Frozen section pathology at time of hysterectomy accurately predicts endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia

Accuracy of Frozen Sections for Intraoperative Diagnosis of Complex Atypical Endometrial Hyperplasia

“…The rate of progression to endometrial carcinoma has been estimated to be 0-3% in patients without atypia, 0-8% in patients with simple atypical hyperplasia, and 9-29% in patients with complex atypical endometrial hyperplasia (CAEH) (Kurman et al, 1985;Tabata et al, 2001). The risk of concomitant endometrial carcinoma has been reported to be 20-59% in CAEH (Lambert et al, 1994;Kimura et al, 2003;Valenzuela et al, 2003;Antonsen et al, 2012;Morotti et al, 2012). In addition to, the distinction between atypical endometrial hyperplasia and well differentiated adenocarcinoma of the endometrium is one of the more difficult differential diagnoses in gynecologic pathology (Mills & Longacre, 2011 deep myometrial invasion, and cervical extension of the tumor.…”

Utility of Frozen Section Pathology with Endometrial Pre-Malignant Lesions

“…Performing a total hysterectomy on patients with CAEH on endometrial biopsy without frozen section investigation, given the known risk of underlying EC, will result in an inappropriate treatment in a large proportion of patients leading to additional secondary surgery and potentially unnecessary radiotherapy or under-treatment of their condition (Morotti et al, 2012). Thus, with the guidance of frozen section results, surgical procedures indicated include not only hysterectomy and bilateral salpingo-oophorectomy (BSO), but also pelvic and paraaortic lymphadenectomy (Wang et al, 2013).…”

Which Endometrial Pathologies Need Intraoperative Frozen Sections?

“…The histopathological diagnosis of AEH is difficult (Zaino et al, 2006). Morotti et al (2012) reported that frozen section effeciently identified the cases that diagnosed with AEH on endometrial biopsy (Morotti et al, 2012). Antonsen et al founded that 59% of women diagnosed preoperatively with AEH had cancer, and one in three of these patients had a high-risk cancer requiring full staging procedure (Antonsen et al, 2012).…”

“…In the literature, studies on the accuracy of FS are limited. Some studies reported low accuracy rate of FS (Morotti et al, 2012). The accuracy of FS is reported in the range of 80-96.5% in high risk uterine pathologies (Coffey et al, 2005;Salman et al, 2009).…”

“…These indications are myoma uteri, pelvic organ prolapse, endometriosis, adenomyosis, abnormal uterine bleeding, chronic pelvic pain, infection and cancer. Frozen section is used in differentiating tumor grade, myometrial invasion, and cervical extension of the tumor in gynecologic operations (Morotti et al, 2012). If there is any doubt in the preoperative diagnosis of the patient, frozen section can be helpful to make the diagnosis.…”