Assessing Residents' Frozen Section Skills for Endometrial Cancer

被引:5
作者
Selove, William [1 ]
Bradford, Leslie S. [2 ]
Liu, Yuxin [1 ]
机构
[1] Univ Massachusetts, Dept Pathol, Sch Med, UMass Mem Med Ctr, Biotech Three,One Innovat Dr, Worcester, MA 01605 USA
[2] Univ Massachusetts, Dept Obstet & Gynecol, Sch Med, UMass Mem Med Ctr, Worcester, MA 01605 USA
关键词
Endometrial cancer; Intraoperative frozen section; Residency training; MYOMETRIAL INVASION; INTRAOPERATIVE ASSESSMENT; PROBLEMATIC ASPECTS; UTERINE CORPUS; LOW-GRADE; ADENOCARCINOMA; CARCINOMA; ACCURACY; LYMPHADENECTOMY; ADENOMYOSIS;
D O I
10.1097/PGP.0000000000000247
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Intraoperative frozen section (IFS) on endometrial cancer is an invaluable skill for pathologists-in-training to master. Within limited time constraints, pathologists are expected to determine tumor type, grade, and depth of myometrial invasion. During their training, pathology residents gradually gain experience in handling the majority of cases. However, significant errors can still be seen among senior level trainees. We aimed to improve training effectiveness by evaluating our trainees' performance, identifying common errors, and recommending focused curriculum. Twenty-two residents [postgraduate year (PGY)-1-PGY-4] performed 260 IFS during a 4-yr period. We compared their independent IFS diagnoses with final diagnoses. Overall resident IFS accuracy was 73%. Accuracy for tumor type and depth of myometrial invasion was 80% and 93%, respectively. Two thirds of errors were due to sampling with the rest because of interpretation. Major deficiencies lay in recognizing high-risk histologic types (serous, clear cell, sarcoma) and unconventional myometrial invasion patterns (MELF, adenoma malignum, and adenomyosis-like). Resident IFS errors would theoretically result in suboptimal staging for 32 (12%) patients and unnecessary staging for 1 (0.4%). Overall IFS performance improved as training level increased (76% accuracy for PGY-1 accompanied by PGY-5; 59% for PGY-2; 74% for PGY-3; and 86% for PGY-4). We recommend a dedicated curriculum targeting these difficult yet clinically important entities through review literature and a collection of classic cases demonstrating the diverse morphology variations. Implementing such focused training would greatly improve our trainees' competence on IFS, preparing them to handle a wide variety of cases and situations in future practice.
引用
收藏
页码:402 / 409
页数:8
相关论文
共 38 条
  • [1] Difficulties in assessing the depth of myometrial invasion in endometrial carcinoma
    Ali, Asya
    Black, Destin
    Soslow, Robert A.
    [J]. INTERNATIONAL JOURNAL OF GYNECOLOGICAL PATHOLOGY, 2007, 26 (02) : 115 - 123
  • [2] Altintas A, 1999, EUR J GYNAECOL ONCOL, V20, P329
  • [3] A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer
    Case, Ashley S.
    Rocconi, Rodney P.
    Straughn, J. Michael, Jr.
    Conner, Michael
    Novak, Lea
    Wang, Wenquan
    Huh, Warner K.
    [J]. OBSTETRICS AND GYNECOLOGY, 2006, 108 (06) : 1375 - 1379
  • [4] Endometrioid carcinoma of the uterine corpus: A review of its pathology with emphasis on recent advances and problematic aspects
    Clement, PB
    Young, TH
    [J]. ADVANCES IN ANATOMIC PATHOLOGY, 2002, 9 (03) : 145 - 184
  • [5] Non-endometrioid carcinomas of the uterine corpus: A review of their pathology with emphasis on recent advances and problematic aspects
    Clement, PB
    Young, RH
    [J]. ADVANCES IN ANATOMIC PATHOLOGY, 2004, 11 (03) : 117 - 142
  • [6] Patterns of Myoinvasion in Endometrial Adenocarcinoma: Recognition and Implications
    Cole, Adam J.
    Quick, Charles M.
    [J]. ADVANCES IN ANATOMIC PATHOLOGY, 2013, 20 (03) : 141 - 147
  • [7] CREASMAN WT, 1987, CANCER, V60, P2035, DOI 10.1002/1097-0142(19901015)60:8+<2035::AID-CNCR2820601515>3.0.CO
  • [8] 2-8
  • [9] Prospective assessment of survival, morbidity, and cost associated with lymphadenectomy in low-risk endometrial cancer
    Dowdy, S. C.
    Borah, B. J.
    Bakkum-Gamez, J. N.
    Weaver, A. L.
    McGree, M. E.
    Haas, L. R.
    Keeney, G. L.
    Mariani, A.
    Podratz, K. C.
    [J]. GYNECOLOGIC ONCOLOGY, 2012, 127 (01) : 5 - 10
  • [10] Fadare O, 2013, AM J CANCER RES, V3, P70