Frozen Section Diagnosis of Low Grade (LG) Endometrial Adenocarcinoma (ECA): Is It a Predictor of Lymph Node Status? A Multi-Institutional Study of 110 Cases
S Karaburun, D Wagner, SM Lele, S Mandavilli. Harford Hospital, Hartford, CT; University of Nebraska Medical Center, Omaha, NV
Background: Hysterectomy specimens are routinely submitted for frozen section (FS) evaluation for grade of ECA and depth of invasion. This information, in come cases, impacts the clinical decision of whether further staging is performed, but the benefit of lymphadenectomy remains unclear in LG ECA. The aim of this study was to assess the combined experience of two institutions to evaluate the accuracy of frozen section (FS) diagnosis of ECA and correlation with final diagnosis including lymph node status.
Design: Cases of ECA were retrieved from the pathology files of two institutions in which FS were performed during the time period 2005 to 2009. The FS diagnosis was compared with the final pathology report. For purposes of analysis, the tumors were divided into Low Grade (FIGO 1, nuclear grades 1 & 2, less than 50% myometrial invasion, and no lymphovascular invasion), and High Grade (FIGO 2 & 3, nuclear grade 3, more than 50% myometrial invasion, or presence of lymphovascular invasion). Additionally, the lymph node status in cases with lymph node dissections (LND) was summarized.
Results: There were 110 hysterectomy specimens in which FS were performed.74 cases were categorized as LG ECA. Of these 42 patients had LND done and all of these were negative for tumor. 6 cases with diagnosis of LG ECA in frozen section diagnosis had HG ECA on final diagnosis. 2 of these 6 patients did not have LN dissections. The 4 with LN dissections were all negative. 36 cases were categorized as HG on FS and remained HG on final diagnosis. Of these 25 patients had LN dissections done, of which 8 cases showed positive LN and 17 cases had negative LN.
Conclusions: There is a good correlation between FS categorization of tumors into LG and HG with only 6 cases (5.45 %) of discrepancy between FS and final diagnosis. Diagnosis of LG ECA on FS is a reliable predictor of nodal status and merits further investigation as to whether LND should be limited to cases with FS diagnosis of HG ECA.
Category: Gynecologic & Obstetrics
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 139, Wednesday Morning