Giuntoli Robert L, Winburn Kimberly A, Silverman M Bradley, Keeney Gary L, Cliby William A
Division of Gynecologic Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Gynecol Oncol. 2003 Nov;91(2):280-4. doi: 10.1016/j.ygyno.2003.08.014.
The purpose of this study was to determine the accuracy of frozen section evaluation of cervical cold knife cone (CKC) specimens in the diagnosis of microinvasive squamous cell carcinoma (SCC).
Using ICD-9 codes for invasive and microinvasive carcinoma of the cervix, a medical record from 1986 to 1998 identified 110 potential study subjects. Society of Gynecologic Oncologists criteria including depth of invasion < or =3 mm and absence of lymph-vascular space involvement were utilized for the diagnosis of microinvasion. Twenty-seven patients met study criteria including a frozen section diagnosis of microinvasive SCC on a cervical CKC specimen at our institution. A pathologist, blinded to patient diagnosis, reevaluated the histologic findings, including grade, depth of invasion, and cell type.
Median age of diagnosis was 41 years. Median follow up was 3.6 years. The median time for pathologic review was 28 min (range 15-44 min). Independent retrospective pathologic review of the permanent sections confirmed the diagnosis of microinvasion in 100% (27/27) of patients. No patient experienced a cervical SCC recurrence. At 10 years, disease-specific survival is 100%.
Frozen section is reliable in the evaluation of CKC specimens with microinvasive SCC: this may afford a simplified surgical approach in certain cases. This accuracy should not be assumed to apply to adeno- or adenosquamous carcinoma of the cervix. At our institution which relies heavily on intraoperative pathologic evaluation, utilizing frozen section diagnosis as the basis for definitive surgical approach did not negatively impact disease-free survival.
本研究旨在确定宫颈冷刀锥切（CKC）标本冰冻切片评估在诊断微浸润性鳞状细胞癌（SCC）中的准确性。
使用国际疾病分类第九版（ICD - 9）中关于宫颈浸润性和微浸润性癌的编码，从1986年至1998年的病历中确定了110名潜在研究对象。采用妇科肿瘤学家协会的标准，包括浸润深度≤3mm且无淋巴管间隙浸润来诊断微浸润。27例患者符合研究标准，包括在我们机构的宫颈CKC标本冰冻切片诊断为微浸润性SCC。一名对患者诊断不知情的病理学家重新评估了组织学结果，包括分级、浸润深度和细胞类型。
诊断时的中位年龄为41岁。中位随访时间为3.6年。病理检查的中位时间为28分钟（范围15 - 44分钟）。对永久切片的独立回顾性病理检查证实100%（27/27）的患者为微浸润诊断。没有患者出现宫颈SCC复发。10年时，疾病特异性生存率为100%。
冰冻切片在评估微浸润性SCC的CKC标本中是可靠的：这在某些情况下可能提供一种简化的手术方法。不应假定这种准确性适用于宫颈腺癌或腺鳞癌。在我们严重依赖术中病理评估的机构，以冰冻切片诊断作为确定性手术方法的基础并未对无病生存率产生负面影响。
