Minhua Wang

The role of frozen section in gynecologic pathology

Intraoperative consultation using frozen sections in gynecologic surgery aids in determining the scope of the surgery. The main indications are to evaluate the presence of malignancy, determine the primary site, histologic type, and grade of the tumor, and assess the extent of local tumor invasion and distant spread. A thorough gross examination of submitted specimens helps identify critical features such as specimen integrity, tumor size, serosa and ovarian surface involvement, myometrial involvement, and lymph node status. Uterine endometrial carcinomas are classified based on histologic type and grade, with attention to features such as myometrial invasion, cervical stromal involvement, and gross tumor size. Correct evaluation of uterine mesenchymal tumors, ovarian epithelial tumors, sex-cord stromal tumors, and germ cell tumors is essential to guide the decision between conservative and extensive surgical staging. It is challenging but essential to distinguish primary ovarian tumors from metastatic neoplasms. Prompt and clear communication with the operating surgeon is crucial for successful consultation. Providing definitive diagnoses on frozen sections can sometimes be difficult; however, understanding the management algorithm and maintaining an open dialogue with the surgeon about differential diagnoses can help in offering the necessary information for subsequent management steps.

Prognostic significance of pelvic washing cytology in early stage endometrial cancer: A 10‐year matched cohort analysis from a large single institute

Abstract Background Pelvic washing (PW) cytology has been excluded from endometrial cancer staging by the 2009 International Federation of Gynecology and Obstetrics (FIGO) criteria, and its prognostic significance in early stage disease remains controversial. In this study, the authors evaluated the clinicopathologic correlates and prognostic impact of positive PW cytology in a large institutional cohort using a matched case–control design. Methods A retrospective case–control cohort was created by reviewing PWs for endometrial cancer from 2013 to 2023 in the authors' pathology database. Cases with positive PW were retrieved from consecutive patients who had FIGO 2009 stage I or II endometrial cancer. The control group was comprised of randomly selected patients with negative PWs who were matched to patients in the positive PW group on patient age, tumor histologic subtype, FIGO grade, and disease stage. Cox proportional hazards models and multivariable logistic regression analyses were used to correlate survival outcomes and to identify predictors of cytologic positivity. Results The cohort included 88 patients who had positive PW cytology and 223 matched controls. Positive PW cytology was independently associated with significantly worse disease‐free survival (hazard ratio, 4.33; p  < .001) and demonstrated borderline significance for overall survival (hazard ratio, 1.67; p  = .05). The presence of free‐floating tumor cells in the fallopian tubes was an independent predictor of positive PW cytology ( p  < .001). Conclusions The current study demonstrates that positive PW cytology is an independent adverse prognostic factor in patients with stage I/II endometrial cancer and suggests that PW cytology status should be considered for accurate risk stratification of patients who have early stage endometrial cancer although it is not part of the current FIGO staging criteria.