Conization, frozen section examination, and planned hysterectomy in the treatment of high-grade cervical intraepithelial neoplasia

• Autor(a) principal: Carvalho,Jesus Paula
• Data de Publicação: 2001
• Outros Autores: Carvalho,Filomena Marino, Pincerato,Katia Maciel, Pereyra,Elsa A. Gay
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Revista do Hospital das Clínicas
• Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0041-87812001000600002
• topic: Cervical neoplasia; Intraepithelial neoplasia; Frozen section examination; Cervical conization; Hysterectomy

PURPOSE: We tested the role of frozen section examination of the cone specimen in the evaluation of the resection margin status and to rule out invasion in patients with high-grade cervical intraepithelial neoplasia. METHODS: Twenty-five patients with cervical intraepithelial neoplasia underwent conization followed by frozen section examination and planned hysterectomy. The results of the definitive paraffin exam were compared with frozen section examination. RESULTS: In the evaluation of the margins by frozen section examination, 16 patients (64%) had positive cone margins and 9 (36%) had negative margins. The definitive paraffin examination of margin status was concordant in all the cases. Intraoperative diagnosis of invasion was made in 5 cases, and 1 of these was microinvasive. Among the remaining 20 cases, we detected 2 additional microinvasive carcinomas after paraffin study, so the diagnosis of the frozen section examination was concordant with the paraffin sections in 23/25 cases (92%). Two cases of microinvasive carcinoma were diagnosed as cervical intraepithelial neoplasia by frozen section examination and had less than 2 mm stromal invasion. CONCLUSIONS: In high-grade cervical intraepithelial neoplasia, frozen section examination can provide immediate and precise evaluation of the cone margin status in high-grade cervical intraepithelial neoplasia. It can identify frank invasion and permit adequate treatment in a one-stage procedure. In early microinvasive disease, frozen section examination fails to detect the area of invasion but reliably detects clear resection margins.