Testing Cancer Tissue Mid-Surgery

Uterine cancer surgery could be more accurate with frozen section analysis mid surgery

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) Surgeons don’t always know what’s going on inside the body until they get in there. With uterine cancer, an old lab technique may help doctors in the middle of the surgery.

Researchers studied a procedure that quickly tests for cancer cells in removed sections of tissue in the middle of surgery. 

The study’s findings showed the test was 99 percent accurate at detecting the presence of cancer.

"Talk to a oncologist about surgery options."

Sanjeev Kumar, MD, from the Division of Gynecologic Surgery at Mayo Clinic in Rochester, MN, led a study to test the effectiveness of a mid-surgery cancer cell testing procedure. Authors recommended uterine cancer surgeries done in facilities with the right lab equipment should utilize this test to give surgeons information on whether the cancer has spread and if further removal of tissue is necessary.

Endometrial cancer, also known as uterine cancer, can be very tricky to treat. While 70 percent of uterine cancer is contained to the uterus, the risk of death is very high if the cancer spreads to surrounding lymph nodes or other areas.

Often, surgeons don’t know how far the cancer has spread until they have surgically entered the pelvic area.

“Intraoperative” decisions are decisions made in the middle of surgery on which areas and how much of those areas needs to be removed from the body to best treat the patient’s cancer.

A frozen section procedure involves removing tiny portions of tissue for a lab to rapidly freeze and analyze quickly for cancer cells. The test can be done on site and deliver results to the surgeon in the middle of surgery. The surgeon then knows exactly what areas are affected by cancer and exactly how much tissue needs to be removed.

For this study, researchers tested the reliability of this intraoperative frozen section procedure on 784 patients with uterine cancer from 2004 to 2008.

Researchers compared the accuracy of results from the intraoperative frozen section to those from another type of test, called a permanent paraffin section. Permanent paraffin section testing is known to be very accurate, but takes longer - at least overnight - to yield results and therefore cannot be used in the middle of surgery.

Out of the 784 patient samples, only 7 percent had to be deferred to permanent paraffin section testing and only 1 percent had any discrepancy between the two types of testing.

The authors concluded that despite skepticism expressed in the medical community, intraoperative frozen sections provide highly reliable data to guide surgical treatment decisions in the middle of surgery at hospitals with the right lab equipment and technicians.

The great advantage of intraoperative frozen section testing could be the reduction in the number of additional surgeries required to remove any spreading of uterine cancer to lymph nodes or other areas close to the uterus.

This study was published in December in Gynecologic Oncology.

No external funding was used for this study. No conflicts of interest were reported.

Reviewed by: 
Review Date: 
February 1, 2013
Last Updated:
February 6, 2013