Indication and Method of Frozen Section in Vaginal Radical Trachelectomy
J Chenevert, M Plante, M Roy, B Tetu, K Grondin, M-C Renaud, J Gregoire, V Dube. Centre Hospitalier Universitaire de Qubec, Quebec, QC, Canada
Background: Vaginal radical trachelectomy (VRT) is a fertility-sparing surgical technique used as an alternative to radical hysterectomy in early stage cervical cancer. Defining the method of per-operative evaluation of VRT has become imperative because if tumor is found within 5mm of the endocervical margin, additional surgical resection is required. However, there are no agreed-upon protocols on how to sample VRT for frozen section (FS). In a previously published study from our center, we concluded that a FS should be done only when a cancerous lesion is grossly visible and it could be omitted in normal-looking VRT or VRT with non-specific lesions. We recommended that only one sample should be taken and that a longitudinal sample is superior to a transversal sample because it allows a precise evaluation of the distance between the margin and the tumor. Since 2002, we performed FS on VRT according to these recommendations and the current study is a reappraisal of our performance.
Design: Cases of VRT accessioned between January 2002 and August 2007 were retrieved from the pathology archive. Cases were classified into three categories: normal-looking VRT (VRTn), VRT with non-specific lesions (VRTns) and VRT with grossly visible cancerous lesions (VRTg). The data collected was: presence of residual invasive disease, final distance to the margin on paraffin sections and adequacy of the FS to predict the final distance to the margin. The final distance to the margin was considered satisfactory when it measured 5mm.
Results: We identified 53 VRT performed in our center since 2002; 15 were classified as VRTn, 24 as VRTns and 14 as VRTg. Final margins were satisfactory on all 15 VRTn. Of the 24 VRTns, 2 cases for which no FS was performed had unsatisfactory final margins (<5mm). Of the 14 VRTg, 3 cases were inadequately evaluated by FS due to sampling error which led to unsatisfactory final margins. There was no residual invasive disease in 14/15 VRTn (93.3%), 20/24 VRTns (83.3%) and 1/14 VRTg (7.1%).
Conclusions: Our results confirm that FS can be omitted on VRTn. However, we now recommend that a FS be performed on all VRTns (2 cases with unsatisfactory margins). As for VRTg, a FS should always be performed. We recommend that more than one sample should be submitted to improve the adequacy of FS because additional sampling of the 3 VRTg with unsatisfactory margins would have likely assessed the margin accurately.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 143, Monday Morning