only
5-15 minutes and is coined as the “Operating Room Consultation”. Meanwhile,
Routine Histopathology considered as the gold standard for histopathological
examination follows a 12-step process to prepare, which takes up to 3 to 5 days.

Although RFS is preferred due to its faster turnaround time it still has its
limitations. The sample used for RFS is fresh tissue and ice crystals tend to form
in the fixative as it is processed in the cryostat therefore it is mostly used for
determination of malignancy. The permanent section used in Routine
Histopathology preserves the morphological structures and is much more useful
in diagnosis of diseases.

The process for the staining of RFS starts with hematoxylin for 90 dips
resulting to a blue stain. Second is rinsing the slides in water for about 10 dips
until excess dye is removed. The third procedure is to dip the sample three times
in acid-alcohol eliminating hemotoxylin from the non-nuclear components. Fourth
is to dip it three times in ammonia water to restore the basic pH to the dye and
enhance the stain. The fifth procedure is to stain it with eosin for 20-30 dips to
stain the cytoplasm and other constituents red. Sixth is to dehydrate the
specimen in alcohol 10 times in each beaker in increasing concentration to
remove the excess eosin and water in the slides. The seventh procedure is to dip
the slides in xylene until the fluid runs clear on the slide making the tissue
transparent. Eight is to remove the excess xylene by paper towel blotting the
slides and do the same mounting procedure as for formalin fixed tissue. Lastly,
label the slides properly and appropriately.

The examination for Routine Histopathology is a 12-step process that

starts with Accessioning where the specimen is assigned a number for proper
identification before starting the second step, which is Fixation where the
specimen is placed in a fixative in order to preserve the morphology of the
specimen and to protect it from the chemical and physical damage. The third is
Dehydration in which the specimen loses excess water when it is placed in
increasing concentrations of alcohol. Fourth is Clearing to remove the alcohol for
the following step which is Impregnation of paraffin wax. The fifth procedure is
Embedding, using molds to guarantee consistency for cutting tissue sections.
Next is blocking where the tissue sections are separated from one another to
prepare it for the following step, which is Trimming of excess wax to form a
truncated pyramid. Seventh step is Sectioning with a microtome to form tissue
ribbons. The eighth step is Staining using synthetic dyes to differentiate the
components of the tissue. Next is Mounting the stained tissues in glass slides
and lastly like the RFS it has to be labeled properly and appropriately.

The main difference of the examinations is that RFS is a limited procedure

than the permanent section. It can only be used for the determination of a
tumor’s malignancy and not much help in further diagnosis for other diseases. As
for Routine Histopathology, it is still considered as the gold standard for
diagnosis in histopathological examinations.