#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Intraoperative consultation in gynecologic pathology


Authors: Petr Škapa;  Marek Pluta 1
Authors place of work: Oddělení patologie a molekulární medicíny, Thomayerova nemocnice, Praha 1;  Ústav patologie, 3. lékařská fakulta Univerzity Karlovy a FNKV, Praha 2;  Ústav patologie, 1. lékařská fakulta Univerzity Karlovy a VFN, Praha 3
Published in the journal: Čes.-slov. Patol., 54, 2018, No. 3, p. 105-118
Category: Reviews Article

Summary

Intraoperative consultation represents an integral part of diagnostic protocols in gynecologic oncology. It may be indicated 1) to evaluate the biologic nature of a pathologic process (distinction between nonneoplastic lesions and tumors), 2) to classify the histologic type of tumor and assess its biologic behavior (typing), 3) to confirm or rule out the metastatic origin of a tumor, 4) to determine the degree of differentiation and extent of local spread of a malignant tumor (grading and staging), 5) to detect tumor deposits in lymph nodes, 6) to examine surgical resection margins, 7) to detect products of conception in uterine curettings when ectopic pregnancy is suspected and 8) to collect native tumor tissue for ancillary studies (molecular methods, flow cytometry). A frozen section of adnexal masses is commonly requested and focused primarily on the recognition of malignant tumors, the distinction between borderline tumors and carcinomas, and the identification of a metastatic process in the ovary. An intraoperative consultation may also be beneficial in the risk stratification of patients with endometrial carcinoma for the indication of lymphadenectomy, in the assessment of an endocervical surgical resection margin during fertility sparing and less radical surgery for the carcinoma of uterine cervix and in the detection of tumor spread into the lymph nodes (including sentinel lymph nodes). For the appropriate evaluation of a frozen section, awareness of the relevant clinical data and history of the patient, interpretation of the histologic findings in the context of macroscopic appearance of a specimen and an active interaction with the surgeon are required as essential conditions.

Keywords:

intraoperative consultation – frozen section – gynecologic pathology – tumors of ovary – metastases – sentinel lymph node


Zdroje

 1. Zikán M, Cibula D, Fischerová D, et al. Guideline gynekologických zhoubných nádorů: Standard – Komplexní léčba ovariálních epiteliálních zhoubných nádorů [online]. 2013 [cit. 16.12.2017]. Dostupné z: http://www.onkogynekologie.com/wp-content/uploads/2011/03/Guideline_C56_Epit_2013.pdf

2. Moodley M, Bramdev A. Frozen section: Its role in gynaecological oncology. J Obstet Gynaecol 2005; 25(7): 629-634.

3. Acs G. Intraoperative consultation in gynecologic pathology. Semin Diagn Pathol 2002; 19(4): 237-254.

4. Baker P, Oliva E. A practical approach to intraoperative consultation in gynecological pathology. Int J Gynecol Pathol 2008; 27(3): 353-365.

5. Ulbright TM, Roth LM, Stehman FB. Secondary ovarian neoplasia. A clinicopathologic study of 35 cases. Cancer 1984; 53(5): 1164-1174.

6. de Waal YR, Thomas CM, Oei AL, Sweep FC, Massuger LF. Secondary ovarian malignancies: frequency, origin, and characteristics. Int J Gynecol Cancer 2009; 19(7): 1160-1165.

7. Young RH, Scully RE. Metastatic tumors in the ovary: a problem-oriented approach and review of the recent literature. Semin Diagn Pathol 1991; 8(4): 250-276.

8. Dankwa EK, Davies JD. Frozen section diagnosis: an audit. J Clin Pathol 1985; 38(11): 1235-1240.

9. Rose PG, Rubin RB, Nelson BE, Hunter RE, Reale FR. Accuracy of frozen-section (intraoperative consultation) diagnosis of ovarian tumors. Am J Obstet Gynecol 1994; 171(3): 823-826.

