Pathological consultation on intraoperative frozen sections plays a crucial role in the management of patients who have undergone surgical therapy. Several studies have been conducted to evaluate its application and reliability. Intraoperative frozen section consultation is an important tool that can provide a more accurate diagnosis and assist physicians in clinical decision making [1]. It requires the skills in gross examination and histopathological diagnosis, excellent quality of frozen sections, and the ability of rapid interpretations under time constraints [2].

Turnaround time has been regarded as a common standard for measuring quality in surgical pathology by patient, clinician, and pathologist [3], [4]. Frozen section turnaround time (FSTAT) is the time interval from receiving the specimens at the Pathology Department to the reporting of pathological consultation to the operating surgeons [5]. The diagnostic value and accuracy of frozen sections have been examined in tumors of various organ systems [6], [7], [8], [9], [10]. Multiple studies have supported that a higher concordance rate within the range of 87 %–98.6 % and a lower deferral rate within the range of 1.3 %–4.8 % [10], [11]. Identification of diagnostic pitfalls through quality assurance reviews on these discrepancies can provide important information for the frozen section pathologist to further reduce the errors.

However, only few studies have determined the accuracy of frozen sections in the diagnosis of hepatobiliary lesions, and the results are not entirely consistent [12], [13]. Therefore, this study aimed to evaluate the values of frozen sections in the histopathological diagnosis of surgically resected hepatobiliary lesions, and to identify the cause of errors and potential pitfalls. In addition, the overall FSTAT of intraoperative consultation was measured, and the technical quality and pitfalls of pathological interpretation for performing a frozen section were also assessed. The main purposes of this study were to understand the diagnostic accuracy of frozen sections, analyze the concordance, discrepancies and deferrals for all cases, improve technical quality, and reduce misdiagnosis rates.