Rouzier Roman, Feyereisen Estelle, Constancis Elisabeth, Haddad Bassam, Dubois Philippe, Paniel Bernard-Jean
Department Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94010 Créteil Cedex, France.
Gynecol Oncol. 2003 Aug;90(2):305-9. doi: 10.1016/s0090-8258(03)00324-x.
We conducted this retrospective study to determine accuracy of frozen section examination of endocervical margin during cold knife conization.
Between June 1993 and June 2001, 310 consecutive patients underwent cervical conization for squamous intraepithelial lesion or stage IA1 cervical cancer. Before 1997, the surgical specimens of 149 patients were processed following a standard pathological procedure (historical group). After 1997, a frozen section of the upper endocervical margin was processed during surgery for 161 patients. If the upper endocervical margin was involved with intraepithelial neoplasia, the surgeon performed a second resection if possible. Results of the frozen section examination were compared with the final diagnoses to determine sensitivity, specificity, and positive and negative predictive values. The usefulness of this procedure was evaluated by comparison of positive margin status rate with the one of the historical control group.
For the diagnosis of intraepithelial neoplasia involving the endocervical margin, the sensitivity, specificity, and positive and negative predictive values of frozen section were 91%, 100%, 100%, and 98%, respectively. Eleven patients had definitive positive endocervical margin in the frozen section group (three false negatives, six patients without additional resection, and two patients with intraepithelial neoplasia involving the upper margin of the additional resection) and 17 patients in the historical group (P =.16).
Frozen section examination of the endocervical margin of cervical specimen obtained during cold knife conization is highly accurate. Its clinical relevance has to be demonstrated in a multicenter study.
我们进行这项回顾性研究以确定冷刀锥切术中宫颈管切缘冰冻切片检查的准确性。
1993年6月至2001年6月期间，310例连续患者因鳞状上皮内病变或IA1期宫颈癌接受宫颈锥切术。1997年之前，149例患者的手术标本按照标准病理程序处理（历史对照组）。1997年之后，161例患者在手术中对宫颈管上切缘进行冰冻切片检查。如果宫颈管上切缘存在上皮内瘤变，外科医生尽可能进行二次切除。将冰冻切片检查结果与最终诊断进行比较，以确定敏感性、特异性、阳性和阴性预测值。通过比较阳性切缘状态率与历史对照组的情况来评估该程序的实用性。
对于诊断宫颈管切缘的上皮内瘤变，冰冻切片的敏感性、特异性、阳性和阴性预测值分别为91%、100%、100%和98%。冰冻切片组有11例患者宫颈管切缘明确为阳性（3例假阴性，6例未进行额外切除，2例上皮内瘤变累及额外切除的上缘），历史对照组有17例（P = 0.16）。
冷刀锥切术中获得的宫颈标本宫颈管切缘的冰冻切片检查高度准确。其临床相关性有待在多中心研究中证实。