10. Scurry JP, Sumithran E. An assessment of the value of frozen sections in gynecological surgery. Pathology 1989; 21(3): 159-163.

11. Wang KG, Chen TC, Wang TY, Yang YC, Su TH. Accuracy of frozen section diagnosis in gynecology. Gynecol Oncol 1998; 70(1): 105-110.

12. Obiakor I, Maiman M, Mittal K, Awobuluyi M, DiMaio T, Demopoulos R. The accuracy of frozen section in the diagnosis of ovarian neoplasms. Gynecol Oncol 1991; 43(1): 61-63.

13. Wakahara F, Kikkawa F, Nawa A, et al. Diagnostic efficacy of tumor markers, sonography, and intraoperative frozen section for ovarian tumors. Gynecol Obstet Invest 2001; 52(3): 147-152.

14. Coffey D, Kaplan AL, Ramzy I. Intraoperative consultation in gynecologic pathology. Arch Pathol Lab Med 2005; 129(12): 1544-1557.

15. Shaaban AM, Rezvani M, Elsayes KM, et al. Ovarian malignant germ cell tumors: cellular classification and clinical and imaging features. Radiographics 2014; 34(3): 777-801.

16. Wang JJ, Liu Q, Wu N, et al. Ovarian small-cell carcinoma hypercalcemic type successfully treated: a case report and literature review. Onco Targets Ther 2016; 9: 1409-1414.

17. Moley KH, Massad LS, Mutch DG. Pelvic inflammatory disease. Correlation of severity with CA-125 levels. J Reprod Med 1996; 41(5): 341-346.

18. Muyldermans M, Cornillie FJ, Koninckx PR. CA125 and endometriosis. Hum Reprod Update 1995; 1(2): 173-187.

19. Lewis MR, Euscher ED, Deavers MT, Silva EG, Malpica A. Metastatic colorectal adenocarcinoma involving the ovary with elevated serum CA125: a potential diagnostic pitfall. Gynecol Oncol 2007; 105(2): 395-398.

20. Seidman JD, Horkayne-Szakaly I, Haiba M, Boice CR, Kurman RJ, Ronnett BM. The histologic type and stage distribution of ovarian carcinomas of surface epithelial origin. Int J Gynecol Pathol 2004; 23(1): 41-44.

21. Leen SL, Singh N. Pathology of primary and metastatic mucinous ovarian neoplasms. J Clin Pathol 2011; 65(7): 591-595.

22. Hart WR. Mucinous tumors of the ovary: a review. Int J Gynecol Pathol 2005; 24(1): 4-25.

23. Mukherjee A, Parvaiz A, Cecil TD, Moran BJ. Pseudomyxoma peritonei usually originates from the appendix: a review of the evidence. Eur J Gynaecol Oncol 2004; 25(4): 411-414.

24. Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH. Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases. Am J Surg Pathol 2003; 27(8): 1089-1103.

25. Seidman JD, Kurman RJ, Ronnett BM. Primary and metastatic mucinous adenocarcinomas in the ovaries: incidence in routine practice with a new approach to improve intraoperative diagnosis. Am J Surg Pathol 2003; 27(7): 985-993.

26. Lee KR, Young RH. The distinction between primary and metastatic mucinous carcinomas of the ovary: gross and histologic findings in 50 cases. Am J Surg Pathol 2003; 27(3): 281-292.

27. Yemelyanova AV, Vang R, Judson K, Wu LS, Ronnett BM. Distinction of primary and metastatic mucinous tumors involving the ovary: analysis of size and laterality data by primary site with reevaluation of an algorithm for tumor classification. Am J Surg Pathol 2008; 32(1): 128-138.

28. Zaino RJ, Brady MF, Lele SM, Michael H, Greer B, Bookman MA. Advanced stage mucinous adenocarcinoma of the ovary is both rare and highly lethal: a Gynecologic Oncology Group study. Cancer 2011; 117(3): 554-562.

