Newspaper in Rochester, Minnesota, tells the story of how the 19th century use of frozen sections by pathologists at Mayo Clinic played key role in developing intra-operative diagnostics

It’s a good thing for pathologists each time a local newspaper runs a story that highlights the contribution of pathology to the practice of medicine. Since pathologists typically don’t see patients, media stories about the pathologist’s role in diagnosing disease are effective ways to educate consumers.

This was the case when Rochester, Minnesota-based PostBulletin.com recently ran a story about—who else—but the pathology laboratory at the Mayo Clinic. The story highlighted the early development of the frozen section technique (FST) at Mayo Clinic. This newspaper story created community exposure about the role of pathology and pathologists in delivering quality healthcare.

Frozen Section Resulted From Need for Rapid Intraoperative Diagnostics

The frozen section developed in the wake of several medical advances that occurred in the late 1800s. This period saw significant advances in surgical technique, anesthesia, hemostasis, and control of infection, according to Anthony A. Gal, M.D., and Philip T. Cagle, M.D., in a commentary on FST published in the Journal of the American Medical Association (JAMA). Gal is Professor of Pathology and Laboratory Medicine, Emory University Hospital. Cagle is Professor of Pathology and Laboratory Medicine, Weill Cornell Medical College of Cornell University.

These advances enabled physicians in departments of surgery or gynecology to study tissue from living patients, Gal and Cagle noted. As a result, the need arose for more rapid intraoperative diagnostics. Pathology at the time, however, was focused elsewhere. “Most pathologists… were more devoted to autopsies and research and were largely disinterested in practical clinical applications of pathology,” they wrote.

Mayo Clinic Pathologist Pioneered Frozen Section Technique

It was Mayo Clinic Chief of Pathology Louis B. Wilson, M.D. who pioneered the frozen section at the Rochester, Minnesota clinic in 1905, according to a recent story published in the PostBulletin. The clinic had hired Wilson to organize and develop its diagnostic laboratories.

Pictured above is Louis Wilson, M.D., a pathologist who joined the Mayo Clinic in 1905. On its website, the Mayo Clinic writes, “It was Dr. Wilson who answered the call from the Mayo brothers to develop a rapid method to assess surgical specimens before the procedures were completed in the operating room. He developed a technique to rapidly freeze surgical tissues with carbon dioxide and cut sections using a specially modified freezing microtome. After the material was stained with polychrome methylene blue, a pathologist examined it under the microscope and made the critical diagnosis, entering the results in the patient's record before he or she left the recovery room.” (Photo copyright Mayo Clinic.)

Pictured above is Louis Wilson, M.D., a pathologist who joined the Mayo Clinic in 1905. On its website, the Mayo Clinic writes, “It was Dr. Wilson who answered the call from the Mayo brothers to develop a rapid method to assess surgical specimens before the procedures were completed in the operating room. He developed a technique to rapidly freeze surgical tissues with carbon dioxide and cut sections using a specially modified freezing microtome. After the material was stained with polychrome methylene blue, a pathologist examined it under the microscope and made the critical diagnosis, entering the results in the patient’s record before he or she left the recovery room.” (Photo copyright Mayo Clinic.)

“I wish you pathologists could tell us if a tissue is cancer or not while the patient is on the table,” declared William Mayo, M.D. to Wilson. Mayo was one of the co-founders of Mayo clinic. The quote appeared in the JAMA piece.

William Mayo, a surgeon, was not alone in his frustration. Surgeons wanted fast, reliable diagnostic tests for patients undergoing surgery. “[S]urgeons sought to investigate whether the microscopic examination of fresh tissue, namely, the frozen section, could be used for intraoperative diagnosis and thus influence the surgical procedure,” wrote Gal in a paper published in the Archives of Pathology & Laboratory Medicine (Archives).

A former high school biology teacher, Wilson was familiar with the use of botanical stains. He deduced a simple technique using methylene blue to stain frozen tissue specimens during surgery. At that time, fixed tissues had traditionally appeared as dull browns and pinks. Wilson’s early endeavors led to a clear microscopic image of reds, purples, and blues. His new frozen section method allowed him to provide a surgeon with a diagnosis within minutes—while the patient was still on the table, the JAMA commentary noted.

Wilson standardized each step of the freezing, cutting, and staining procedures, Gal wrote in the Archives. He used a Spencer automatic freezing microtome, equipped with a carbon dioxide attachment. The attachment facilitated freezing and sectioning. With some modifications, Wilson’s technique is still used at the Mayo Clinic today.

Wilson published his frozen section technique in the December 2, 1905, issue of the Journal of the American Medical Association.

Frozen Section Leads to Valuing Pathologist’s Diagnostic Consultant Role

Prior to the introduction of frozen section, malignant growths were typically inoperable and led to patient death soon after surgery, according to the Archives.

Following introduction of the procedure, surgeons saw a drop in inoperable cancer rates. At Johns Hopkins Hospital, for example, the rate dropped from 50% around 1900 to less than 5% in 1920, Gal noted in the Archives. Increasingly, surgeons and gynecologists accepted frozen section as a reliable diagnostic tool. Simultaneously, they became increasingly comfortable with the role of the pathologist as diagnostician and consultant.

Others Paved the Way for Development of Frozen Section Method

Wilson’s was not the first description of the frozen section procedure. As early as 1818, Dutch anatomist Pieter de Riemer was the first to use a salt and water solution to harden tissues for sectioning, according to the Archives article. The earliest recorded clinical use of the freezing method for diagnosis was at the Glasgow Western Infirmary (GWI). No later than 1882, GWI used frozen section for biopsy and autopsy. Thomas S. Cullen, M.D., a gynecologist at Johns Hopkins, had written reports involving frozen section prior to Wilson’s. William H. Welch, M.D., a Professor of Pathology at Johns Hopkins, conducted experiments using Cullen’s procedure.

But it was Wilson who developed the first reliable frozen section method, Gal and Cagle observed in their JAMA commentary. It was his work that ushered in the new era of intraoperative diagnosis. The frozen section procedure as practiced today in medical laboratories is based on Wilson’s description.

The takeaway for pathologists and clinical laboratory managers is that good public relations efforts can generate news stories that educate the public about the good work that pathologists do every day to support patient care.

Finally, your Dark Daily editors hope that this bit of history about one aspect of pathology and laboratory medicine was a welcome insight for medical laboratory scientists, who might be unaware of how the technique of frozen sections was developed and contributed to improved patient outcomes in the early days of modern medicine.

—Pamela Scherer McLeod

Related Information:

Mayo pathologists decrease the need for repeat surgeries

Mayo Clinic Pathologists Decrease Need for Repeat Surgeries

The Centennial Anniversary of the Frozen Section Technique at the Mayo Clinic 2005

Intraoperative diagnosis using the frozen section technique

TECHNIQUES OF THE FROZEN 

Intraoperative Consultations by Pathologists at the Mayo Clinic: A Unique Experience