Intraoperative Margin Assessment of the Radical Vaginal Trachelectomy Specimen
N Ismiil, Z Ghorab, A Covens, S Nofech-Mozes, R Saad, V Dube, MA Khalifa. Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Odette Cancer Centre, Toronto, ON, Canada
Background: Radical vaginal trachelectomy (RVT) is a fertility preserving procedure for early cervical cancer where the cervix is excised at the level of the upper endocervix (EC) or lower uterine segment (LUS) along with a vaginal cuff and parametria. There is limited experience among pathologists regarding the intraoperative handling of this specimen. Our local protocol calls for examining the entire circumference of the EC/LUS margin through perpendicular serial sections. The aim of this work is to summarize our experience in the frozen section (FS) assessment of the EC/LUS margin.
Design: All surgeries from 1994 to 2007 were performed by one surgeon and the FS examination was carried out by a group of gynecologic pathologists. The peripheral soft tissue and the EC/LUS margins are inked with different colors. The proximal 1 cm segment is cut off the rest of the specimen and is opened to display its mucosa. It is then serially slices into 10-12 sections which are examined by FS. If the EC/LUS margin is positive or < 5 mm from the tumor, an additional segment of the LUS is resected.
Results: 132 patients were identified with complete pathology records. They ranged from 17 46 years old (median 31). Surgeries were performed for clinically Stages IA (n=39) and IB (n=93) tumors (63 adenocarcinoma, 59 squamous cell carcinoma, 7 adenosquamous and 3 others). In 78 cases (59.1%), no residual tumor was seen in the trachelectomy specimens as it was resected by the preceding LEEP or cone. The EC/LUS margin was reported as negative in 123, suspicious in 3 and positive in 6 cases. It was revised in 16 cases (6 positive, 2 suspicious and 8 negative but < 5 mm). Final margin assessment agreed with the FS diagnosis in 130 (98.5%) and showed interpretational overcall in 2 cases (1.5%); only one of which resulted in a revised margin. No false negative intraoperative assessment was found. After a follow up period of 1 149 months (average = 50), recurrence occurred in only 6 patients; none of which was related to the intraoperative reporting of the margin.
Conclusions: We describe our FS protocol and summarize our data. This protocol is reliable since none of the patients was under-treated. Examining the entire EC/LUS margin helps eliminate the chance for false negative results. Also, the perpendicular sections allow for the accurate measurement of the distance to tumor. The protocol needs to be considered by institutions that are beginning to perform this procedure.
Monday, March 9, 2009 1:00 PM
Poster Session II # 153, Monday Afternoon