Background: Uterine sarcoma has a very low incidence. Nevertheless, morcellation to remove what was initially thought to be a benign tumour, can be associated with disease spread and change in staging. To date the only reliable test for determination of the type of myometrial tumour is histological analysis. Previously 2 case studies involving this type of pre-morcellation biopsy have been published.¹

Aims: To determine the accuracy and feasibility of obtaining biopsies of uterine tumours for frozen section analysis at the time of surgery prior to laparoscopic morcellation.

Methods: A prospective cohort study of consecutive patients undergoing laparoscopic myomectomy or hysterectomy. Eligible patients had tumours or total uterine size requiring the use of power morcellation for removal. Biopsies were taken using the laparoscopic harmonic scalpel (Ethicon), see video for technique. All cases were pre-arranged with the Pathologist for specimen collection and transport. Results were provided via telephone directly to the operating surgeon. Frozen section specimens were then compared with permanent formalin-fixed tissue sections.

Results: Twelve patients had frozen section analysis prior to morcellation during the study period, 3 for myomectomy and 9 for hysterectomy.
In 9 of the patients a clear diagnosis of benign leiomyoma was provided via frozen section and confirmed with formalin-fixed tissue in the final report. In 2 cases the frozen section included degenerate stromal tissue (one of which was also hyalinised and calcified). That made a definitive diagnosis more difficult but both cases were reported as benign on the frozen section. Both of these were confirmed as benign leiomyomas on the final report.
In one hysterectomy the frozen section reported adenomyosis. The final report confirmed extensive adenomyosis with leiomyomata.

Conclusion: Uterine tumour biopsy for frozen section prior to morcellation appears to be a safe and effective means for histological diagnosis of pathology prior to morcellation. Difficulties can arise for the pathologist if the tumour is degenerated. When the pathologist was confident to report the tumour as benign that was always confirmed by the final paraffin specimen.