[1039] Vascular Pseudoinvasion in Laparoscopic Hysterectomies: Intraoperative Effect or Pathology Grossing Artifact?

Linda Feeley, Anna Marie Mulligan, Sarah James, Adriana Krizova, Blaise Clarke. St Michaels Hospital, Toronto, Canada; UHN, Toronto, Canada; University of Toronto, ON, Canada

Background: We have previously shown that histologic artifacts including vascular pseudo-invasion (VPI) are significantly more common in laparoscopic than non-laparoscopic hysterectomies and specifically in cases in which a uterine manipulator (UM) is used. Whether or not VPI occurs intraoperatively or is a post-operative grossing artifact is unknown. The aim of this study was to assess the influence of grossing techniques in introducing artifacts including VPI in a subset of prospectively accrued laparoscopic hysterectomies (LH) utilizing a UM. The specimens were processed using an alternative approach aimed at reducing mechanical transport at the time of grossing.
Design: The previously recommended alternative grossing technique was used in 16 LH as follows: the uterus was bivalved on receipt to permit overnight fixation. In contrast to the standard approach of sectioning from mucosa to serosal surface, the uterine wall was sectioned from the serosal aspect towards the mucosal surface with care to clean the scalpel blade between sections. The presence of artefactual changes including nuclear crush artifact, endomyometrial clefting, debris (inflammatory or tumor fragments) in fallopian tube (FT) lumen and VPI, were evaluated and compared with those from 57 LH grossed in the standard way using the Fisher exact test. The number of vessels involved by VPI was compared between the groups using the Student t-test.
Results: No significant difference between the groups was identified for any of the artifacts [Table 1].

Table 1
ArtifactStandard Grossing Technique, N(%)Alternative Grossing Technique, N(%)P-value
VPI16(28)4(25)1
Cleft artifact23(41)2(13)0.07
Intratubal material19(33)3(23)∗0.36
Serosal carry over11(20)5(31)0.49
Nuclear crush14(25)8(50)0.07
∗3 LH did not include FT

In cases with VPI the number of vessels involved ranged from 1 to 13 (average 5.25) in specimens grossed using the standard technique and from 1 to 2 (average 1.25) in specimens grossed using the alternative technique (P=0.04).
Conclusions: Use of the alternative grossing technique described herein was not effective in eliminating the presence of artifacts; however, the extent of VPI was significantly less in these specimens. While the data is limited by small numbers, the findings suggest that adopting this technique may help to reduce VPI and should help to minimize potential misinterpretation of prognostic parameters in these specimens. We intend to accrue more cases to ensure the study is adequately powered.
Category: Gynecologic & Obstetrics

Wednesday, March 2, 2011 1:00 PM

Poster Session VI # 140, Wednesday Afternoon

 

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