Application of an innovative tissue support in rapid pathological diagnosis during surgery

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Data may be preliminary. 23 September 2025 V1 Latest version Share on Application of an innovative tissue support in rapid pathological diagnosis during surgery Authors : Hongwei Chen , Qingquan Fang , Xiaofen Cai , and Yuhuan Wang 0009-0002-6259-3027 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.175860558.87192017/v1 122 views 76 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract This work was designed to analyse the application value of a tissue support structure (Innovative Tissue Support) of the pathological tissue cryosection machine during rapid intraoperative pathological diagnosis.In present study, fifty fresh thyroid specimens were collected and randomly divided into two groups, respectively. The amount of embedding agent used, freezing time and ice crystal-free score of the sections were compared between these two different freezing methods. We found that the the average amount of embedding agent used per patient was 1.99±0.19 ml in the traditional tissue support group, which was markedly more than the 0.97±0.30 ml in the innovative tissue support group (t=20.00,P<0.01).Besides, The average freezing time was159.56±6.47s in traditional tissue support group,which was longer than 90.58±3.04s in innovative tissue support group significantly(t=68.23,P<0.01). Furthermore,we found that the average ice crystal-free score was 7.94±0.33 in the traditional tissue support group, which was significantly lower than the 9.36±0.46 in the innovative tissue support group (t =17.77, P < 0.01).In conclusion,The application of innovative tissue trays could improve the quality of slides and the accuracy of pathological diagnosis via saving embedding agents, improving freezing efficiency and reducing ice crystals in sections in the freezing process of pathological tissues. Application of an innovative tissue support in rapid pathological diagnosis during surgery Hongwei Chen 12 , Qingquan Fang 12 , Xiaofen Cai 3 , Yuhuan Wang 12 1. Department of Pathology, First Affiliated Hospital of Xiamen University, Xiamen 361003. 2. Xiamen Pathology Quality Control Center, Xiamen 361003. 3. Xiamen Xinglin Hospital, Xiamen 361020. Hongwei Chen, Qingquan Fang and Xiaofen Cai contributed equally to this work. Correspondence: Yuhuan Wang, [email protected] . ABSTRACT This work was designed to analyse the application value of a tissue support structure (Innovative Tissue Support) of the pathological tissue cryosection machine during rapid intraoperative pathological diagnosis.In present study, fifty fresh thyroid specimens were collected and randomly divided into two groups, respectively. The amount of embedding agent used, freezing time and ice crystal-free score of the sections were compared between these two different freezing methods. We found that the the average amount of embedding agent used per patient was 1.99±0.19 ml in the traditional tissue support group, which was markedly more than the 0.97±0.30 ml in the innovative tissue support group (t=20.00,P<0.01).Besides, The average freezing time was159.56±6.47s in traditional tissue support group,which was longer than 90.58±3.04s in innovative tissue support group significantly(t=68.23,P<0.01). Furthermore,we found that the average ice crystal-free score was 7.94±0.33 in the traditional tissue support group, which was significantly lower than the 9.36±0.46 in the innovative tissue support group (t =17.77, P < 0.01).In conclusion,The application of innovative tissue trays could improve the quality of slides and the accuracy of pathological diagnosis via saving embedding agents, improving freezing efficiency and reducing ice crystals in sections in the freezing process of pathological tissues. 1 Background Pathological diagnosis is regarded as the gold standard for the diagnosis of most diseases [1] . the rapid intraoperative pathological diagnosis is the emergency work of pathology department,which is used to provide a immediate and rapid evaluation for the surgeon to formulate the next surgical plan in surgery [2-4] .Therefore, the rapid intraoperative pathological diagnosis using frozen sections is essential in determining the surgical approach. The rapid and high-quality frozen section of pathological tissue is helpful to make efficient and accurate intraoperative rapid pathological diagnosis [5] .The pathological tissue to be frozen must be cut into 2 cm in length, 1.5cm in width, and 0.3cm in thickness according to the diagnosis and treatment standards, however, the tissue support of the existing freezing microtome is disk-shaped and the depression is concentric circles on the upper surface, which has some defects such as waste of embedding agent, long freezing time, and many ice crystals. We developed a tissue support structure of a pathological freezing microtome (The Patent Certificate Number: 19109224) to optimize the freezing process of rapid intraoperative pathological diagnosis, which was in order to improve frozen section efficiency and section quality. 2 Methods and Materials 2.1 General Information The fifty fresh thyroid specimens for frozen section were obtained from the Pathology Department of the First Affiliated Hospital of Xiamen University. Two similar pathological tissues were taken from each case and divided into two groups randomly. 