Intraoperative Frozen Section Analysis Research Articles

Value of routine frozen section analysis of urethral margin in male patients undergoing radical cystectomy in predicting prostatic involvement

To prospectively investigate diagnostic value of routine frozen section analysis (FSA) of urethral margin for male patients undergoing cystectomy for bladder cancer. One hundred consecutive male patients were subjected to radical cystectomy for bladder cancer with routine FSA obtained from distal prostatic urethral margin. Definitive pathological condition of the specimens was reviewed to diagnose urethral±prostatic malignant involvement. The diagnostic value of FSA was identified and compared with different clinical and pathological predictors. Patients with false-negative results were followed for 5 years. Six patients showed evidence of malignancy by FSA of the prostatic urethral margin (one patient was false positive), and all were managed by urethrectomy. Prostatic ± urethral involvement was diagnosed in 15 patients by definitive histopathology (15%). Sensitivity and specificity of urethral margin frozen section were 33.3 and 98.8%, respectively, with overall accuracy of 89% while positive and negative predictive values were 83.3 and 89.4%, respectively. There was no significant correlation identified between tumor site or morphology, clinical staging, clinically suspicious prostate, cystoscopic involvement of bladder neck, tumor grade, and associated carcinoma in situ or nodal involvement with prostatic malignant involvement. Positive intraoperative FSA was the only predictor significantly associated with malignant urothelial involvement of the prostate. None of the 10 patients with false-negative results developed late urethral recurrence at 5 years. Intraoperative urethral frozen section shows high predictive diagnostic value of malignant prostatic involvement. Nevertheless, its impact in preventing late urethral recurrence is doubtful.

Schnellschnittdiagnostik bei Erkrankungen des weiblichen Genitaltrakts

Intraoperative frozen sections are particularly important for ovarian tumors because definitive preoperative histology is not possible. The diagnostic accuracy of frozen sections is highest for primary invasive ovarian carcinomas and benign ovarian lesions, followed by borderline tumors and poorest for ovarian metastases and rare neoplasms, such as germ cell tumors. Endometrial carcinoma should be diagnosed preoperatively by curettage or biopsy. For endometrioid endometrial carcinomas the indications for lymphadenectomy are often based on intraoperative assessment of the uterus. The differential diagnosis of low grade stromal neoplasms is based on myometrial invasion and can be supported by assessment of frozen sections as well as the diagnosis of other mesenchymal uterine tumors suspected of being malignant. Frozen sections of pelvic lymph nodes provide the possibility of immediate subsequent para-aortic lymphadenectomy in endometrial and cervical carcinomas but have recently lost importance. Sentinel node biopsy with intraoperative frozen section analysis is routinely performed only for vulval carcinoma. The German Association of Gynecological Oncology (AGO) recommends deferred diagnosis and a two stage surgical procedure for any doubtful intraoperative ovarian histology. Intraoperative frozen sections for endometrial carcinoma and lymphadenectomy specimens as well as for sentinel node biopsies are currently not recommended but are also not completely rejected.

Intraoperative imprint cytology and frozen section pathology for margin assessment in breast conservation surgery: a systematic review.

Achieving negative surgical margins is critical to minimizing the risk of tumor recurrence in patients undergoing breast conservation surgery (BCS) for a breast malignancy. Our objective was to perform a systematic review comparing reexcision rates, sensitivity and specificity of the intraoperative use of the margin assessment techniques of imprint cytology (IC) and frozen section analysis (FSA), against permanent histopathologic section (PS). The databases PubMed, Web of Knowledge, Cochrane Library and CINAHL Plus were searched for literature published from 1997 to 2011. Original investigations of patients who underwent BCS for breast cancer that evaluated margin assessment with PS and/or IC or FSA were included. Of 182 titles identified, 41 patient cohorts from 37 articles met inclusion criteria: PS (n = 19), IC (n = 7) and FSA (n = 15). Studies were summarized qualitatively using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cohort studies and the Strength of Recommendation Taxonomy (SORT) numerical scale for diagnostic studies. The final reexcision rates after primary BCS were 35 % for PS, 11 % for IC (p = 0.001 vs. PS) and 10 % for FSA (p < 0.0001 vs. PS). For IC, reexcision rates decreased from 26 to 4 % (p = 0.18) and for FSA, reexcision rates decreased from 27 to 6 % (p < 0.0001). The pooled sensitivity of IC and FSA were 72 and 83 %. The pooled specificity of IC and FSA were 97 and 95 %. The average length of each technique was 13 min for IC and 27 min for FSA. Patients who underwent BCS with intraoperative IC or FSA to assess negative surgical margins had significantly fewer secondary surgical procedures for excision of their breast malignancies.

