Intravaginal amputation of the uterine cervix with frozen section examination of the endocervical margin: a review of 414 consecutive patients

We report our institutional experience with the accuracy and usefulness of cervical amputations with frozen section evaluation of the endocervical margin in the management of preinvasive squamous epithelial lesions. Four hundred and fourteen consecutive patients, who underwent amputation of the cervix because of a preinvasive epithelial lesion, or discrepancy between cytologic and biopsy findings especially when colposcopic evaluation was unsatisfactory, had frozen section evaluation of the endocervical margin. Medical records were reviewed and pathologic findings were compared with those obtained on paraffin embedded sections. Frozen section analysis of the upper endocervical margin led to the diagnosis of a residual lesion in 90 (21.7%) cases. In 59 (14.2%) of these cases a further excision was performed during the same operative procedure leading to complete resection in 34 (8.2%) cases. In 403 (97.3%) cases the diagnosis based on the frozen section was corroborated by the permanent sections. For the diagnosis of insufficient cervical resection, the sensitivity and specificity of frozen sections were 93.8% and 99.7% respectively. We conclude that frozen section evaluation of the upper endocervical margin at the time of cervical amputation is a reliable procedure that increases the rate of complete resection. The risks associated with additional anesthesia are then reduced, as are inconvenience to the patients and costs.