Clinical Value and Risk Analysis of Intraoperative Frozen Section Diagnosis in 313 Pediatric Bone Lesions: A Single-Center Study

Objective: To analyze the clinical value and diagnostic risks of intraoperative frozen section diagnosis in pediatric bone lesions. Methods: A retrospective analysis was conducted on 313 pediatric bone lesion cases, including clinical data and imaging characteristics. The concordance between intraoperative frozen section diagnosis and postoperative paraffin-section pathological diagnosis was evaluated. Results: Among the 313 patients, 193 were male and 120 were female, ranging in age from 10 months to 17 years. The overall concordance rate of frozen section diagnosis was 95.2%, with a discordance rate of 4.8%. For malignant tumors, the concordance and discordance rates were 90.63% and 9.37%, respectively. Major risk areas included diagnostic pitfalls, non-representative sampling, and technical artifacts related to slide preparation. Effective risk-control strategies included: (1) thorough preoperative review of clinical history and imaging findings; (2) improvement of frozen section quality to reduce artificial artifacts; (3) familiarity with the clinical, radiologic, and pathologic characteristics of diseases and identification of characteristic histomorphologic features; and (4) adequate communication with clinicians. Conclusion: Intraoperative frozen section diagnosis in pediatric bone lesions is challenging but demonstrates high diagnostic accuracy and significant clinical value. Familiarity with diagnostic pitfalls and risk areas can improve diagnostic accuracy.