A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer
A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer
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DOI：
10.1097/01.aog.0000245444.14015.00
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发表时间：
2006-12-01
影响因子：
7.2
通讯作者：
Huh, Warner K.
中科院分区：
文献类型：
--
作者：
Case, Ashley S.;Rocconi, Rodney P.;Huh, Warner K.
目的：前瞻性地评估在一个盲的方式冷冻切片在子宫内膜cancer.METHODS的准确性：60例子宫内膜癌或复杂的不典型增生患者连续入组。术中，获得、处理并储存冷冻切片，以供设盲的病理学家解读。最终的病理诊断是以常规方式进行的，病理学家对冷冻结果不知情。冷冻切片上的组织学分级和子宫肌层浸润与最终的病理结果相关。结果：中位年龄为61岁（范围39-82岁）。57%的患者为白色，平均体重指数为40 mg/kg。(2)冷冻时的浸润深度与最终病理学结果相关性为67%（95%置信区间[CI] 55-79%）。28%（95% CI 17-39%）的患者从冷冻提前至最终。46%（95% CI 28-64%）冷冻时无浸润的患者分期升高。58%（95% CI 46-70%）的冷冻组织学分级与最终病理学相关; 38%（95% CI 26-50%）的患者最终分级升级。61%（95% CI 45-77%）的冷冻1级组织学或更低的患者升级。11例患者（18%）（95%CI 8- 28%.CONCLUSION）发生了临床相关的分期上调：子宫内膜癌的组织学分级和肌层浸润深度的冷冻切片与最终病理学相关性较差。由于大量患者使用冷冻切片可能分期不足，随后存在过度和治疗不足的风险，因此我们建议对所有子宫内膜癌患者考虑全面的手术分期。
OBJECTIVE: To prospectively evaluate in a blinded fashion the accuracy of frozen section in endometrial cancer.METHODS: Sixty patients with endometrial cancer or complex atypical hyperplasia were consecutively enrolled. Intraoperatively, a frozen section was obtained, processed, and stored for interpretation by blinded pathologists. Final pathologic diagnosis was conducted in the usual fashion with the pathologists blinded to frozen results. Histologic grade and myometrial invasion on frozen section was correlated with final pathology.RESULTS: Median age was 61 years (range, 39-82 years). Fifty-seven percent of patients were white, and mean body mass index was 40 mg/kg.(2) Depth of invasion on frozen correlated with final pathology in 67% (95% confidence interval [CI] 55-79%). Twenty-eight percent (95% CI 17-39%) of patients were upstaged from frozen to final. Patients with no invasion on frozen were upstaged in 46% (95% CI 28-64%). Histologic grade on frozen correlated with final pathology in 58% (95% CI 46-70%); 38% (95% CI 26-50%) of patients were upgraded by final grade. Patients with frozen grade 1 histology or less were upgraded in 61% (95% CI 45-77%). Clinically relevant upstaging occurred in 11 patients (18%) (95% CI 8-28%).CONCLUSION: Frozen section for histologic grade and depth of myometrial invasion in endometrial cancer correlates poorly with final pathology. Because a large number of patients are potentially understaged with the use of frozen section with a subsequent risk of over and under treatment, we recommend consideration of comprehensive surgical staging for all patients with endometrial cancer.