Intraoperative Ex Vivo High-Resolution Sonography: A Novel Technique for the Assessment of Myometrial Invasion in Endometrial Cancer

ObjectiveThis study aims to assess the diagnostic performance of a novel intraoperative ex vivo ultrasonography technique in determining deep myometrial invasion (MI) in patients with apparently low-risk endometrial cancer (EC).MethodsThis prospective study included patients with type I EC who underwent staging laparotomy at Hacettepe University Hospital from December 2011 to September 2014. After hysterectomy, a radiologist with special training in gynecology examined the uterus ex vivo using a 12-MHz superficial linear probe. The specimen was sent for intraoperative frozen section (FS) analysis. The results were compared with permanent section reports.ResultsIn total, 45 female patients were eligible for analysis. Intraoperative ex vivo high-resolution sonography (IEVHS) correctly assessed depth of MI in 39 of 45 cases (86.6%) and overestimated it in 5 cases (11.1%). Only 1 case with deep infiltration was underestimated by IEVHS as invasion of less than one half of the myometrium. Frozen section correctly identified depth of MI in 41 of 46 cases (91.1%), overestimated it in 1 case (2.2%), and underestimated it in 3 cases (6.6%). The sensitivity, specificity, positive predictive value, and negative predictive value of IEVHS and FS for assessment of deep MI were 87.5%, 86.4%, 58.3%, and 96.9%, and 62.5%, 97.3%, 83.3%, and 92.3%, respectively.ConclusionsIntraoperative ex vivo high-resolution sonography is a novel technique for assessing MI in EC. Its high sensitivity for deep MI could be useful as an adjunct to FS (enabling pathologists to obtain targeted FS slices) and could improve the accuracy of FS.

Download Full-text

O69: THE SENTINEL LYMPH NODE TECHNIQUE IN THE ENDOMETRIAL CANCER

British Journal of Surgery ◽

10.1093/bjs/znab117.069 ◽

2021 ◽

Vol 108 (Supplement_1) ◽

Author(s):

H Bouaziz ◽

S Sghaier ◽

M Slimane ◽

L Zabaar ◽

H Bouzaiene ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Predictive Value ◽

Gynecological Cancer ◽

Myometrial Invasion ◽

Pelvic Mri ◽

Patent Blue ◽

Paraaortic Lymphadenectomy ◽

Medicine Physician

Abstract Introduction The sentinel lymph node (SLN) concept represents advancement in the management of the endometrial cancer (EC). We aim to assess the performance of the SLN procedure; its positive predictive value (PPV) and negative predictive value (NPV); in stage I of EC (FIGO2009). Method A prospective study is conducted in our institution. We perform a double detection of the SLN (radiolabel Tc 99 microsulfur colloid and a color method using patent blue) followed by pelvic lymphadenectomy with or without paraaortic lymphadenectomy. A pelvic MRI is performed to determine myometrial invasion and nodal status. The injection of Tc 99m colloid occurs the day prior to surgery. The injection into the stroma of the cervix at the 3 and 9 o'clock positions was performed by an oncologist surgeon with the assistance of a nuclear medicine physician. Preoperative lymphoscintigraphy was obtained after 90-120 minutes. We inject into the cervical stroma 2cc of patent blue similar to the Tc99 injection. A gamma detecting probe is used to locate radioactive lymph nodes. The SLNs identified then are labelled as radioactive and/or blue. No frozen-section analysis was performed. Results For the pathological analysis of the SLN, Haematoxylin Eosin is used. If there is no metastasis detected, an ultra staging protocol using different anti-cytokeratines is conducted. Studies have shown that this approach is possible having satisfactory results when conducted by dedicated surgical, radiology and pathology team. We look forward to our outcomes to illustrate those results. Take-home message Sentinel lymph node is a good alternative for gynecological cancer

Download Full-text

Intraoperative Gross Examination and Intraoperative Frozen Section in Patients With Endometrial Cancer for Detecting Deep Myometrial Invasion

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000618 ◽

2016 ◽

Vol 26 (2) ◽

pp. 407-415 ◽

Cited By ~ 14

Author(s):

Juan Luis Alcazar ◽

Jaime Dominguez-Piriz ◽

Leire Juez ◽

Maria Caparros ◽

Matias Jurado

Keyword(s):

