Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Gynecol Oncol. 2012 Dec;127(3):525-31. doi: 10.1016/j.ygyno.2012.08.024. Epub 2012 Aug 29.
To determine the reliability of intraoperative frozen sections (IFSs) for surgical staging of endometrial cancer (EC).
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.
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.
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.
确定术中冰冻切片（IFS）在子宫内膜癌（EC）手术分期中的可靠性。
本研究前瞻性收集了 2004 年 1 月 1 日至 2008 年 12 月 31 日期间在我院接受子宫切除术的 784 例连续 EC 患者的数据。通过使用 4 个变量（肿瘤大小、组织学分级、组织学亚型和肌层浸润深度（MI））的 IFS 决定是否需要进行手术分期。将 IFS 结果与石蜡切片（PS）进行比较，以评估是否存在差异。
在 784 例病例中，有 30 例（4%）的 PS 病理报告存在差异。此外，53 例（7%）的 4 个参数的明确诊断被推迟到 PS，其中 30 例（4%）与 PS 结果一致，23 例（3%）与 PS 结果不一致。IFS 与规定手术方案的偏差在 10 例（1.3%；95%置信区间，0.6%-2.3%）中发生。在这 10 例中，有 3 例在 PS 审查后进行了修订，7 例为 IFS 推迟以进行 PS 明确解释。
IFS 与 PS 之间仅出现 1.3%的临床显著差异。尽管在医学文献中存在质疑，但在具有足够病理专业知识的机构中，IFS 可提供高度可靠的数据来指导术中治疗决策。
