Frozen Biopsy in the Diagnosis of Gastric Cancer

Bradley Somer, MD
Last Modified: November 1, 2001

Dear OncoLink "Ask the Experts,"
Is there a role for frozen section biopsy prior to definitive surgical resection in management of gastric cancer? Can the two procedures (frozen section and definitive resection) be done at the time of surgery or do they have to be done at different time intervals?  
Thank you,
Dr. A.

Bradley Somer, MD, Editorial Assistant for OncoLink, responds:

The answer to your question is determined by whether or not the diagnosis of gastric cancer has already been made (by endoscopy, surgery etc.) If it has then there is likely no need for a frozen section because the definitive diagnosis is already made. If it hasn?t, then further evaluation needs to be made as to how to best make the diagnosis.

The evaluation process is generally;

  • make a diagnosis by the least invasive means,
  • clinical staging with imaging studies (ie. CT scans etc),
  • evaluation as to surgical approach and resectability.
If it is resectable, proceed and pathologically evaluate the specimen to get an idea of how aggressive it is and to see if there are good surgical margins (ie. it was all taken out). A frozen section wouldn't give much more information about this. Then there is an evaluation to see what further treatment would be warranted.

A frozen section may be done to confirm that the tumor is a malignant carcinoma as opposed to a lymphoma, which would dictate different management.

This is generally the process, but in the specific case that you are referring to there may be deviations from the process. If you would like more information you can either give more detail of this instance or ask the patient's doctor if and why it is being done differently.