Accuracy of frozen section for the operative management of endometrial cancer

Objective To assess the accuracy of intra-operative frozen section reports at identifying the features of high risk uterine disease compared with fina l histopathology. Design Retrospective study. Methods The records, of 460 patients with uterine cancer registered with th e Queensland Centre for Gynaecological Cancer between January 1, 1996 and D ecember 31, 1998 were reviewed. Intra-operative frozen section was undertak en in 260 patients with endometrial adenocarcinoma. Frozen section patholog y was compared with the final histopathology reports. Inter-observer reliab ility was assessed using percentage agreement and kappa statistics. Clinica l notes were also reviewed to determine if errors resulted in sub-optimal p atient care. Results Respectively, tumour grade and depth of myometrial invasion were ac curately reported in 88.6% of cases (expected 61.5%, Kappa 0.70) and 94.7% (expected 53.8%, Kappa 0.89). Errors were predominantly attributable to dif ficulties with respect to the interpretation of tumour grade. The error res ulted in the patient receiving sub-optimal surgical management in only I I cases (5.3%) Conclusion Frozen section is accurate at identifying the features of high r isk uterine disease in the setting of endometrial cancer and can play an im portant role in directing primary operative management.