Efficacy and Diagnostic Reliability of Intraoperative Frozen Section in the Surgical Management of Early-Stage Cervical Cancer.

IF 2 4区 医学 Q2 OBSTETRICS & GYNECOLOGY Gynecologic and Obstetric Investigation Pub Date : 2024-08-27 DOI:10.1159/000541096
Sarah Louise Smyth, Edward Jackson, Negin Sadeghi, Christina Pappa, Nahid Ghanbarzadeh, Ciro Pinelli, Pathiraja Pubudu, Sunanda Dhar, Zoe Traill, Pietro Serra, Antonio Simone Laganà, Moiad Alazzam
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Abstract

Objectives: The aim of this study of this study was to evaluate preoperative radiology and histopathology findings in cervical cancer lymphadenopathy detection, allowing targeted frozen section examination (FSE).

Design: A retrospective analysis was conducted of 203 early-stage cervical cancer patients between 2010 and 2019 in a tertiary centre.

Participants/materials, setting, and methods: All patients had histologically confirmed cervical cancer and underwent magnetic resonance imaging (MRI) prior to intraoperative FSE. The primary objectives of the study were to determine the diagnostic accuracy of intraoperative FSE in the identification of lymph node metastases (LNM) in early-stage cervical cancer by correlation with final results obtained using standard histopathology techniques and to examine different preoperative, intraoperative, demographic, radiological, and histopathological factors that could identify those at greatest risk of nodal disease and hence predict those most likely to benefit from FSE, enabling more selective and targeted use.

Results: Nineteen patients were found to have LNM (9.36%) at FSE. Patients were at increased risk of LNM by 6-fold with positive LVSI, 3-fold with MRI lymphadenopathy, and 3.5-fold with MRI-visible disease. The presence of lymphadenopathy on MRI and positive LVSI in combination increased the risk of LNM by 19-fold.

Limitations: We acknowledge that FSE is expensive and time intensive, exposing patients to increased surgery duration and associated risk. We also recognize that it may not be feasible for all patients. Finally, the analysis is limited by retrospective nature of the study.

Conclusions: By application of the preoperative risk stratification algorithm, we may suggest that FSE can be a useful tool in high-risk patients.

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术中冰冻切片在早期宫颈癌手术治疗中的有效性和诊断可靠性。
目的:评估宫颈癌淋巴结病检测中的术前放射学和组织病理学发现:评估宫颈癌淋巴结病检测的术前放射学和组织病理学结果,以便进行有针对性的冰冻切片检查(FSE):对一家三级医疗中心2010年至2019年间的203例早期宫颈癌患者进行回顾性分析:所有患者均经组织学确诊为宫颈癌,并在术中 FSE 之前接受了磁共振成像(MRI)检查。研究的主要目的是:通过与使用标准组织病理学技术获得的最终结果的相关性,确定术中 FSE 在早期宫颈癌淋巴结转移(LNM)鉴定中的诊断准确性,并研究不同的术前、术中、人口学、放射学和组织病理学因素,这些因素可以确定哪些患者最有可能发生结节病,从而预测哪些患者最有可能从 FSE 中获益,使 FSE 的使用更具选择性和针对性:19 名患者在进行 FSE 检查时被发现患有 LNM(9.36%)。LVSI 阳性患者的 LNM 风险增加了 6 倍,MRI 淋巴结病增加了 3 倍,MRI 可见疾病增加了 3.5 倍。MRI 淋巴结病和 LVSI 阳性同时存在会使 LNM 风险增加 19 倍:我们认识到,FSE 费用昂贵且不可预测地耗费时间,使患者面临更长的手术时间和相关风险。我们也认识到,并非所有患者都能接受 FSE。最后,研究的回顾性也限制了分析的进行:通过应用术前风险分层算法,我们认为 FSE 对高风险患者来说是一种有用的工具。
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来源期刊
CiteScore
4.20
自引率
4.80%
发文量
44
审稿时长
6-12 weeks
期刊介绍: This journal covers the most active and promising areas of current research in gynecology and obstetrics. Invited, well-referenced reviews by noted experts keep readers in touch with the general framework and direction of international study. Original papers report selected experimental and clinical investigations in all fields related to gynecology, obstetrics and reproduction. Short communications are published to allow immediate discussion of new data. The international and interdisciplinary character of this periodical provides an avenue to less accessible sources and to worldwide research for investigators and practitioners.
期刊最新文献
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