Utility of conization with frozen section for intraoperative triage prior to definitive hysterectomy

ObjectiveTo review our experience with conization with intraoperative frozen section analysis and to compare results from our tertiary cancer center with those from 2 community hospitals. MethodsThe records of all women who underwent conization with intraoperative frozen section analysis from January 1, 1997, through April 30, 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—were reviewed. Findings on pathologic analysis of frozen sections, permanent loop electrosurgical excisional procedure/conization specimens, and hysterectomy specimens were compared for each patient, and the results from the cancer center were compared to those from the community hospitals. ResultsOne hundred fifty-three patients met the inclusion criteria. Rates of accuracy of conization with frozen section analysis in predicting definitive pathologic findings were as follows: cervix with no residual disease after prior extirpative procedure, 96.5% (95% 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%); microinvasive carcinoma, 97.4% (95% CI 90.1–100%); and invasive carcinoma≥3mm, 100%. Most importantly, conization with frozen section analysis was 100% accurate for triaging patients to simple or radical hysterectomy. Finally, this approach performed equally well in the cancer center with subspecialized pathologists and the 2 community hospitals with general pathologists. ConclusionConization with frozen section analysis is an effective technique for intraoperative triage of patients to immediate simple or radical hysterectomy and can be accurately performed in both academic and community hospitals.

Lymph Node Metastasis in Patients with Frozen Section Analyses That Are Negative for Tumors

Objectives: This study was designed to assess the necessity of delayed complete axillary lymph node dissection (cALND) for patients whose sentinel lymph nodes (SLNs) were negative for tumors on intraoperative frozen section analysis, but later proven positive on hematoxylin and eosin staining or immunohistochemistry. Methods: We identified 341 patients who underwent sentinel lymph node biopsy (SLNB) with cALND at the Samsung Medical Center between 1998 and 2008, and reviewed the clinicopathological records of women diagnosed with invasive carcinoma of the breast. Results: Of the 341 patients, 59 underwent delayed cALND due to negative results on frozen section. Only 1 patient had a non-SLNs metastasis in the group of delayed cALND. Delayed cALND was associated with higher rates of breast-conserving surgery, smaller primary tumor and metastasis size in SLNs, fewer metastatic lymph nodes and SLNs and a lower TNM stage. The detection of metastases of SLNs on frozen section and the number of metastatic SLNs were related to the detection of additional metastases of nonsentinel lymph nodes (NSLNs) in cALND. Conclusion: Our findings suggest that the lack of detection of metastases on frozen sections may be a predictive factor for nonmetastasis in NSLNs. cALND could therefore be omitted in such cases.

Scoring system for prediction of having three or more involved axillary nodes for breast cancer.

