Diagnostic possibilities and limitations of urgent intraoperative pathologicanatomical studies in oncogynecology

Abstract

Introduction. One of the variants of intravital pathological and anatomical diagnostics is intraoperative pathological and anatomical ("urgent") examination, which serves for tumor process verification. Urgent intraoperative pathological and anatomical examination is widely used when there are certain differential diagnostic difficulties and limitations of instrumental methods of examination.The purpose of the study — to analyze the possibilities, limitations and the accuracy of "urgent" pathologic and anatomical diagnostics in oncogynecological diseases. Materials and methods. We retrospectively analyzed medical records of 378 inpatients treated in the gynecologic oncology department of CHOKZO and NM for the period from January 2016 to January 2021. Results and discussion. Urgent histological examination was used to diagnose ovarian tumors (82%, n=310); to evaluate the extent of a tumor process in uterine body cancer, ovarian cancer, cervical cancer (peritoneal carcinomatosis, ingrowth into adjacent tissues and organs) (15%, n=57); less often to evaluate resection margin ablation in cervical cancer, uterine body cancer (3%, n=11). In a comparison of conclusions after urgent morphological examination and conduction of material, discrepancies were registered only in hypodiagnostic ovarian tumors (in 5.8% of all "urgent" ovarian tumor studies, n=18), when the question about the malignancy potential of a process cannot be reliably decided. The reliability of intraoperative morphological verification of the process is 94.2%. The sensitivity is 96%, specificity is 97%, which is consistent with the results of other studies. Conclusions. Intraoperative morphological diagnosis is a highly specific and highly sensitive method of investigation. There are limitations of this diagnostic method depending on the volume of tissue material, quality of cryostat sections, as well as tumor features (e.g., ovarian masses) consisting of heterologous morphological areas. A compliant, multidisciplinary approach is required to successfully meet the challenges of intraoperative examination.