Ferrandina Gabriella, Fanfani Francesco, Ludovisi Manuela, Fagotti Anna, Carbone Arnaldo, Zannoni Gianfranco, Guerriero Massimiliano, Petrillo Marco, Scambia Giovanni
Department of Oncology, Catholic University, Campobasso, Contrada Tappino, Campobasso, Italy.
Gynecol Oncol. 2008 Jan;108(1):220-5. doi: 10.1016/j.ygyno.2007.09.034. Epub 2007 Oct 31.
No thorough investigation of the diagnostic performance of frozen section analysis in predicting the final status of lymph nodes after exposure to concomitant chemoradiation (CT/RT) has been performed until now. The aim of the study was to analyze the accuracy of pelvic lymph node frozen section examination in a large, consecutive series of locally advanced cervical cancer (LACC) patients undergoing preoperative CT/RT.
A total of 123 consecutive LACC patients underwent preoperative CT/RT followed by radical hysterectomy according to Piver classification, with bilateral systematic pelvic lymphadenectomy. If pelvic nodes were intraoperatively defined as positive for tumor metastasis, para-aortic lymphadenectomy up to inferior mesenteric artery was carried out. The diagnostic performance of frozen section examination of pelvic lymph nodes was assessed by calculating the negative predictive value (NPV), the positive predictive value (PPV), specificity, sensitivity, and overall accuracy.
A total of 1647 and 4345 pelvic lymph nodes were analyzed by frozen section examination and at final diagnosis, respectively. Lymph node metastases were found in 11 cases (8.9%) at frozen section examination, and in 14 cases (11.4%) at definitive histological diagnosis. We found 7 incorrect diagnoses at frozen section examination, represented by 5 false negative and 2 false positive cases. Specificity, sensitivity, overall accuracy, NPV, and PPV were 98.2%, 64.3%, 94.3%, 95.5% and 81.8%, respectively.
Preoperative chemoradiation does not impair the role of frozen section analysis in predicting the pelvic lymph node involvement in LACC patients.
迄今为止，尚未对冷冻切片分析在预测同步放化疗（CT/RT）后淋巴结最终状态方面的诊断性能进行全面研究。本研究的目的是分析在一系列连续的接受术前CT/RT的局部晚期宫颈癌（LACC）大样本患者中，盆腔淋巴结冷冻切片检查的准确性。
共有123例连续的LACC患者接受了术前CT/RT，随后根据Piver分类进行根治性子宫切除术，并进行双侧系统性盆腔淋巴结清扫术。如果术中确定盆腔淋巴结有肿瘤转移，则进行至肠系膜下动脉水平的腹主动脉旁淋巴结清扫术。通过计算阴性预测值（NPV）、阳性预测值（PPV）、特异性、敏感性和总体准确性，评估盆腔淋巴结冷冻切片检查的诊断性能。
分别通过冷冻切片检查和最终诊断分析了1647个和4345个盆腔淋巴结。冷冻切片检查发现11例（8.9%）有淋巴结转移，最终组织学诊断发现14例（11.4%）有淋巴结转移。我们在冷冻切片检查中发现7例假诊断，包括5例假阴性和2例假阳性病例。特异性、敏感性、总体准确性、NPV和PPV分别为98.2%、64.3%、94.3%、95.5%和81.8%。
术前放化疗并不影响冷冻切片分析在预测LACC患者盆腔淋巴结受累情况中的作用。
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