title: Assessment of the Intraoperative Consultation Service Rendered by General Pathologists in a Scenario Where a Well-Defined Decision Algorithm Is Followed.
abstract: OBJECTIVE
  Intraoperative consultation (IOC) remains an area of general practice even within subspecialized pathology departments. This study assesses the IOCs rendered in a general pathology setting where surgeons integrate these results in a well-defined algorithm, developed with the input of specialized pathologists.
  
  
  METHODS
  The surgical decisions to perform lymphadenectomy in patients with endometrial adenocarcinoma operated on at our institution between January 2003 and June 2015 as a result of the IOC assessment of tumor size, histologic grade, and depth of invasion in the hysterectomy specimen were analyzed.
  
  
  RESULTS
  Frozen section (FS) was examined in 801 cases. In comparison to permanent section analysis, FS International Federation of Gynecology and Obstetrics (FIGO) grade had an overall accuracy of 0.95 (95% confidence interval [CI], 0.93-0.98). The FS depth of invasion had an overall accuracy of 0.92 (95% CI, 0.89-0.94). FIGO grade was not documented in 47.8%, the depth of myometrial invasion in 45.2%, and tumor size in 41.8% of the pathology reports.
  
  
  CONCLUSIONS
  The high omission rate of the needed parameters by the general pathologists would question their overall understanding of the paradigm shift intended by this algorithm. Possible explanations of this phenomenon and potential solutions are discussed.
authors.affiliation: From the Department of Laboratory Medicine and Pathology.
authors.forename: Mahmoud A
authors.initials: MA
authors.lastname: Khalifa
authors.affiliation: Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
authors.forename: Sherine
authors.initials: S
authors.lastname: Salama
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis.
authors.forename: Rachel I
authors.initials: RI
authors.lastname: Vogel
authors.affiliation: From the Department of Laboratory Medicine and Pathology.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Klein
authors.affiliation: From the Department of Laboratory Medicine and Pathology.
authors.forename: James
authors.initials: J
authors.lastname: Richter
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis.
authors.forename: Tanya
authors.initials: T
authors.lastname: Pulver
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Mullany
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis.
authors.forename: Boris
authors.initials: B
authors.lastname: Winterhoff
mesh_terms: D000465:Algorithms; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000601:surgery; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007430:Intraoperative Care / Q000592:standards*; D008197:Lymph Node Excision; D009367:Neoplasm Staging / Q000592:standards*; D010340:Pathology, Surgical / Q000379:methods / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards
keywords: Anatomic pathology quality; Decision algorithms; Frozen sections; General pathologists; Intraoperative consultation; Subspecialization in pathology