Inter-Institutional Differences in Frozen Section Protocols for Endometrial Carcinoma
V Parkash, N Rassaei, O Fadare, CN Otis, GL Keeney, JL Hecht. Yale University, New Haven, CT; Beth Israel Deaconess Hospital, Boston, MA; Baystate Health Systems, Springfield, MA; Vanderbilt University, Nashville, TN; Mayo Clinic, Rochester, MN
Background: The NCCN guidelines call for pelvic and periaortic lymphadenopathy in staging of all cases of endometrial carcinoma, citing a likelihood of 15-20% for preoperative undergrading and understaging, Data from the Mayo Clinic suggests that pre and intraoperative evaluation can accurately identify carcinoma that is at low risk for metastasis and save 20% of patients from lymphadenectomy. The difference in data may be due to a lack of pathologist standardization.
Design: A questionnaire was sent to pathologists with interest in gynecologic pathology at institutions that perform FS for endometrial carcinoma. Specifically the questionnaire focused on number of blocks frozen, and reporting of high risk parameters at FS namely – confirmation of grade of tumor, size of tumor, depth of myoinvasion, presence of lymphovascular space invasion (LVSI) and cervical involvement.
Results: The Mayo Clinic FS evaluation consisted of a detailed gross evaluation, with reporting on the size of tumor, a significantly larger number of blocks frozen (range 4-10 blocks), and evaluation of said high risk parameters in all cases. The other institutions were more variable, with number of blocks frozen ranging between 1 (3 institutions) and 4 (1 institution). While depth of invasion and grade were reported at all institutions, volume/size of tumor was reported by none. LVSI was uniformly searched for and reported (albeit on 1 section) at only one institution. Only one institution routinely evaluated cervical involvement.
Conclusions: We have documented the reasons for differences in FS results for endometrial carcinoma at different institutions, which may explain the reasons for the inability to accurately identify high risk endometrial carcinoma pre-operatively. A modification of the FS protocols to include the Mayo clinic parameters may allow for more accurate preoperative staging of endometrial carcinoma, and save women with low risk endometrial carcinoma from an extensive lymph node staging operation.
Category: Quality Assurance
Monday, March 22, 2010 1:00 PM
Poster Session II # 207, Monday Afternoon