29. Hess V, A‘Hern R, Nasiri N, et al. Mucinous epithelial ovarian cancer: a separate entity requiring specific treatment. J Clin Oncol 2004; 22(6): 1040-1044.

30. Lewis MR, Deavers MT, Silva EG, Malpica A. Ovarian involvement by metastatic colorectal adenocarcinoma: still a diagnostic challenge. Am J Surg Pathol 2006; 30(2): 177-184.

31. Young RH, Hart WR. Metastases from carcinomas of the pancreas simulating primary mucinous tumors of the ovary. A report of seven cases. Am J Surg Pathol 1989; 13(9): 748-756.

32. Ronnett BM, Yemelyanova AV, Vang R, et al. Endocervical adenocarcinomas with ovarian metastases: analysis of 29 cases with emphasis on minimally invasive cervical tumors and the ability of the metastases to simulate primary ovarian neoplasms. Am J Surg Pathol 2008; 32(12): 1835-1853.

33. Ronnett BM, Seidman JD. Mucinous tumors arising in ovarian mature cystic teratomas: relationship to the clinical syndrome of pseudomyxoma peritonei. Am J Surg Pathol 2003; 27(5): 650-657.

34. McKenney JK, Soslow RA, Longacre TA. Ovarian mature teratomas with mucinous epithelial neoplasms: morphologic heterogeneity and association with pseudomyxoma peritonei. Am J Surg Pathol 2008; 32(5): 645-655.

35. Prat J. Ovarian carcinomas: five distinct diseases with different origins, genetic alterations, and clinicopathological features. Virchows Arch 2012; 460(3): 237-249.

36. Škapa P, Dundr P. Onkopatologické aspekty inaktivace genů BRCA1 a BRCA2 v nádorech ovaria, děložní tuby a pánevního peritonea. Cesk Patol 2016; 52(4): 199-204.

37. Stewart CJ, Brennan BA, Hammond IG, Leung YC, McCartney AJ. Accuracy of frozen section in distinguishing primary ovarian neoplasia from tumors metastatic to the ovary. Int J Gynecol Pathol 2005; 24(4): 356-362.

38. Geomini PM, Zuurendonk LD, Bremer GL, de Graaff J, Kruitwagen RF, Mol BW. The impact of size of the adnexal mass on the accuracy of frozen section diagnosis. Gynecol Oncol 2005; 99(2): 362-366.

39. Brun JL, Cortez A, Rouzier R, et al. Factors influencing the use and accuracy of frozen section diagnosis of epithelial ovarian tumors. Am J Obstet Gynecol 2008; 199(3): 244 e241-247.

40. Twaalfhoven FC, Peters AA, Trimbos JB, Hermans J, Fleuren GJ. The accuracy of frozen section diagnosis of ovarian tumors. Gynecol Oncol 1991; 41(3): 189-192.

41. Maheshwari A, Gupta S, Kane S, Kulkarni Y, Goyal BK, Tongaonkar HB. Accuracy of intraoperative frozen section in the diagnosis of ovarian neoplasms: experience at a tertiary oncology center. World J Surg Oncol 2006; 4: 12.

42. Hart WR. Borderline epithelial tumors of the ovary. Mod Pathol 2005; 18(Suppl 2): S33-50.

43. Prat J. Ovarian carcinomas, including secondary tumors: diagnostically challenging areas. Mod Pathol 2005; 18(Suppl 2): S99-111.

44. Riopel MA, Ronnett BM, Kurman RJ. Evaluation of diagnostic criteria and behavior of ovarian intestinal-type mucinous tumors: atypical proliferative (borderline) tumors and intraepithelial, microinvasive, invasive, and metastatic carcinomas. Am J Surg Pathol 1999; 23(6): 617-635.

45. Song T, Choi CH, Kim HJ, et al. Accuracy of frozen section diagnosis of borderline ovarian tumors. Gynecol Oncol 2011; 122(1): 127-131.