2.2 The innovative pathological tissue tray structure of freezing microtome The structure is composed of a tissue tray and a limiting frame, which are made of metal materials. The tissue support consists of a square tray body and a base fixed on the bottom of the tray body. The top surface of the tray body is arranged in several square grooves spaced from outside to inside. The base is used to be stuck in the groove of the freezing microtome, and the pathological tissue is placed on the top surface of the tray body. The limiting frame can be separated and placed on the tissue support, and it is provided with a square groove. The bottom end of the square groove can be embedded in the square groove of the support body, and a limiting space is formed between the side wall of the square groove, the top surface of the body and the square groove corresponding to the square groove. When the limiting frame cover was placed on the tissue support, the four inner sides of the outer frame body were attached to the four outer sides of the support body, the lower edge of the outer frame body was flush with the lower edge of the tissue support and the outer frame body was just standing on the freezing table of the freezing microtome( Figure 1). 2.3 Frozen tissue 2.3.1 Traditional organization support group The pathological tissue was placed in the middle of the upper surface of the traditional tissue tray and the embedding agent was added to the tissue and its surrounding area. The tissue tray was placed on the freezing table of a freezing microtome subsequently. When the tissue and embedding agent were frozen into hard blocks, the tissue tray was embedded into the groove of the freezing microtome to be sliced. The tissue tray base could not be embedded in the groove of the freezing microtome when the embedding agent flows out of the edge of tray rounding the tissue base and was frozen into white hard blocks, so the tissue tray was removed and thawed at room temperature to remove the excess embedding agent.Finally, the tissue tray was refrozen in the freezing microtome( Figure 2). 2.3.2 Innovative tissue support group The pathological tissue was placed in the middle of the upper surface of the support body and the limiting frame with the appropriate size was selected and placed on the tissue support. Then the embedding agent was added into the limiting space until the embedding agent covered the pathological tissue and the tissue support was placed on the freezing table of a freezing microtome subsequently. The limiting frame and tin foil were removed when the pathological tissue and embedding agent were frozen into hard blocks, and then sectioning could be performed when the tissue support was embedded into the groove of the freezing microtome( Figure 2). 2.4 The amount of embedding agent used was measured The amount of embedding agent used in each pathological tissue of the two freezing methods was calculated. 2.5 Calculating freezing time The freezing time of each tissue in the two freezing methods was calculated as following:the time from the pathological tissue was placed on the tissue tray to the tissue tray was successfully embedded into the groove of the freezing microtome when the tissue was frozen into a hard block. Attentively, the tissue tray base could not be embedded in the groove of the freezing microtome when the embedding agent flows out of the edge of tray rounding the tissue base and was frozen into white hard blocks, it needs to be thawed and frozen again and the time of the two freezing processes is counted as the freezing time of the tissue. 2.6 The ice crystal-free was scored in the sections Score of ice crystal-free under the standard microscope as following: Scoring 10, the ice crystal-free was in the section absolutely. Scoring 4-9.9, there was a small amount of ice crystals, which affected the observation partly.Scoring 0-3.9, there was a large area covered with ice crystals affecting the observation seriously. 2.7 Statistical analysis Statistical analysis was performed with the Student’s t-test and ANOVA using SPSS 20.0 software. Data were presented as\(\bar{x}\)±s. Differences with P<0.05 were considered statistically significant. 3 Results 3.1 Comparison of the amount of embedding agent used in these two tissue support groups The average amount of embedding agent used per patient in the traditional tissue tray group was 1.99±0.19 ml, which was more than 0.97±0.30 ml in the innovative tissue tray group significantly (t = 20.00, P < 0.01). 3.2 Comparison of the Freezing time in these two tissue support groups The average freezing time of each case in traditional tissue support group was 159.56±6.47s, which was markedly longer than 90.58±3.04 s in innovative tissue support group (t = 68.23, P < 0.01). 3.3 Comparison of the Score of ice crystal-free in these two tissue support groups As showing in the figure3, the average score of ice crystal-free in traditional tissue support group was 7.94±0.33, which was lower than 9.36±0.46 in innovative tissue support group observably(t =17.77, P < 0.01). 