Utility of Conization With Frozen Section for Intraoperative Triage Prior to Definitive Hysterectomy

Abstract

Patients with early-stage cervical cancer are usually treated with conization or simple hysterectomy without removal of regional lymph nodes. A critical prognostic factor in patients with this cancer is the depth of invasion. Previous studies have reported that conization with frozen section analysis correlates 75% to 100% of the time with the pathologic findings in distinguishing dysplasia from invasive carcinoma. These studies were conducted at single academic centers; their applicability to general practice is unknown. The aims of this retrospective study were to review data from a single tertiary cancer center on the accuracy of conization with intraoperative frozen section analysis and to compare results with those from 2 community hospitals. Data were obtained for women who underwent conization with intraoperative frozen section analysis between 1997 and 2011 at the University of Texas MD Anderson Cancer Center and 2 community hospitals—The Woman’s Hospital of Texas and St Luke’s Episcopal Hospital. Results of pathologic analysis of frozen sections, loop electrosurgical excisional procedure/conization specimens, and hysterectomy specimens were compared for each patient. A total of 153 patients met study inclusion criteria. Based on the pathologic findings, the overall accuracy of conization with frozen section analysis in detecting cervical cancer was as follows: no residual disease, 96.5% (95% confidence interval [CI], 86.9%–100%); cervical squamous carcinoma in situ, 95.4% (95% CI, 84.5%–100%); cervical adenocarcinoma in situ, 98.7% (95% CI, 92.7%–100%); and invasive carcinoma 3 mm or greater, 100%. The frozen section findings were 100% accurate for triaging patients to simple or radical hysterectomy. This approach performed equally well in the 2 community hospitals with general pathologists as in the major cancer center with specialized pathologists. These findings show that conization with frozen section analysis is an effective technique for intraoperative triage of patients to immediate simple or radical hysterectomy in both an academic center and community hospitals.