46. Medeiros LR, Rosa DD, Edelweiss MI, et al. Accuracy of frozen-section analysis in the diagnosis of ovarian tumors: a systematic quantitative review. Int J Gynecol Cancer 2005; 15(2): 192-202.

47. Menzin AW, Rubin SC, Noumoff JS, LiVolsi VA. The accuracy of a frozen section diagnosis of borderline ovarian malignancy. Gynecol Oncol 1995; 59(2): 183-185.

48. Kayikcioglu F, Pata O, Cengiz S, et al. Accuracy of frozen section diagnosis in borderline ovarian malignancy. Gynecol Obstet Invest 2000; 49(3): 187-189.

49. Al-Agha OM, Nicastri AD. An in-depth look at Krukenberg tumor: an overview. Arch Pathol Lab Med 2006; 130(11): 1725-1730.

50. Moore RG, Chung M, Granai CO, Gajewski W, Steinhoff MM. Incidence of metastasis to the ovaries from nongenital tract primary tumors. Gynecol Oncol 2004; 93(1): 87-91.

51. Hirono M, Taniyama K, Matsuki K, Nakagami K, Niimoto M, Hattori T. Clinico-pathological studies on ovarian metastasis from gastric cancer. Jpn J Surg 1983; 13(1): 25-31.

52. Kiyokawa T, Young RH, Scully RE. Krukenberg tumors of the ovary: a clinicopathologic analysis of 120 cases with emphasis on their variable pathologic manifestations. Am J Surg Pathol 2006; 30(3): 277-299.

53. Lim FK, Yeoh CL, Chong SM, Arulkumaran S. Pre and intraoperative diagnosis of ovarian tumours: how accurate are we? Aust N Z J Obstet Gynaecol 1997; 37(2): 223-227.

54. Sasaki KJ, Miller CE. Adnexal torsion: review of the literature. J Minim Invasive Gynecol 2014; 21(2): 196-202.

55. Tumours of the ovary. In: Kurman RJ, eds. WHO Classification of Tumours of Female Reproductive Organs. Lyon, PA: IARC Press; 2014: 11-83.

56. Stewart CJ, Brennan BA, Hammond IG, Leung YC, McCartney AJ, Ruba S. Intraoperative assessment of clear cell carcinoma of the ovary. Int J Gynecol Pathol 2008; 27(4): 475-482.

57. Offman SL, Longacre TA. Clear cell carcinoma of the female genital tract (not everything is as clear as it seems). Adv Anat Pathol 2012; 19(5): 296-312.

58. Pinto PB, Andrade LA, Derchain SF. Accuracy of intraoperative frozen section diagnosis of ovarian tumors. Gynecol Oncol 2001; 81(2): 230-232.

59. Eichhorn JH, Young RH. Transitional cell carcinoma of the ovary: a morphologic study of 100 cases with emphasis on differential diagnosis. Am J Surg Pathol 2004; 28(4): 453-463.

60. Irving JA, Alkushi A, Young RH, Clement PB. Cellular fibromas of the ovary: a study of 75 cases including 40 mitotically active tumors emphasizing their distinction from fibrosarcoma. Am J Surg Pathol 2006; 30(8): 929-938.

61. Kikkawa F, Ishikawa H, Tamakoshi K, Nawa A, Suganuma N, Tomoda Y. Squamous cell carcinoma arising from mature cystic teratoma of the ovary: a clinicopathologic analysis. Obstet Gynecol 1997; 89(6): 1017-1022.

62. Menzin AW, Gal D, Lovecchio JL. Contemporary surgical management of borderline ovarian tumors: a survey of the Society of Gynecologic Oncologists. Gynecol Oncol 2000; 78(1): 7-9.

63. Houck K, Nikrui N, Duska L, et al. Borderline tumors of the ovary: correlation of frozen and permanent histopathologic diagnosis. Obstet Gynecol 2000; 95(6 Pt 1): 839-843.

