The Accuracy of Frozen Section Histopathology in the Rapid Diagnosis of Severe Cutaneous Adverse Reactions

BACKGROUNDFrozen section analysis enables rapid diagnosis, but its diagnostic accuracy in the setting of severe cutaneous adverse reactions (SCARs) remains poorly defined.

METHODSA systematic review and meta-analysis were performed to evaluate the diagnostic performance of frozen sections in the rapid identification of SCARs, with a focus on Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), compared to paraffin-embedded sections. Studies were identified from MEDLINE, EMBASE, the Cochrane Library, ISI Web of Science, and SCOPUS. Random-effects models were used for meta-analysis, and study quality was evaluated using the QUADAS-2 and STARD tools.

RESULTSThree diagnostic accuracy studies, comprising 134 patients, were eligible for meta-analysis. For SJS/TEN, pooled sensitivity was 0.91 (95% CI 0.83-0.96) and pooled specificity was 0.90 (95% CI 0.79-0.95), with a diagnostic odds ratio of 91.3 (95% CI 18.1-460.6). The area under the summary receiver operative characteristic (sROC) curve was 0.957. Data for other SCAR subtypes were insufficient for pooled analysis. Turnaround times were inconsistently reported, and risk-of-bias assessments identified high risk in two studies.

CONCLUSIONFrozen sections demonstrate high diagnostic accuracy for the rapid evaluation of SJS/TEN, but the evidence is confined to a limited number of small, heterogeneous studies.

Abstract from PubMed