1133 Background: Completion axillary lymph node dissection (ALND) is currently the standard of care in the event of a positive sentinel lymph node biopsy (SLNB). However, result from Z0011 indicate that women with a one or two involved axillary nodes and clinical T1-T2 tumors undergoing lumpectomy with radiation therapy followed by systemic therapy do not benefit from completion of ALND in terms of survival. The purpose of this study was to define possible predictors of having three or more involved axillary node to provide information for surgeons making decision about sparing intraoperative frozen section analysis of sentinel lymph node and completion ALND. Methods: We reviewed the records of 1215 patients with clinical T1-T2 invasive breast cancer. None of these patients were in situ cancer on initial gun biopsy nor received neoadjuvant chemotherapy. Factors associated with having three or more involved axillary nodes were evaluated by univariate and multivariate logistic regression analysis. Results: Among 1215 patients, 321 patients had three or more positive nodes. On a multivariate analysis, having three or more positive nodes was associated with primary tumor size by breast US, axillary LN grade according to cortical thickness by US, presence of axillary LN enlargement on chest CT and age. A scoring system to predict the probability of having three or more nodes based on patients’ data and preoperative image findings was developed from the multivariate logistic regression model. The area under the ROC curve was 0.827 (95% CI: 0.793-0.860), and negative predictive value was 90.2% for a score ≤2.7. Similar findings were observed for a validation dataset of 505 patients. Conclusions: Patients with a low probability of having three or more positive nodes can be identified from preoperative image finding. The scoring system developed will be helpful to surgeons making decision about sparing intraoperative frozen section analysis of sentinel lymph node and completion ALND.

Intra-operative frozen section analysis for suspected early-stage ovarian cancer

Intra-operative frozen section analysis for suspected early-stage ovarian cancer

Intra‐operative frozen section analysis for suspected early‐stage ovarian cancer

Intra‐operative frozen section analysis for suspected early‐stage ovarian cancer

P2-16-09: Nipple-Areolar Sparing Mastectomy: Utility of the Lateral Inframammary Incision in Immediate Implant-Based Reconstructions.

Abstract Purpose: Nipple and/or areola-sparing mastectomy as a therapeutic or prophylactic procedure for breast cancer is rapidly gaining popularity as the literature continues to support it safety. The lateral inframammary fold (IMF) approach provides adequate exposure and eliminates visible scars on the anterior surface of the breast, making this incision cosmetically superior to radial or periareolar approaches. Methods: We reviewed 58 consecutive nipple and/or areola-sparing mastectomies performed through a lateral IMF incision with immediate implant-based reconstruction, with or without tissue expansion, between June 2008 and February 2011. Prior to incision, breasts were lightly tumesced with dilute anesthetic solution with epinephrine. Sharp dissection, rather than electrocautery, was used as much as possible to minimize thermal injury to the mastectomy flap. When indicated, acellular dermal matrix was placed as an inferolateral sling. Subsequent fat grafting to correct contour deformities was performed in select patients. Three-dimensional (3D) photographs assessed changes in volume, antero-posterior projection, and ptosis. Retroareolar/nipple tissue underwent routine intraoperative frozen section analysis in cancer cases. Results: Mean patient age was 44 years, and mean follow-up time was 14 months. Depending upon the judgment of the oncologic surgeon, 44 (76%) mastectomies were nipple/areola-sparing, and 14 (24%) were areola-sparing. Thirteen mastectomies (22%) were therapeutic, the remaining 45 mastectomies (78%) were prophylactic. Five of the nine sentinel lymph node biopsies (56%) were performed through the lateral IMF incision without the need for a counter-incision. Acellular dermal matrix was used in 44 (76%) breasts. Average permanent implant volume was 313 cc (range 170 to 750 cc), and average fat grafting volume was 90 cc (range 36 to 177 cc). Mastectomy flap necrosis, requiring operative debridement, occurred in three breasts (5%). One of these breasts required a salvage latissimus dorsi myocutaneous flap to complete the reconstruction. Of the 44 nipple/areola sparing mastectomies, three (7%) required operative debridement and reconstruction for partial nipple necrosis. No statistically significant differences existed between therapeutic and prophylactic mastectomies for developing partial skin or nipple necrosis (p = 0.65). Morphologic outcomes using 3D scan measurements showed reconstructed breasts were larger, more projected, and less ptotic (196 vs. 248 cc, 80 vs. 90 mm, 146 vs. 134 mm, p &amp;lt; 0.01 for each parameter). Conclusion: Excellent results can be achieved with immediate implant-based reconstruction of nipple and/or areola-sparing mastectomy through a lateral IMF incision. NAC survival is reliable, and complication rates are low. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-09.

