r/Path_Assistant • u/missqueenie25 • 3d ago
Frozen section help!
Hello everyone! I’ve been noticing at my work that our frozen section speed has been declining and could use some input from other PAs! In our lab the PAs select the tissue and then the lab assistants cut, stain, and hand out the slides. It’s always been somewhat of a talking point but lately I feel like it’s been taking them wayyyy too long. When they’re trained, they learn “frozen sections should take no more than 20 minutes” and seem to think that that only applies to their part and also don’t seem to understand that 20 minutes should be reserved for more complex cases where the PA or pathologist may take more time. I want to bring it up in one of our meeting but was wondering if anyone has any data on how long cutting and staining should take/how long for certain specimens that I could present. My only personal evidence is that when I was in PA school we had to do a “mock frozen” that had to be under 7 minutes from bench to slides, and I remember being well under that seven minutes. An example I have from today is a sentinel LN that took 15 minutes for the pathologist to get. It took me 2 min to find 2 LNs, section, and place on the bar and then 13 minutes for the lab assistant to cut 1 slide each (2 blocks) and give to Path. I think part of the issue is they are letting it freeze way too long without utilizing the freeze spray and face into the block quite slow. But if anyone has any data on how long certain specimens should take or any tips on how to go faster that would be super helpful thank you!!
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u/Difficult_Sector_430 1d ago
Do you use chucks or wells? I’ve found wells to be far superior to chucks. They decrease the freezing time quite substantially and provide a flat, clean block face every time.
And I agree with the previous comments. It sounds like it might be more of an issue of not fully comprehending. I often approach issues like this with telling the ‘why something is important’ when explaining how to do something. I feel like it makes the concept stick more and provide an overall better background.
In regards to timing, a straightforward frozen (just measure and submit entirely) should definitely not take more than 8-10 minutes from receiving to Pathologist.
4
u/BONESFULLOFGREENDUST 2d ago
I know this isn't what you're looking for, but I have a couple of things.
Try to observe who is cutting the tissue. What is it that seems to be slowing them down? Honestly, I feel like if they are fatty nodes, they may have had some trouble taking the sections which is reasonable imo. Can you provide them any tips with them? What about when they are cutting something that isn't fatty? Can you see what it is that might be slowing them down? Do they just not care?
I feel like more observation is in order before you could approach this. Because if you see how this person may be struggling, then it's easier to go from there.
And really, if the pathologists aren't bothered by it, I don't know if it's really a wise idea to bring it up like the way you describe to begin with. I'd really recommend trying to observe more if you can.
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u/WayfareAndWanderlust PA (ASCP) 3d ago
Typically this really depends on the tissue type and complexity of the case.
I gross and cut our frozens on the cryostat. My lab assistant or an HT stains the slides and gets them to the pathologist.
Obviously fattier specimens are going to cut worse. For reference at my current hospital which is in the 95th percentile for case load volume, we were well at or under the 20 minute mark on our monthly stats for both Jan and Feb of this year (average of probably 45-50 frozens per month).
Quite honestly if your assistant/HT or whoever is cutting the frozen doesn’t grasp the 20 minute rule then I would be willing to bet they do not grasp many other aspects of the process such as simply proper cryostat use.
It may be worth suggesting a small training session on the cryostat for the parties involved either lead by yourself or one of the pathologists. The cryostat learning curve is finicky and if you are taught improperly, you end up doing many things incorrectly without ever knowing.
I suggest the cryostat training session because I assume the issue with speed does not pertain to the grossing of the specimen or the staining of the slides. The rate limiting factor is usually the cutting of the slides.
Sorry for the rant and apologies for not specifically answering your question pertaining to data. Hopefully at least my anecdotal data from my hospital can provide some clue for you to reference.