scholarly journals EPV075/#455 Intraoperative lymph node frozen section examination (FSE) in early stage cervical cancer – a risk stratification algorithm

2021 ◽  
Author(s):  
S Smyth ◽  
E Jackson ◽  
N Sadeghi ◽  
C Pinelli ◽  
N Ghanbarzadeh ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Risk Stratification ◽  
Early Stage ◽  
Frozen Section ◽  
Frozen Section Examination ◽  
Early Stage Cervical Cancer

Frozen section examination of sentinel lymph nodes can be used as a decisional tool in the surgical management of early cervical cancer

2020 ◽  
Vol 30 (3) ◽  
pp. 358-363 ◽  
Author(s):  
Agnieszka Rychlik ◽  
Martina Aida Angeles ◽  
Federico Migliorelli ◽  
Sabrina Croce ◽  
Eliane Mery ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Early Stage ◽  
Frozen Section ◽  
Lymph Node Involvement ◽  
Stage Iiic ◽  
Frozen Section Examination ◽  
Early Stage Cervical Cancer ◽  
Node Involvement ◽  
The Impact

IntroductionSentinel lymph node (SLN) detection has been shown to be accurate in detecting lymph node involvement in early-stage cervical cancer. The objective of this study was to evaluate the accuracy of frozen section examination in the assessment of SLN status, with the aim of adequately driving the intra-operative decision.MethodsWe designed a retrospective study including patients from two comprehensive cancer centers between January 2001 and December 2018 with early-stage cervical cancer (IA1-IB2 according to International Federation of Gynecology and Obstetrics (FIGO) 2018) undergoing SLN dissection. The SLN procedure was performed using a cervical injection with technetium-99m combined with blue dye or indocyanine green in most cases.ResultsA total of 176 patients fulfilled inclusion criteria. Bilateral mapping was detected in 153 (86.7%) of them. Nineteen of these patients (12.4%) had SLN involvement: 13 with macrometastases, three with micrometastases and three with isolated tumor cells (ITC). Macrometastatic disease was missed on frozen section in 3/13 FIGO 2018 stage IIIC patients. The three patients with ITC were also missed by frozen section examination.Considering only macrometastases as lymph node involvement, frozen section sensitivity was 76.9% (95% CI 49.7 to 91.8) and negative predictive value (NPV) was 97.9% (95% CI 94.0 to 99.3) in patients with bilateral detection. Including micrometastases, sensitivity was 81.2% (95% CI 57.0 to 93.4) and NPV remained at 97.9% (95% CI 93.9 to 99.3).ConclusionsWith a prevalence of final-stage IIIC in patients with pre-operative early-stage cervical cancer of the order of 10% in this series, the NPV of frozen section examination of SLN is very high, with an inferior limit of the CI superior to 94%. Diagnostic accuracy remains acceptable even if micrometastases are considered. The impact of missed ITC has not been established. Frozen section examination can be incorporated in the intra-operative decision algorithm.

scholarly journals Routine Intraoperative Frozen Section Examination to Minimize Bimodal Treatment in Early-Stage Cervical Cancer

2016 ◽  
Vol 26 (6) ◽  
pp. 1148-1153 ◽  
Author(s):  
Phanedra K. Gubbala ◽  
Alexandros Laios ◽  
Zhe Wang ◽  
Sunanda Dhar ◽  
Pubudu J. Pathiraja ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Frozen Section ◽  
Gynecological Cancer ◽  
False Negative ◽  
Low Risk ◽  
Nodal Disease ◽  
Intraoperative Frozen Section ◽  
Frozen Section Examination ◽  
Early Stage Cervical Cancer

ObjectiveIn early-stage cervical cancer, single modality therapy is the main objective, to minimize patient morbidity while offering equivalent cure rates. Intraoperative frozen section examination (FSE) of lymph nodes (LNs) can facilitate this aim, ensuring that radical surgery is avoided in patients requiring adjuvant therapy for metastatic LN involvement. We aimed to evaluate the accuracy of routine intraoperative FSE of pelvic LNs during the surgical staging of early-stage cervical cancers and identify a group at low risk for nodal metastases.MethodsA retrospective cohort study of 94 women aged 23 to 80 years who underwent primary surgery and planned intraoperative FSE of the pelvic LNs at the gynecological cancer center in Oxford was performed. The diagnostic value of FSE and the prediction of metastatic nodal disease were assessed by use of preoperative and intraoperative variables.ResultsA total of 1825 LNs were submitted for FSE. Of 94 women (13.8%), 13 had positive LNs at FSE. Two false-negative cases were reported with micrometastases but no false-positive cases. Frozen section examination as a diagnostic test reached a sensitivity of 86.7% and a specificity of 100%. A regression model including grade I to II and tumor size of less than 20 mm identified a low-risk group for LN involvement.ConclusionsIn light of diverse practice patterns, FSE should be routinely offered to women with early-stage cervical cancer in a 1-step protocol. We equally devised a model to predict those patients at least risk of nodal disease, who may be spared of FSE.