Thyroid Paragangliomas Are Locally Aggressive

Thyroid paraganglioma (TP) is a very rare neoplasm that can be misdiagnosed. We evaluated the clinical and pathologic characteristics of three patients with TP. The records of all patients from 1981 to 2008 who had thyroidectomy with a final histologic diagnosis of TP were retrieved, and histology was reviewed by a single pathologist. Head and neck paragangliomas arising outside of the thyroid were excluded. TP accounted for 3 of all 6782 (0.04%) patients undergoing thyroidectomy during three decades. One patient has been previously reported and will not be discussed. In the remaining two patients and a surgical pathology consult case that we also describe herein, the mean age at diagnosis was 56 years (40-67) and two patients were men. Presenting features were indicative of advanced local invasion, including stridor, tracheal invasion, compression of the great vessels, and hemoptysis. The diagnosis of TP was not suspected preoperatively; in two patients, fine-needle aspiration (FNA) cytology was inadequate for diagnosis because of excessive blood. Intraoperative frozen section analysis suggested medullary thyroid cancer in two patients and oncocytic (Hurthle) cell carcinoma in one patient. Local invasion was common, requiring concurrent tracheal resection in two of three patients, and present histologically in all three patients. In all three cases, immunohistochemical analysis was negative for cytokeratin AE1/3, calcitonin, and thyroglobulin but positive for S100, highlighting sustentacular cells. After resection of a large TP with tracheal and vascular invasion, a 67-year-old woman experienced a 7-year disease-free interval. Primary TP is indeed rare. It does occur in men, frequently presents with compressive symptoms, and is typically locally aggressive, but does not appear to cause symptoms suggestive of catecholamine excess. Despite invasion of adjacent structures, aggressive resection can achieve a long disease-free interval.

Editors’ Choice

Editors’ Choice

Frozen section analysis of sentinel lymph nodes in patients with breast cancer does not impair the probability to detect lymph node metastases

Intra-operative frozen section analysis (FS analysis) of sentinel lymph nodes (SLNs) in patients with breast cancer can prevent a second operation for axillary lymph node dissection. In contrast, loss of tissue during FS analysis may impair the probability to detect lymph node metastases. To determine the effect of tissue loss on the probability of detection of metastases, dimensions and tissue loss resulting from intra-operative frozen section analysis were measured for 21 SLNs. In a mathematical model, the influence of tissue loss on the probability to detect metastases was calculated in relation to SLN size for various pathology protocols: an American, a widely used European, the extensive ‘Milan’ and the Dutch protocol. For median-sized SLN 11 × 8 × 5 mm (length × width × height), FS analysis led to a median loss of 680 μm (13.6%) of the height of the SLN. Irrespective of SLN size or used pathology protocol, the probability of detecting 2 mm metastases remained unchanged or even increased (0–12.8%). Moreover, the probability to detect 0.2 mm metastases increased for the majority of tested combinations of SLN size, tissue loss and used protocol. Only when combining maximum tissue loss and smallest SLN size in the Dutch protocol, or when applying the extensive Milan protocol on a median-sized SLN, the probability to detect 0.2 mm metastases decreased by 2.7% and 14.3%, respectively. Contrary to ‘common knowledge’, doing FS analysis of SLNs does not impair the probability to detect lymph node metastases.