64. Frumovitz M, Schmeler KM, Malpica A, Sood AK, Gershenson DM. Unmasking the complexities of mucinous ovarian carcinoma. Gynecol Oncol 2010; 117(3): 491-496.

65. Reichert RA. Primary ovarian adenofibromatous neoplasms with mucin-containing signet-ring cells: a report of 2 cases. Int J Gynecol Pathol 2007; 26(2): 165-172.

66. McCluggage WG, Young RH. Primary ovarian mucinous tumors with signet ring cells: report of 3 cases with discussion of so-called primary Krukenberg tumor. Am J Surg Pathol 2008; 32(9): 1373-1379.

67. Lash RH, Hart WR. Intestinal adenocarcinomas metastatic to the ovaries. A clinicopathologic evaluation of 22 cases. Am J Surg Pathol 1987; 11(2): 114-121.

68. Lerwill MF, Young RH. Ovarian metastases of intestinal-type gastric carcinoma: A clinicopathologic study of 4 cases with contrasting features to those of the Krukenberg tumor. Am J Surg Pathol 2006; 30(11): 1382-1388.

69. Meriden Z, Yemelyanova AV, Vang R, Ronnett BM. Ovarian metastases of pancreaticobiliary tract adenocarcinomas: analysis of 35 cases, with emphasis on the ability of metastases to simulate primary ovarian mucinous tumors. Am J Surg Pathol 2011; 35(2): 276-288.

70. Fontanelli R, Paladini D, Raspagliesi F, di Re E. The role of appendectomy in surgical procedures for ovarian cancer. Gynecol Oncol 1992; 46(1): 42-44.

71. Salom EM, Schey D, Penalver M, et al. The safety of incidental appendectomy at the time of abdominal hysterectomy. Am J Obstet Gynecol 2003; 189(6): 1563-1567. Discussion: 1567-1568.

72. Lin JE, Seo S, Kushner DM, Rose SL. The role of appendectomy for mucinous ovarian neoplasms. Am J Obstet Gynecol 2013; 208(1): 46 e41-44.

73. Ozyurek ES, Karacaoglu UM, Kaya E, Gundogdu EC, Odacilar E. Appendectomy in the surgical treatment of benign ovarian mucinous cystadenomas - is it necessary? Ginekol Pol 2016; 87(5): 338-341.

74. Ozcan A, Toz E, Turan V, et al. Should we remove the normal-looking appendix during operations for borderline mucinous ovarian neoplasms?: A retrospective study of 129 cases. Int J Surg 2015; 18: 99-103.

75. Cheng A, Li M, Kanis MJ, et al. Is it necessary to perform routine appendectomy for mucinous ovarian neoplasms? A retrospective study and meta-analysis. Gynecol Oncol 2017; 144(1): 215-222.

76. Mikuta JJ. International Federation of Gynecology and Obstetrics staging of endometrial cancer 1988. Cancer 1993; 71(4 Suppl): 1460-1463.

77. Franchi M, Ghezzi F, Riva C, Miglierina M, Buttarelli M, Bolis P. Postoperative complications after pelvic lymphadenectomy for the surgical staging of endometrial cancer. J Surg Oncol 2001; 78(4): 232-237. Discussion: 237-240.

78. Hidaka T, Kato K, Yonezawa R, et al. Omission of lymphadenectomy is possible for low-risk corpus cancer. Eur J Surg Oncol 2007; 33(1): 86-90.

79. Kumar S, Bandyopadhyay S, Semaan A, et al. The role of frozen section in surgical staging of low risk endometrial cancer. PLoS One 2011; 6(9): e21912.

80. Fanning J, Tsukada Y, Piver MS. Intraoperative frozen section diagnosis of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 1990; 37(1): 47-50.