scholarly journals Results from Survey to Assess Current Trends in Surgical Practice in the Management of Women with Early Stage Cervical Cancer within the BGCS Community with an Emphasis on Routine Frozen Section Examination

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Kumar Gubbala ◽  
Alexandros Laios ◽  
Thulumuru Kavitha Madhuri ◽  
Pubudu Pathiraja ◽  
Krishnayan Haldar ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Frozen Section ◽  
Pelvic Lymphadenectomy ◽  
Frozen Section Examination ◽  
Fertility Sparing ◽  
Early Stage Cervical Cancer ◽  
Early Cervical Cancer ◽  
The Uk

In the UK, more than 3,200 new cases of cervical cancer are diagnosed each year. Early stage cervical cancer (IA2-IB1) treatment comprises central surgery mainly in the form of radical hysterectomy or fertility sparing surgery including trachelectomy as well as systematic pelvic lymphadenectomy to detect metastases and adjust treatment accordingly. Given the variation in determining the lymph node (LN) status, a major prognosticator, we reviewed the current UK practice of LN assessment in women undergoing surgery for early cervical cancer. A 7-question, web-based survey, screened by the BGCS committee, was circulated amongst BGCS members. The overall response rate was 51%. Only 12.5% of the respondents routinely performed frozen section examination (FSE); the main reasons for not doing FSE were the pressure on theatre time (54.5%) and the lack of available facilities (48.5%). When positive pelvic nodal disease was detected, in 21 out of 50 (42%) the planned radical hysterectomy (RH) was aborted. More than 70% of the respondents routinely performed RH without any prior resort to pelvic lymphadenectomy. Pretreatment surgical para-aortic LN assessment was performed by 20% of the respondents. The survey confirms the diversity of the UK practice patterns in the surgical treatment of early cervical cancer.

Sentinel lymph node biopsy versus pelvic lymphadenectomy in early-stage cervical cancer: a multi-center randomized trial (PHENIX/CSEM 010)

2020 ◽  
Vol 30 (11) ◽  
pp. 1829-1833
Author(s):  
Hua Tu ◽  
He Huang ◽  
Bingna Xian ◽  
Jibin Li ◽  
Ping Wang ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Primary Endpoint ◽  
Early Stage ◽  
Frozen Section ◽  
Disease Free Survival ◽  
Pelvic Lymphadenectomy ◽  
Oncological Outcomes ◽  
Early Stage Cervical Cancer

BackgroundThere is no accepted strategy for applying sentinel lymph node (SLN) biopsy as an alternative to pelvic lymphadenectomy in cervical cancer. It is unclear whether and when pelvic lymphadenectomy can be safely replaced by SLN biopsy alone.Primary ObjectiveTo comprehensively compare the oncological outcomes of SLN biopsy with pelvic lymphadenectomy in patients with and without SLN metastasis.Study HypothesisIt is hypothesized that the oncological outcomes provided by SLN biopsy are non-inferior to those of pelvic lymphadenectomy in patients with clinically early-stage cervical cancer if risk-adapted adjuvant treatments are given.Trial DesignAll eligible patients will undergo SLN biopsy at the start of surgery. The resected SLNs will be submitted for frozen section examination. and patients will be triaged into the PHENIX-I (SLN-negative) or PHENIX-II (SLN-positive) cohort. In each cohort of this trial, patients will be randomized in a 1:1 ratio into the experimental (SLN biopsy alone) or reference (pelvic lymphadenectomy) arm. Radical hysterectomy will be performed for all patients, and adjuvant treatments will be planned according to post-operative pathological factors.Major Inclusion/Exclusion CriteriaPatients aged between 18 and 65 years with histologically confirmed, untreated stage IA1 (lymphovascular space involvement), IA2, IB1, and IB2 cervical squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma.Primary EndpointThe primary endpoint is disease-free survival.Sample SizeEstimated sample sizes of 830 and 250 are required to fulfill the study objectives of PHENIX-I and II, respectively.Estimated Dates for Completing Accrual and Presenting ResultsAs of May 2020, more than 600 eligible patients have been enrolled. Enrollment is expected to be completed by December 2022, and presentation of results is expected in 2026.Trial RegistrationNCT02642471.

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