Organ-sparing Surgery for Penile Cancer: Complications and Outcomes

To evaluate the complications and outcomes of organ-sparing surgery in penile cancer. Thirty-two penile cancer patients had undergone organ-sparing surgery between 2006 and 2010 in Fudan University Shanghai Cancer Center. Applied surgical techniques included radical circumcision and/or wide local excision. Intraoperative frozen section analyses of circumference and deep margins were performed to guarantee complete removal of cancerous tissue. Complications and oncological and functional outcomes were recorded prospectively. Bilateral inguinal lymphadenectomy was routinely performed in patients with invasive penile cancer. Of 32 patients, 8 underwent radical circumcision, 18 were treated with wide local excision, and 6 received wide local excision and circumcision. Postoperatively, only 3 (9.4%) patients had minor complications. With a median follow-up of 26.5 months, local control was achieved in 29 (90.6%) patients, and 3 patients (9.4%) with positive lymph nodes died of disseminated disease. Of 29 patients who completed follow-up surveys of functional outcome, only 1 (4.5%) claimed decreased sexual function and all reported satisfied urination. Organ-sparing surgery, such as radical circumcision and wide local excision is an appropriate treatment option for selected penile cancer patients. It preserves sexual and urination function without significantly increasing the risk of recurrence.

Ex Vivo Ultrasound Control of Resection Margins During Partial Nephrectomy

Surgery remains the treatment of choice for localized renal neoplasms. While radical nephrectomy was long considered the gold standard, partial nephrectomy has equivalent oncological results for small tumors. The role of negative surgical margins continues to be debated. Intraoperative frozen section analysis is expensive and time-consuming. We assessed the feasibility of intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy and its correlation with margin status on definitive pathological evaluation. A study was done at 2 institutions from February 2008 to March 2011. Patients undergoing partial nephrectomy for T1-T2 renal tumors were included in analysis. Partial nephrectomy was done by a standardized minimal healthy tissue margin technique. After resection the specimen was kept in saline and tumor margin status was immediately determined by ex vivo ultrasound. Sequential images were obtained to evaluate the whole tumor pseudocapsule. Results were compared with margin status on definitive pathological evaluation. A total of 19 men and 14 women with a mean ± SD age of 62 ± 11 years were included in analysis. Intraoperative ex vivo ultrasound revealed negative surgical margins in 30 cases and positive margins in 2 while it could not be done in 1. Final pathological results revealed negative margins in all except 1 case. Ultrasound sensitivity and specificity were 100% and 97%, respectively. Median ultrasound duration was 1 minute. Mean tumor and margin size was 3.6 ± 2.2 cm and 1.5 ± 0.7 mm, respectively. Intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy is feasible and efficient. Large sample studies are needed to confirm its promising accuracy to determine margin status.

Sentinel lymph node biopsy following neoadjuvant chemotherapy in clinically node-negative breast cancer patients.

15 Background: Sentinel lymph node biopsy (SLNB) is a widely accepted staging method for patients with early breast cancer. But SLNB following neoadjuvant chemotherapy (NAC) is also controversial because of insufficient evidence to recommend as a standard procedure. The aim of our study was to demonstrate the feasibility of SNLB following NAC. Methods: The clinical study of SLNB for clinically node-negative breast cancer patient was conducted as a large cohort study to confirm the identification rate and safety of this procedure. It was investigated by The Japanese Breast Cancer Society and was accomplished between the years March 2008 and October 2009. In this study 11,228 cases are registered before SLNB from 64 institutions. Of the 11,228 eligible cases, analysis was conducted among 489 cases that were introduced neoadjuvant chemotherapy. Results: SLNB was performed in 110 cases before NAC, 379 cases after NAC. The sentinel node identification rate before NAC was 106/110 cases (96.4%), after NAC was 373/379 cases (98.4%). Intraoperative frozen section analysis was performed in 280 cases, 71 cases were positive. The remaining 219 patients displayed no metastasis in the intraoperative examination, and 6 of these 219 (2.7%) were positive in the final pathological analysis. Conclusions: The identification rate of SLNB following NAC is not inferior to the result of major clinical studies previously reported in the world. There is insufficient evidence to recommend this as a standard procedure. Further research with subgroup analysis is necessary to identify whether SLNB following NAC is feasible or not (planned study). The primary end point for Group A is local relapse rate, Group B is not only the accuracy and false negative rate also the utility of One-step Nucleic Acid Amplification (OSNA).

