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Accuracy of frozen-section diagnosis at surgery in clinical stage I and II endometrial carcinoma

  • Author Footnotes
    a From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Massachusetts Medical Center
    Jae Uk Shim
    Footnotes
    a From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Massachusetts Medical Center
    Affiliations
    Worcester, Massachusetts
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  • Author Footnotes
    a From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Massachusetts Medical Center
    Peter G. Rose
    Correspondence
    Reprint requests: Peter G. Rose, MD, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Massachusetts Medical Center, 55 Lake Ave., North, Worcester, MA 01655.
    Footnotes
    a From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Massachusetts Medical Center
    Affiliations
    Worcester, Massachusetts
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  • Author Footnotes
    b Department of Pathology, University of Massachusetts Medical Center
    Frank R. Reale
    Footnotes
    b Department of Pathology, University of Massachusetts Medical Center
    Affiliations
    Worcester, Massachusetts
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  • Author Footnotes
    c Department of Radiation Therapy, University of Massachusetts Medical Center
    Henry Soto
    Footnotes
    c Department of Radiation Therapy, University of Massachusetts Medical Center
    Affiliations
    Worcester, Massachusetts
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  • Author Footnotes
    d From the Department of Pathology, Saint Vincent's Hospital.
    Won K. Tak
    Footnotes
    d From the Department of Pathology, Saint Vincent's Hospital.
    Affiliations
    Worcester, Massachusetts
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  • Author Footnotes
    a From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Massachusetts Medical Center
    Richard E. Hunter
    Footnotes
    a From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Massachusetts Medical Center
    Affiliations
    Worcester, Massachusetts
    Search for articles by this author
  • Author Footnotes
    a From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Massachusetts Medical Center
    b Department of Pathology, University of Massachusetts Medical Center
    c Department of Radiation Therapy, University of Massachusetts Medical Center
    d From the Department of Pathology, Saint Vincent's Hospital.
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      OBJECTIVES: The purpose of our study was to determine if frozen section accurately identifies certain poor prognostic pathologic factors in endometrial carcinoma that are known to be associated with pelvic and paraaortic nodal metastasis, including deep myometrial invasion, poorly differentiated tumor, cervical invasion, adnexal involvement, and poor histologic type.
      STUDY DESIGN: The frozen-section pathologic results of 199 patients with clinical stage I and II endometrial cancer were retrospectively compared with permanent-section pathologic findings.
      RESULTS: The depth of myometrial invasion (superficial third vs deep two thirds) was accurately determined by frozen-section diagnosis at surgery in 181 of 199 cases (91.0%). The sensitivity of frozen-section diagnosis for deep myometrial invasion was 82.7%, and the specificity was 89.1%. The following tumor characteristics were accurately determined on frozen section at surgery: poorly differentiated tumor (95.0%), cervical invasion (94.0%), adnexal involvement (98.5%), and histologic type (94.0%). Frozen section underestimated deep myometrial invasion in 17.3% of patients with this characteristic and poorly differentiated tumor in 26.3% when compared with permanent-section diagnosis. In patients with unfavorable histologic types, papillary serous and adenosquamous carcinomas were the most commonly misdiagnosed histologic types by frozen section at surgery (70.6%). However, when the preoperative curettage pathologic findings were included, these inaccuracies in tumor grade and histologic type dropped to 15.8% and 35.3%, respectively. Only 13 of 199 patients (6.5%) were not correctly identified by frozen section at surgery as having poor prognostic pathologic features.
      CONCLUSION: Frozen section diagnosis at surgery is an important procedure that enables the surgeon to identify patients at high risk for pelvic and paraaortic nodal metastasis.

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      References

        • Boring CC
        • Squires TS
        • Tong T
        Cancer Statistics, 1991.
        CA. 1991; 41: 19-36
        • Creasman WT
        • Morrow CP
        • Bundy BN
        • Homesley HD
        • Graham JE
        • Heller PB
        Surgical pathological spread patterns of endometrial cancer.
        Cancer. 1987; 60: 2035-2041
        • Torrisi JR
        • Barnes WA
        • Popescu G
        • et al.
        Postoperative adjuvant external-beam radiotherapy in surgical stage I endometrial carcinoma.
        Cancer. 1989; 64: 1414-1417
        • Piver MS
        • Hempling RE
        A prospective trial of postoperative vaginal radium-cesium for grade 1–2 less than 50% myometrial invasion and pelvic radiation therapy for grade 3 or deep myometrial invasion in surgical stage I endometrial adenocarcinoma.
        Cancer. 1990; 66: 1133-1138
        • Cowles TA
        • Magrina JF
        • Masterson BJ
        • Capen CV
        Comparison of clinical and surgical staging in patients with endometrial carcinoma.
        Obstet Gynecol. 1985; 66: 413-416
        • Averette HE
        • Donato DM
        • Lovecchio JL
        • Sevin B
        Surgical staging of gynecologic malignancies.
        Cancer. 1987; 60: 2010-2020
        • Mehta CR
        • Patel NR
        • Gray R
        Computing an exact confidence interval for the common odds ratio in several 2×2 tables.
        J Am Stat Assoc. 1985; 80: 969-973
        • Mannel RS
        • Berman ML
        • Walker JL
        • Manetta A
        • DiSaia PJ
        Management of endometrial cancer with suspected cervical involvement.
        Obstet Gynecol. 1990; 75: 1016-1022
        • Malviya VK
        • Deppe G
        • Malone JM
        • Sundareson AS
        • Lawrence WD
        Reliability of frozen section examination in identifying poor prognostic indicators in stage I endometrial adenocarcinoma.
        Gynecol Oncol. 1989; 34: 299-304
        • Fanning J
        • Tsukada Y
        • Piver MS
        Intraoperative frozen section diagnosis of myometrial invasion in endometrial adenocarcinoma.
        Gynecol Oncol. 1990; 37: 47-50
        • Goff BA
        • Rice LW
        Assessment of depth of myometrial invasion in endometrial adenocarcinoma.
        Gynecol Oncol. 1990; 38: 46-48
        • Doering DL
        • Barnhill DR
        • Weiser EB
        • Burke TW
        • Woodward JE
        • Park RC
        Intraoperative evaluation of depth of myometrial invasion in stage I endometrial adenocarcinoma.
        Obstet Gynecol. 1989; 74: 930-933
        • Gordon AN
        • Fleischer AC
        • Dudley BS
        • et al.
        Preoperative assessment of myometrial invasion in endometrial adenocarcinoma by sonography (US) and magnetic resonance imaging (MRI).
        Gynecol Oncol. 1989; 34: 175-179
        • Cacciatore B
        • Lehtovirta P
        • Wahlstrom T
        • Ylostalo P
        Preoperative sonographic evaluation of endometrial cancer.
        Am J Obstet Gynecol. 1989; 160: 133-137
        • Obata A
        • Akamatsu N
        • Sekiba K
        Ultrasound estimation of myometrial invasion of endometrial cancer by intrauterine radial scanning.
        JCU. 1985; 13: 394-397
        • Hericak H
        • Stern JL
        • Fisher MR
        Endometrial carcinoma staging by MR imaging.
        Radiology. 1987; 162: 297-305
        • Chen SS
        • Rumancik WM
        • Spiegel G
        Magnetic resonance imaging in stage I endometrial carcinoma.
        Obstet Gynecol. 1990; 75: 274-277