A prospective assessment of the reliability of frozen section to direct intraoperative decision making in endometrial cancer

Sanjeev Kumar, Fabiola Medeiros, Sean Christopher Dowdy, Gary Keeney, Jamie N Bakkum-Gamez, Karl C. Podratz, William Arthur Cliby, Andrea Mariani

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Objective: To determine the reliability of intraoperative frozen sections (IFSs) for surgical staging of endometrial cancer (EC). Methods: Data were collected prospectively on 784 consecutive patients with EC who were undergoing a hysterectomy at our institution from January 1, 2004, to December 31, 2008. The need for surgical staging was decided through IFS using 4 variables: tumor size, histologic grade, histologic subtype, and depth of myometrial invasion (MI). The IFS results were compared with the permanent paraffin sections (PSs) to assess for discordances. Results: In 30 of the 784 cases (4%), the PS pathology report was amended with discordant results. In addition, a definitive diagnosis of the 4 parameters was deferred to PS in 53 cases (7%), of which 30 (4%) were concordant and 23 (3%) were discordant. IFS-related deviations from the prescribed surgical algorithm occurred in 10 cases (1.3%; 95% confidence interval, 0.6%-2.3%). Of these 10 cases, 3 were amendments after PS review and 7 were IFS deferrals for definitive PS interpretation. Conclusions: Clinically significant discordance between IFS and PS occurred in only 1.3% of cases. Despite skepticism expressed in the medical literature, IFS provides highly reliable data to guide intraoperative treatment decisions at institutions with sufficient pathologic expertise.

Original languageEnglish (US)
Pages (from-to)525-531
Number of pages7
JournalGynecologic Oncology
Volume127
Issue number3
DOIs
StatePublished - Dec 2012

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Frozen Sections
Endometrial Neoplasms
Decision Making
Paraffin
Hysterectomy
Confidence Intervals
Pathology
Neoplasms

Keywords

  • Endometrial cancer
  • Frozen sections
  • Intraoperative procedures
  • Neoplasm staging
  • Surgical staging

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

A prospective assessment of the reliability of frozen section to direct intraoperative decision making in endometrial cancer. / Kumar, Sanjeev; Medeiros, Fabiola; Dowdy, Sean Christopher; Keeney, Gary; Bakkum-Gamez, Jamie N; Podratz, Karl C.; Cliby, William Arthur; Mariani, Andrea.

In: Gynecologic Oncology, Vol. 127, No. 3, 12.2012, p. 525-531.

Research output: Contribution to journalArticle

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abstract = "Objective: To determine the reliability of intraoperative frozen sections (IFSs) for surgical staging of endometrial cancer (EC). Methods: Data were collected prospectively on 784 consecutive patients with EC who were undergoing a hysterectomy at our institution from January 1, 2004, to December 31, 2008. The need for surgical staging was decided through IFS using 4 variables: tumor size, histologic grade, histologic subtype, and depth of myometrial invasion (MI). The IFS results were compared with the permanent paraffin sections (PSs) to assess for discordances. Results: In 30 of the 784 cases (4{\%}), the PS pathology report was amended with discordant results. In addition, a definitive diagnosis of the 4 parameters was deferred to PS in 53 cases (7{\%}), of which 30 (4{\%}) were concordant and 23 (3{\%}) were discordant. IFS-related deviations from the prescribed surgical algorithm occurred in 10 cases (1.3{\%}; 95{\%} confidence interval, 0.6{\%}-2.3{\%}). Of these 10 cases, 3 were amendments after PS review and 7 were IFS deferrals for definitive PS interpretation. Conclusions: Clinically significant discordance between IFS and PS occurred in only 1.3{\%} of cases. Despite skepticism expressed in the medical literature, IFS provides highly reliable data to guide intraoperative treatment decisions at institutions with sufficient pathologic expertise.",
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