Intra‐operative frozen section analysis for suspected early‐stage ovarian cancer: 11 years of Gateshead Cancer Centre experience

In centres in which intra-operative frozen section (FS) analysis is not performed, 'apparent' early-stage ovarian cancer diagnosed after surgery on paraffin section may require further restaging laparotomy or adjuvant chemotherapy. Previous studies on FS analysis have reported high sensitivity, specificity and overall accuracy. The objective of this article is to present the largest published dataset on the accuracy of FS analysis over an 11-year period from a single institution. Diagnostic test accuracy. Northern Gynaecological Oncology Centre and Department of Cellular Pathology, Gateshead, UK. 1439 intra-operative FS analyses performed between January 2000 and December 2010 for suspected ovarian cancer. Prospectively collected data on FS analysis were compared with gold standard paraffin section. Sensitivity, specificity, likelihood ratios and post-test probability. The overall sensitivity and specificity of FS analysis were 91.2% and 98.6%, respectively. Positive and negative likelihood ratios were 64.7% and 0.09%, respectively. The pre-test probability of an ovarian tumour being borderline or malignant was 45.8%. When FS analysis was reported to be positive, the post-test probability increased to 98% (confidence interval, 97-99%). Conversely, when FS analysis was reported to be negative, the post-test probability decreased to 7% (confidence interval, 6-9%). The majority of false test results were either borderline tumours or of mucinous differentiation. Intra-operative FS analysis has excellent diagnostic test accuracy and assists gynaecological oncologists to perform the appropriate surgery in 95% of cases, thereby preventing the morbidity of surgical staging in benign cases and the morbidity of restaging procedures or chemotherapy in early-stage malignant tumours.

Lymphatic spread of endometriosis to pelvic sentinel lymph nodes: a prospective clinical study

To establish the prevalence of endometriosis metastatic to pelvic sentinel lymph nodes (PSLN) in women with ovarian and/or peritoneal endometriosis. Prospective clinical study. Academic research institution. Women with a laparoscopic diagnosis of ovarian and/or peritoneal endometriosis verified by intraoperative frozen section analysis. Resection of endometriotic lesions and PSLN after cervical blue dye injection. Histologic analysis of PSLN for the presence of endometriosis and immunohistochemical analysis of estrogen receptor (ER), progesterone receptor (PR), cytokeratin (CK), and CD-10 expression. The study enrolled 26 women with suspected endometriosis; endometriosis was confirmed in 23 women, and a PSLN was identified in 19 women. A total of 37 (right side: 20; left side: 17) lymph nodes were removed. The prevalence of endometriotic lesions in PSLN was 11% (2 of 19). Both lesions were positive for ER, PR, CK, and CD-10. Isolated endometriotic-like cells (IELCs) staining positive for ER and PR were identified in the peripheral sinus of 16 (80%) of 20 and 14 (70%) of 20 PSLN, respectively. All IELCs lacked CK staining, whereas CD-10 staining was present in 16 (80%) of 20 cases, indicating a stromal origin of IELCs. Intraoperative and/or postoperative complications were observed in 1 (5%) of 19 women. Spread of IELCs to PSLN is common in ovarian and/or peritoneal endometriosis. Metastatic lesions in PSLN are present in 11% of women. Further studies to evaluate the prognostic and predictive value of endometriotic spread to PSLN are warranted.

