Intraoperative Pathologic Consultation on Hysterectomy Specimens for Endometrial Cancer An Assessment of the Accuracy of Frozen Sections, "Gross-Only" Evaluations, and Obtaining Random Sections of a Grossly "Normal" Endometrium
Intraoperative Pathologic Consultation on Hysterectomy Specimens for Endometrial Cancer An Assessment of the Accuracy of Frozen Sections, "Gross-Only" Evaluations, and Obtaining Random Sections of a Grossly "Normal" Endometrium
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DOI：
10.1093/ajcp/aqx076
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发表时间：
2017-10-01
影响因子：
3.5
通讯作者：
Fadare, Oluwole
中科院分区：
文献类型：
--
作者：
Desouki, Mohamed Mokhtar;Li, Zaibo;Fadare, Oluwole
目的：病理术中会诊（IOC）是一种常见的方法，用于分离子宫内膜癌患者的亚组，这些患者可能需要淋巴结切除术。方法：我们评估与IOC的性能和价值相关的因素，包括冷冻切片的准确性，“仅肉眼检查”，以及在肉眼病变不明显时获得随机切片。结果：250例中17例（8%）仅行大体检查，其诊断癌的特异性为100%，阴性预测值为85%。在肉眼病变不明显的64例中，随机切片检查，20例最终诊断为癌，其中只有3例（15%）在随机切片上可诊断为恶性肿瘤。冷冻切片/最终诊断的肿瘤分级一致性为80%。确定子宫肌层浸润的深度是有问题的，有36%低估和2.6%高估。结论：在没有肉眼病变的情况下获得随机切片没有显着的好处，和一个负面的结果是可能提供不准确的数据给外科医生。冰冻切片分析是一种确定“低风险”病理学参数的可靠工具，当存在肉眼病变时，在此进行评价。
Objectives: Pathologic intraoperative consultation (IOC) is a common approach for segregating the subset of patients with endometrial cancer who likely require a lymphadenectomy.Methods: We evaluate factors related to the performance and value of IOC, including the accuracy of frozen sections, "gross-only examinations," and obtaining random sections when a gross lesion is not apparent.Results: IOC was performed by gross examination only in 17 (8%) of 250 cases, the specificity and negative predictive value of which in diagnosing cancer were 100% and 85%, respectively. Among the 64 cases wherein a gross lesion was not apparent and random sections were examined, a final diagnosis of carcinoma was rendered in 20, of which only three (15%) had a diagnosable malignancy on the random section. The frozen-section/final diagnosis concordance was 80% for tumor grade. Determining the depth of myometrial invasion was problematic, with 36% underestimation and 2.6% overestimation.Conclusions: Obtaining random sections in the absence of a gross lesion has no significant benefit, and a negative result is likely to provide inaccurate data to the surgeon. Frozen-section analyses are a generally reliable tool to determine "low-risk" pathologic parameters that were evaluated herein when a gross lesion is present.