title: The role of frozen section in surgical staging of low risk endometrial cancer.
abstract: BACKGROUND
  The role of frozen section (FS) in intraoperative decision making for surgical staging of endometrial cancer is controversial. Objective of this study is to assess the agreement rate between the FS and paraffin section (PS); and the potential impact of the role of FS in the intra-operative decision making for the complete surgical staging in low risk endometrial cancer.
  
  
  METHODS
  This is a retrospective analysis of patients diagnosed with intra-operative FS stage I, grade I or II endometrial cancer from 1995-2004. FS results were compared with final pathology results with regard to tumor grade, depth of myometrial invasion, cervical involvement, lymphovascular invasion, and lymph node involvement. Agreement statistic with kappa was calculated using SPSS statistical software. Categorical variables were tested using chi-square test with p value of ≤0.05 being statistically significant.
  
  
  RESULTS
  Of the 457 patients with endometrial cancer, 146 were evaluated by intra-operative FS and met inclusion criteria. FS results were in disagreement with permanent section in 35% for the grade (kappa 0.58, p = 0.003), 28% for depth of myometrial invasion (kappa 0.61, p<0.0001), 13% for cervical involvement (kappa 0.78, p = 0.002), and 32% for lymphovascular invasion (kappa 0.6, p = 0.01). Permanent pathology upstaged 31.9% & 23.2% of FS stage IA, & IB specimen respectively. Lymph node dissection was done in 56.8%. Lymph node metastasis was identified in 8.4%. Use of intraoperative FS would have resulted in suboptimal surgical treatment in 13% stage IA and 6.6% of stage IB patients respectively by foregoing lymphadenectomy.
  
  
  CONCLUSIONS
  A significant number of patients with low risk endometrial cancer by FS were upstaged and upgraded on final pathology. Before placing absolute reliance on intraoperative FS to undertake complete surgical staging, the inherent limitation of the same in predicting final stage and grade highlighted by our data need to be carefully considered.
authors.affiliation: Section of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kumar
authors.forename: Sudeshna
authors.initials: S
authors.lastname: Bandyopadhyay
authors.forename: Assaad
authors.initials: A
authors.lastname: Semaan
authors.forename: Jay P
authors.initials: JP
authors.lastname: Shah
authors.forename: Haider
authors.initials: H
authors.lastname: Mahdi
authors.forename: Robert
authors.initials: R
authors.lastname: Morris
authors.forename: Adnan
authors.initials: A
authors.lastname: Munkarah
authors.forename: Rouba
authors.initials: R
authors.lastname: Ali-Fehmi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002584:Cervix Uteri / Q000473:pathology; D016889:Endometrial Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005629:Frozen Sections; D006801:Humans; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods*; D010232:Paraffin / Q000378:metabolism; D012306:Risk; D055815:Young Adult
chemical_list: D010232:Paraffin