Frozen-section evaluation of cervical adenocarcinoma at time of radical trachelectomy: Pathologic pitfalls and the application of an objective scoring system Journal Article

   

Authors:	Park, K. J.; Soslow, R. A.; Sonoda, Y.; Barakat, R. R.; Abu-Rustum, N. R.
Article Title:	Frozen-section evaluation of cervical adenocarcinoma at time of radical trachelectomy: Pathologic pitfalls and the application of an objective scoring system
Abstract:	Objective: To analyze the incidence of diagnostic discrepancy between frozen-section and final diagnosis of the endocervical margin at time of radical trachelectomy and to apply an objective scoring system to non-invasive endocervical glandular atypia to determine its utility in distinguishing benign from malignant lesions. Methods: Histologic slides from 19 cases of radical trachelectomy performed for invasive endocervical adenocarcinoma were evaluated for correlation between the frozen and permanent sections of the endocervical margin. An objective scoring system for grading non-invasive endocervical glandular lesions proposed by Ioffe et al. was also applied to the frozen and permanent section slides and compared to the final diagnosis. Results: There was 84% concordance between the frozen-section and final diagnosis using histology alone, vs. 95% concordance using the Ioffe scoring system. One trachelectomy was converted to completion hysterectomy for what was presumed to be adenocarcinoma in situ at the margin, which in retrospect, was a benign lesion and was correctly classified using the Ioffe system. Most of the discrepancies were due to misinterpretation of tubal metaplasia, tubo-endometrioid metaplasia, and atypical tubal metaplasia as adenocarcinoma in situ. Conclusion: Benign mimics of endocervical adenocarcinoma in situ can be difficult to distinguish from malignant lesions, especially during frozen-section evaluation of the trachelectomy. Correctly diagnosing the margin status intraoperatively has great clinical impact and the application of an objective scoring system, like that proposed by Ioffe et al., can increase diagnostic accuracy when applied to frozen-section slides and better correlates with final diagnosis when compared to histology alone. © 2008 Elsevier Inc. All rights reserved.
Keywords:	immunohistochemistry; adult; clinical article; controlled study; human tissue; retrospective studies; histopathology; cancer diagnosis; adenocarcinoma; severity of illness index; clinical evaluation; scoring system; gynecologic surgical procedures; frozen section; radical trachelectomy; uterine cervical neoplasms; gynecologic surgery; frozen sections; cervix; trachelectomy; uterine cervix carcinoma; uterine cervix carcinoma in situ; tumor stem cell assay
Journal Title:	Gynecologic Oncology
Volume:	110
Issue:	3
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2008-09-01
Start Page:	316
End Page:	323
Language:	English
DOI:	10.1016/j.ygyno.2008.05.029
PUBMED:	18635252
PROVIDER:	scopus
PMCID:	PMC4996344
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-50149122165&partnerID=40&md5=0c514aa8451786244680f3df49db1578
Notes:	--- - "Cited By (since 1996): 5" - "Export Date: 17 November 2011" - "CODEN: GYNOA" - "Source: Scopus"

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