4 Discussion It will be help to formulated surgical plans for surgeons as soon as possible and reduce the risk of surgery shortening the time of intraoperative rapid pathological diagnosis [6] . The freezing methods of pathological tissue is a critical affecting the timely rate and diagnostic accuracy of rapid pathological diagnosis during surgery. It has several defects that traditional freezing method uses disc-shaped tissue support to carry pathological tissue for freezing as following. Firstly, it would waste the embedding agent,because that the rectangular pathological tissue was placed on the round tissue support and there was no limiting frame to limit the flow of the embedding agent when the embedding agent was added, the embedding agent would not around the rectangular pathological tissue block obediently.Secondly, it was a pivotal factors affecting efficiency of sectioning, because it was easy to form irregular white hard blocks on the side wall or lower surface of the base of the tissue tray, which caused the base of the tissue tray to embed into the groove of the freezing microtome difficultly. it is necessary to thaw the tissue tray with the pathological frozen tissue and freeze the tissue again after removing the extra extra.Furthermore,it would affect the diagnostic results due to that a large number of ice crystals were produced in the tissue after twice freezing and thawing. Last but not least, it would affect the efficiency of diagnosis to a certain extent,because there was only one way to freeze the pathological tissue from freezing table of the microtome, tissue support to pathological tissue resulting in more ice crystals in pathological tissue easily and the efficiency of quick freezing poorly. In the present study, we designed ”a supporting structure of a pathological tissue freezing microtome”, which was applied to the pathological tissue freezing process with several advantages: firstly, it would save the use of embedding agent due to that the embedding agent only encapsulates the pathological tissue in the limited space without overflowing to the base. Besides,it could shorten the freezing time partly due to that the amount of embedding agent used is less. Moreover, it could improve the freezing efficiency of pathological tissue tissue, because the embedding agent would not overflow into the base and avoid the phenomenon of the embedding agent forms irregular white masses on the side wall or lower surface of the base of the tissue tray. And then the four inner sides of the outer frame body are attached to the four outer sides of the support body, the lower edge of the outer frame body is parallel to the lower edge of the tissue support, and the outer frame body is just standing on the freezing table of the freezing slicer. It could be frozen by freezing table of freezing microtome to outer frame and inner frame to embedding agent,which could significantly improve the freezing efficiency. In conclusion, the tissue support with unique designs could shorten the freezing time and reduce the formation of ice crystals in pathological tissue, thereby improving the quality of pathological frozen section and improving the accuracy of rapid intraoperative pathological diagnosis. Reference 1.Sybenga AB, Jupiter DC, Speights VO, Rao A. Diagnosing Osteomyelitis: A Histology Guide for Pathologists. J Foot Ankle Surg. 2020 Jan-Feb;59(1):75-85. 2.Plesec TP, Prayson RA. Frozen section discrepancy in the evaluation of nonneoplastic central nervous system samples. Ann Diagn Pathol. 2009,13(6):359-66. 3.Ozer E, Bilecen AE, Ozer NB, Yanikoglu B. Intraoperative cytological diagnosis of brain tumours: A preliminary study using a deep learning model.Cytopathology. 2023,34(2):113-119. 4.Ud Din N, Memon A, Idress R, Ahmad Z, Hasan S. Central nervous system lesions: correlation of intraoperative and final diagnoses, six year experience at a referral centre in a developing country, Pakistan. Asian Pac J Cancer Prev. 2011;12(6):1435-7. 5.Schaap PMR, van den Bosch S, Spies S, van Eeden S, van Dijkum EJMN, Groot ML,Engelsman AF. Instant Intraoperative Histopathological Assessment of Fresh Parathyroid Tissue: Higher Harmonic Generation Microscopy as a Potential Alternative to Frozen Section. Head Neck. 2025,47(8):2223-2230. 6.Xu S, Gao D, Li X, Zhang J, Yang J, Yang E, Ma Y, Qian J. Clinical application of standardization right thoracic incision for thoracoscopic thymic tumor resection. J Cardiothorac Surg. 2024,19(1):637. Information & Authors Information Version history V1 Version 1 23 September 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords innovation microscope organizational support pathological diagnosis Authors Affiliations Hongwei Chen The First Affiliated Hospital of Xiamen University View all articles by this author Qingquan Fang The First Affiliated Hospital of Xiamen University View all articles by this author Xiaofen Cai Xinglin Hospital View all articles by this author Yuhuan Wang 0009-0002-6259-3027 [email protected] The First Affiliated Hospital of Xiamen University View all articles by this author Metrics & Citations Metrics Article Usage 122 views 76 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Hongwei Chen, Qingquan Fang, Xiaofen Cai, et al. Application of an innovative tissue support in rapid pathological diagnosis during surgery. Authorea . 23 September 2025. DOI: https://doi.org/10.22541/au.175860558.87192017/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. 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