Endometrial Cancer ◽

Frozen Section ◽

Myometrial Invasion ◽

Intraoperative Frozen Section ◽

Deep Myometrial Invasion ◽

Gross Examination

Download Full-text

Preoperative and intraoperative assesment of myometrial invasion and histological grade in endometrial cancer: Role of MRI and frozen section

10.1055/s-0039-1685336 ◽

2016 ◽

Author(s):

Rohit Raghunath Ranade

Keyword(s):

Endometrial Cancer ◽

Tumor Size ◽

Early Stage ◽

Frozen Section ◽

Myometrial Invasion ◽

Tumor Grade ◽

Endometrial Biopsy ◽

Intraoperative Frozen Section ◽

Cervical Involvement

Introduction: The role of systematic lymphadenectomy in clinically early stage endometrial cancer is controversial. A number of factors can predict lymph node metastasis including myometrial invasion, tumor grade in endometrial cancers. The purpose of the present study is to evaluate the accuracy of preoperative MRI and intraoperative frozen section in determining the depth of myometrial invasion, cervical involvement, tumor size and lymph nodal status. We also studied the accuracy of preoperative endometrial biopsy and intraoperative frozen section in determining the grade of the tumor. Materials and Methods: Medical records of 235 consecutive cases of clinically early stage endometrial cancer were reviewed retrospectively. A record of depth of myometrial invasion, tumor size, cervical involvement and presence of enlarged lymph nodes was made on a preoperative MRI. Similarly depth of myometrial invasion, tumor size, cervical involvement and grade of the tumor were recorded on an intraoperative frozen section. The grade of the tumor was also recorded on a preoperative endometrial biopsy. Standard statistical calculations were used. Results: The sensitivity and specificity of MRI for myometrial invasion for the first 160 cases were 81.3 and 75%, respectively while that for frozen section were 80 and 96.2%, respectively. For tumor grade the sensitivity and specificity of preoperative endometrial biopsy were 60 and 95.6%, respectively while that of frozen section were 53.8 and 97.6%, respectively. For cervical involvement the sensitivity of MRI and frozen section was 62.5 and 98.4%, respectively. Updated results of the entire cohort of 235 cases will be presented at the conference if selected. Conclusion: Although the sensitivity of both frozen section and MRI for predicting deep myometrial invasion was similar (80 vs 81.3%) but the specificity (96.2 vs 75%) and negative predictive value (92.7 vs 88.2%) of frozen section were superior to MRI. Both preoperative biopsy and intraoperative frozen section had low sensitivity (60 vs 53.8%) for detecting a high grade lesion.

Download Full-text

EVALUATION OF MYOMETRIAL INVASION AND CERVICAL INVOLVEMENT IN TYPE I ENDOMETRIAL CANCER USING DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING

International Journal of Applied Pharmaceutics ◽

10.22159/ijap.2020.v12s3.39452 ◽

2020 ◽

pp. 4-6

Author(s):

HARIYONO WINARTO ◽

BRIAN PRIMA ARTHA ◽

SAHAT B. MATONDANG ◽

TANTRI HELLYANTI ◽

ARIA KEKALIH

Keyword(s):

Magnetic Resonance Imaging ◽

Endometrial Cancer ◽

Magnetic Resonance ◽

Cancer Patients ◽

Myometrial Invasion ◽

Type I ◽

Resonance Imaging ◽

Diffusion Weighted ◽

Weighted Magnetic Resonance Imaging ◽

Cervical Involvement

Objective: Surgical procedure and adjuvant treatment of type I endometrial cancer were affected by some variables assessed preoperatively. Diffusion-weighted magnetic resonance imaging (DWI) is a promising modality in evaluating myometrial invasion and cervical involvement, investigating the diagnostic values of DWI in assessing myometrial invasion and cervical involvement. Methods: A cross-sectional study was conducted. This study involved all type I endometrial cancer patients in Dr. Cipto Mangunkusumo Hospital from April 2016 until April 2019. The depth of myometrial invasion and cervical involvement was examined using 1.5-T MR unit. The result was compared to the surgical pathologic findings as the reference standard. Results: 34 types I endometrial cancer patients were enrolled in this study. The sensitivity of DWI in evaluating myometrial invasion and cervical involvement in type I endometrial cancer was 94.12% and 57.14%, while the specificity was 64.71% and 92.59%, respectively. Conclusion: DWI can provide reliable prognostic variable information about the myometrial invasion and cervical involvement in the preoperative preparation of endometrial cancer patients.