81. Shim JU, Rose PG, Reale FR, Soto H, Tak WK, Hunter RE. Accuracy of frozen-section diagnosis at surgery in clinical stage I and II endometrial carcinoma. Am J Obstet Gynecol 1992; 166(5): 1335-1338.

82. Mikuta JJ. Preoperative evaluation and staging of endometrial cancer. Cancer 1995; 76(10 Suppl): 2041-2043.

83. Kilgore LC, Partridge EE, Alvarez RD, et al. Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol 1995; 56(1): 29-33.

84. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer 1987; 60(8 Suppl): 2035-2041.

85. Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC. Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol 2000; 182(6): 1506-1519.

86. Watanabe M, Aoki Y, Kase H, Fujita K, Tanaka K. Low risk endometrial cancer: a study of pelvic lymph node metastasis. Int J Gynecol Cancer 2003; 13(1): 38-41.

87. Seracchioli R, Solfrini S, Mabrouk M, et al. Controversies in surgical staging of endometrial cancer. Obstet Gynecol Int 2010; 2010: 181963.

88. Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 2009; 373(9658): 125-136.

89. Walker JL, Piedmonte MR, Spirtos NM, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol 2009; 27(32): 5331-5336.

90. Mourits MJ, Bijen CB, Arts HJ, et al. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial. Lancet Oncol 2010; 11(8): 763-771.

91. Kumar S, Medeiros F, Dowdy SC, et al. A prospective assessment of the reliability of frozen section to direct intraoperative decision making in endometrial cancer. Gynecol Oncol 2012; 127(3): 525-531.

92. Quinlivan JA, Petersen RW, Nicklin JL. Accuracy of frozen section for the operative management of endometrial cancer. BJOG 2001; 108(8): 798-803.

93. Goff BA, Rice LW. Assessment of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 1990; 38(1): 46-48.

94. Soliman PT, Frumovitz M, Spannuth W, et al. Lymphadenectomy during endometrial cancer staging: practice patterns among gynecologic oncologists. Gynecol Oncol 2010; 119(2): 291-294.

95. Case AS, Rocconi RP, Straughn JM, Jr., et al. A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer. Obstet Gynecol 2006; 108(6): 1375-1379.

96. Frumovitz M, Slomovitz BM, Singh DK, et al. Frozen section analyses as predictors of lymphatic spread in patients with early-stage uterine cancer. J Am Coll Surg 2004; 199(3): 388-393.

97. Dargent D, Martin X, Sacchetoni A, Mathevet P. Laparoscopic vaginal radical trachelectomy: a treatment to preserve the fertility of cervical carcinoma patients. Cancer 2000; 88(8): 1877-1882.

98. Smith JR, Boyle DC, Corless DJ, et al. Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma. Br J Obstet Gynaecol 1997; 104(10): 1196-1200.

99. Rob L, Charvat M, Robova H, et al. Less radical fertility-sparing surgery than radical trachelectomy in early cervical cancer. Int J Gynecol Cancer 2007; 17(1): 304-310.

100. Rob L, Pluta M, Strnad P, et al. A less radical treatment option to the fertility-sparing radical trachelectomy in patients with stage I cervical cancer. Gynecol Oncol 2008; 111(2 Suppl): S116-120.

101. Zhang D, Ge H, Li J, Wu X. A new method of surgical margin assuring for abdominal radical trachelectomy in frozen section. Eur J Cancer 2015; 51(6): 734-741.

102. Park KJ, Soslow RA, Sonoda Y, Barakat RR, Abu-Rustum NR. Frozen-section evaluation of cervical adenocarcinoma at time of radical trachelectomy: pathologic pitfalls and the application of an objective scoring system. Gynecol Oncol 2008; 110(3): 316-323.

103. Chenevert J, Tetu B, Plante M, et al. Indication and method of frozen section in vaginal radical trachelectomy. Int J Gynecol Pathol 2009; 28(5): 480-488.

