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Schnellschnittdiagnostik bei Erkrankungen des weiblichen Genitaltrakts

Intraoperative frozen sections in diseases of the female genital tract

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Zusammenfassung

Die Schnellschnittuntersuchung hat insbesondere bei Ovarialtumoren eine große Bedeutung, da eine adäquate präoperative histologische Abklärung nicht möglich ist. Die diagnostische Treffsicherheit ist bei primären Ovarialkarzinomen und benignen Ovarialtumoren am höchsten, bei Metastasen in den Ovarien und seltenen Ovarialtumoren wie Keimzelltumoren am geringsten. Bei Tumoren des Endometriums, insbesondere dem Endometriumkarzinom, sollte die Diagnostik bereits präoperativ mittels Kürettage oder Biopsie erfolgen. Dem intraoperativen Schnellschnitt kommt die Aufgabe der Bestimmung des Tumorstadiums mit der Option zur einzeitigen Lymphadenektomie zu. Bei „Low-grade“-Stromaneoplasien kann dem Schnellschnitt eine diagnostische Rolle zukommen, ebenso bei anderen klinisch malignitätsverdächtigen mesenchymalen Uterustumoren. Die Schnellschnittuntersuchung pelviner Lymphknoten eröffnet die Möglichkeit der einzeitigen paraaortalen Lymphadenektomie. Die Sentinellymphknotenbiopsie ist nur beim Vulvakarzinom von Bedeutung. Die deutsche Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) empfiehlt bei Ovarialtumoren mit fraglicher Schnellschnittdiagnose diagnostische Zurückhaltung und ein zweizeitiges operatives Vorgehen. Im Falle eines Endometriumkarzinoms wird die Schnellschnittuntersuchung des Uterus und der Lymphknoten derzeit ebenso wenig empfohlen wie bei Sentinellymphknoten, aber auch nicht abgelehnt.

Abstract

Intraoperative frozen sections are particularly important for ovarian tumors because definitive preoperative histology is not possible. The diagnostic accuracy of frozen sections is highest for primary invasive ovarian carcinomas and benign ovarian lesions, followed by borderline tumors and poorest for ovarian metastases and rare neoplasms, such as germ cell tumors. Endometrial carcinoma should be diagnosed preoperatively by curettage or biopsy. For endometrioid endometrial carcinomas the indications for lymphadenectomy are often based on intraoperative assessment of the uterus. The differential diagnosis of low grade stromal neoplasms is based on myometrial invasion and can be supported by assessment of frozen sections as well as the diagnosis of other mesenchymal uterine tumors suspected of being malignant. Frozen sections of pelvic lymph nodes provide the possibility of immediate subsequent para-aortic lymphadenectomy in endometrial and cervical carcinomas but have recently lost importance. Sentinel node biopsy with intraoperative frozen section analysis is routinely performed only for vulval carcinoma. The German Association of Gynecological Oncology (AGO) recommends deferred diagnosis and a two stage surgical procedure for any doubtful intraoperative ovarian histology. Intraoperative frozen sections for endometrial carcinoma and lymphadenectomy specimens as well as for sentinel node biopsies are currently not recommended but are also not completely rejected.

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Authors and Affiliations

  1. Institut für Pathologie, LKH Graz West, Göstingerstr. 22, 8020, Graz, Österreich

    S. Lax & K. Prein

  2. Klinische Abteilung für Gynäkologie, Universitätsfrauenklinik Graz, Graz, Österreich

    K. Tamussino

  3. Gynäkologische Abteilung, Krankenhaus der Barmherzigen Brüder, Graz, Österreich

    P. Lang

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  1. S. Lax
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Correspondence to S. Lax.

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Lax, S., Tamussino, K., Prein, K. et al. Schnellschnittdiagnostik bei Erkrankungen des weiblichen Genitaltrakts. Pathologe 33, 430–440 (2012). https://doi.org/10.1007/s00292-012-1597-5

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