Cost-Effectiveness Analysis of Routine Frozen-Section Analysis of Breast Margins Compared with Reoperation for Positive Margins

Negative margins are associated with decreased local recurrence after lumpectomy for breast cancer. A 2nd operation for re-excision of positive margins is required with rates varying from 15 to 50%. At our institution we routinely use frozen-section analysis of all margins to minimize rates of 2nd operations. The aim of this study was to evaluate the cost/benefit of routine frozen-section analysis. A decision tree was built to compare 2 strategies: (A) lumpectomy without frozen section and a 2nd operation for positive margin(s) versus (B) lumpectomy with intraoperative frozen-section analysis and a 2nd operation for positive margin(s). For strategy A the rate of positive margins and reoperation were varied from 15 to 50%. For strategy B, a 2nd operation rate of 3% was used. Review of our institutional experience demonstrates an intraoperative re-excision of at least 1 margin in 57% of cases performed with frozen-section support. The cost to provider (i.e., institution) per patient resected to negative margins for strategy A ranged from $4835 to $6306. Average weighted cost of strategy B was $5708. Strategy B was less expensive when the reoperation rate was above 36%. The cost to payor (i.e., Medicare) for strategy A ranged from $3577 to $4665. Average weighted cost for strategy B was $3913. Strategy B was less expensive when the re-excision rate was above 26%. Routine use of frozen-section analysis of lumpectomy margins decreases reoperation rates for margin control; therefore, the cost to provider and payor can be cost effective.

Intra-operative frozen section analysis of common iliac lymph nodes in patients with stage IB1 and IIA1 cervical cancer

IntroductionTo evaluate frozen section analysis of common iliac lymph nodes for developing the accuracy of para-aortic lymphadenectomy and detection of para-aortic lymph node metastasis in patients with stage IB1 and IIA1 cervical cancer treated by surgical intent.MethodsThree hundred and ninety-two patients with stage IB1 and IIA1 cervical cancer who underwent radical hysterectomy with pelvic and/or para-aortic lymphadenectomy were retrospectively analyzed. Among those patients, 183 (group A) underwent para-aortic lymphadenectomy when para-aortic lymph nodes were identified as suspicious by visualization and palpation. Other 209 patients (group B, underwent intra-operative frozen section analysis of common iliac lymph nodes) underwent para-aortic lymphadenectomy when frozen section analysis was positive, or para-aortic lymph nodes were identified as suspicious metastases by visualization and palpation.ResultsWe found 21 positive cases (10.0%) of 209 patients by frozen section examination, represented by 1 false negative (4.5%) and 0 false positive case. The specificity and the positive predictive value of frozen section examination were 100%; the negative predictive value was 99.5% (187/188). Overall, the metastasis rates of pelvic lymph node, common iliac lymph node, and para-aortic lymph node were 35.7, 10.2, and 3.3%, respectively. We found the dissection and metastasis rates of para-aortic lymph node in group B statistically significantly higher than group A (14.4% vs. 7.1%, for dissection rates of group B vs. group A, P = 0.022) (5.3% vs. 1.1%, for metastasis rates of group B vs. group A, P = 0.021).ConclusionThe frozen section analysis of common iliac lymph nodes can develop the accuracy of the para-aortic lymphadenectomy and metastasis rate of para-aortic lymph node in patients with stage IB1 and IIA1 cervical cancer.

Role of frozen section analysis of testicular/paratesticular fibrous pseudotumours: a five-case experience

Fibrous pseudotumours of the testicular and paratesticular tissues are fibroinflammatory reactive lesions that can clinically mimic neoplasms. Very little is known about the role of frozen section analysis (FSA) for these lesions in terms of intraoperative surgical management. We recently experienced 5 patients with testicular/paratesticular fibrous pseudotumours in whom frozen sections were used to demonstrate its non-neoplastic nature prior to the decision for radical surgery. In 2 cases, FSA resulted in testicular-sparing surgery. In contrast, the remaining 3 cases ultimately underwent radical orchiectomy, due to questionable viability of the testicle involved by inflammatory/infiltrative lesions and in 1 case a slight possibility of lymphoproliferative malignancy. Urologists should be aware of this entity and its gross features, such as firm masses and diffuse fibrous proliferation encasing the testicle to help determine intraoperative management. In select cases, intraoperative FSA is helpful in obviating radical orchiectomy.