104. Tanguay C, Plante M, Renaud MC, Roy M, Tetu B. Vaginal radical trachelectomy in the treatment of cervical cancer: the role of frozen section. Int J Gynecol Pathol 2004; 23(2): 170-175.

105. Ismiil N, Ghorab Z, Covens A, et al. Intraoperative margin assessment of the radical trachelectomy specimen. Gynecol Oncol 2009; 113(1): 42-46.

106. Bretelle F, Agostini A, Rojat-Habib MC, Cravello L, Roger V, Blanc B. The role of frozen section examination of conisations in the management of women with cervical intraepithelial neoplasia. BJOG 2003; 110(4): 364-370.

107. Rouzier R, Feyereisen E, Constancis E, Haddad B, Dubois P, Paniel BJ. Frozen section examination of the endocervical margin of cervical conization specimens. Gynecol Oncol 2003; 90(2): 305-309.

108. Torres JE, Moorman J, Shiu A, Gyer D. Colposcopically directed conization for frozen-section examination in the management of cervical intraepithelial neoplasia. J Reprod Med 1983; 28(2): 123-125.

109. Cochran AJ, Wen DR, Huang RR, Wang HJ, Elashoff R, Morton DL. Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node. Mod Pathol 2004; 17(7): 747-755.

110. Fleming FJ, Kavanagh D, Crotty TB, et al. Factors affecting metastases to non-sentinel lymph nodes in breast cancer. J Clin Pathol 2004; 57(1): 73-76.

111. Viale G, Maiorano E, Pruneri G, et al. Predicting the risk for additional axillary metastases in patients with breast carcinoma and positive sentinel lymph node biopsy. Ann Surg 2005; 241(2): 319-325.

112. Lecuru F, Mathevet P, Querleu D, et al. Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol 2011; 29(13): 1686-1691.

113. Moore RG, DePasquale SE, Steinhoff MM, et al. Sentinel node identification and the ability to detect metastatic tumor to inguinal lymph nodes in squamous cell cancer of the vulva. Gynecol Oncol 2003; 89(3): 475-479.

114. Cibula D, Zikan M, Slama J, et al. Risk of micrometastases in non-sentinel pelvic lymph nodes in cervical cancer. Gynecol Oncol 2016; 143(1): 83-86.

115. Barlin JN, Khoury-Collado F, Kim CH, et al. The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. Gynecol Oncol 2012; 125(3): 531-535.

116. Rob L, Strnad P, Robova H, et al. Study of lymphatic mapping and sentinel node identification in early stage cervical cancer. Gynecol Oncol 2005; 98(2): 281-288.

117. Plante M, Renaud MC, Tetu B, Harel F, Roy M. Laparoscopic sentinel node mapping in early-stage cervical cancer. Gynecol Oncol 2003; 91(3): 494-503.

118. Marnitz S, Kohler C, Bongardt S, Braig U, Hertel H, Schneider A. Topographic distribution of sentinel lymph nodes in patients with cervical cancer. Gynecol Oncol 2006; 103(1): 35-44.

119. Slama J, Dundr P, Dusek L, Cibula D. High false negative rate of frozen section examination of sentinel lymph nodes in patients with cervical cancer. Gynecol Oncol 2013; 129(2): 384-388.

120. Fader AN, Edwards RP, Cost M, et al. Sentinel lymph node biopsy in early-stage cervical cancer: utility of intraoperative versus postoperative assessment. Gynecol Oncol 2008; 111(1): 13-17.

121. Bats AS, Buenerd A, Querleu D, et al. Diagnostic value of intraoperative examination of sentinel lymph node in early cervical cancer: a prospective, multicenter study. Gynecol Oncol 2011; 123(2): 230-235.

122. Pluta M, Rob L, Charvat M, et al. Less radical surgery than radical hysterectomy in early stage cervical cancer: a pilot study. Gynecol Oncol 2009; 113(2): 181-184. 

Štítky
Anatomical pathology Forensic medical examiner Toxicology
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#