Desouki Mohamed Mokhtar, Li Zaibo, Hameed Omar, Fadare Oluwole
Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN.
Department of Pathology,Ohio State University, Cincinnati.
Am J Clin Pathol. 2017 Oct 1;148(4):345-353. doi: 10.1093/ajcp/aqx076.
Pathologic intraoperative consultation (IOC) is a common approach for segregating the subset of patients with endometrial cancer who likely require a lymphadenectomy.
We evaluate factors related to the performance and value of IOC, including the accuracy of frozen sections, "gross-only examinations," and obtaining random sections when a gross lesion is not apparent.
IOC was performed by gross examination only in 17 (8%) of 250 cases, the specificity and negative predictive value of which in diagnosing cancer were 100% and 85%, respectively. Among the 64 cases wherein a gross lesion was not apparent and random sections were examined, a final diagnosis of carcinoma was rendered in 20, of which only three (15%) had a diagnosable malignancy on the random section. The frozen-section/final diagnosis concordance was 80% for tumor grade. Determining the depth of myometrial invasion was problematic, with 36% underestimation and 2.6% overestimation.
Obtaining random sections in the absence of a gross lesion has no significant benefit, and a negative result is likely to provide inaccurate data to the surgeon. Frozen-section analyses are a generally reliable tool to determine "low-risk" pathologic parameters that were evaluated herein when a gross lesion is present.
术中病理会诊（IOC）是一种区分可能需要行淋巴结切除术的子宫内膜癌患者亚组的常用方法。
我们评估了与IOC的实施及价值相关的因素，包括冰冻切片、“仅大体检查”以及在无明显大体病变时获取随机切片的准确性。
250例病例中仅17例（8%）通过大体检查进行IOC，其诊断癌症的特异性和阴性预测值分别为100%和85%。在64例无明显大体病变且检查了随机切片的病例中，最终诊断为癌的有20例，其中随机切片上仅有3例（15%）可诊断为恶性肿瘤。肿瘤分级的冰冻切片/最终诊断一致性为80%。确定肌层浸润深度存在问题，低估率为36%，高估率为2.6%。
在无明显大体病变时获取随机切片无显著益处，阴性结果可能会给外科医生提供不准确的数据。当存在明显大体病变时，冰冻切片分析是确定本文所评估的“低风险”病理参数的常用可靠工具。