Download Full-text

Assessment of the Role of Intraoperative Frozen Section in Guiding Surgical Staging for Endometrial Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000692 ◽

2016 ◽

Vol 26 (5) ◽

pp. 918-923 ◽

Cited By ~ 7

Author(s):

Xiaoyuan Wang ◽

Li Li ◽

Janiel M. Cragun ◽

Setsuko K. Chambers ◽

Kenneth D. Hatch ◽

...

Keyword(s):

Risk Factors ◽

Endometrial Cancer ◽

Tumor Size ◽

Frozen Section ◽

Medical Center ◽

Myometrial Invasion ◽

Surgical Staging ◽

Endometrioid Adenocarcinoma ◽

Intraoperative Frozen Section

ObjectiveThe aim of this study was to assess the role of intraoperative frozen section (FS) in guiding decision making for surgical staging of endometrioid endometrial cancer (EC).MethodsMedical records were collected retrospectively on 112 patients with endometrioid EC, who underwent total hysterectomy and bilateral salpingo-oophorectomy at the University of Arizona Medical Center from January 1, 2010, to December 31, 2014. Only patients with endometrioid adenocarcinoma, grade 1, less than 50% myometrial invasion, and tumor size less than 2 cm determined by intraoperative FS omitted lymphadenectomy; otherwise, surgical staging was performed with lymph node dissection. The FS results were compared with the permanent paraffin sections (PSs) to assess the diagnostic accuracy.ResultsThe concordance rate of different variables between FS and PS in EC was 100%, 89.3% (100/112), 97.3% (109/112), and 95.5% (107/112), respectively, with respecting to histological subtype, grade, myometrial invasion, and tumor size. Diagnostic accurate rate of combined risk factors deciding surgical staging at the time of FS was 95.5% (107/112), and the discordance rate of all risk factors considered between FS and PS was 4.5%, resulting 3 cases (2.7%) undertreated and 2 cases (1.8%) overtreated.ConclusionsDespite nonideal FS evaluation, intraoperative FS diagnosis for EC is highly reliable by providing guidance for the intraoperative decisions of surgical staging at our institution, and such guidelines may be referenced by the institutions with sufficient gynecologic pathology expertise.

Download Full-text

Diagnostic Accuracy of Magnetic Resonance Imaging in Endometrial Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e3182571490 ◽

2012 ◽

Vol 22 (6) ◽

pp. 1020-1025 ◽

Cited By ~ 11

Author(s):

Mark H. McComiskey ◽

W. Glenn McCluggage ◽

Arthur Grey ◽

Ian Harley ◽

Stephen Dobbs ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Endometrial Cancer ◽

Magnetic Resonance ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Myometrial Invasion ◽

Preoperative Assessment ◽

Tumor Board ◽

Resonance Imaging ◽

Outer Half

ObjectivesThe objectives of this study were to investigate the accuracy of magnetic resonance imaging (MRI) in predicting the depth of myometrial invasion in the preoperative assessment of women with endometrial cancer and to quantify the impact of MRI as an adjunct to predicting patients requiring full surgical staging.MethodsThis was a diagnostic accuracy study of prospective cases in conjunction with STARD guidelines using collected data from a tumor board within a cancer network. Consecutive series of all endometrial cancers in Northern Ireland over a 21-month period was discussed at the Gynaecological Oncology Multidisciplinary Team/tumor board meeting. This study concerns 183 women who met all the inclusion criteria. Main outcome measure was the correlation between the depth of myometrial invasion suggested by preoperative MRI study and the subsequent histopathological findings following examination of the hysterectomy specimen. Secondary end point was how MRI changed management of women who required surgery to be performed at a central cancer center.ResultsFor the detection of outer-half myometrial invasion, overall sensitivity of MRI was 0.73 (95% confidence interval [CI], 0.59–0.83), and specificity was 0.83 (95% CI, 0.76–0.89). The positive predictive value was 0.63 (95% CI, 0.50–0.74), and negative predictive value was 0.89 (95% CI, 0.82–0.93). Positive likelihood ratio was 4.35 (95% CI, 2.87–6.61), and negative likelihood ratio was 0.33 (95% CI, 0.21–0.52). Magnetic resonance imaging improved the sensitivity and negative predictive value of endometrial biopsy alone in predicting women with endometrial cancer who require full surgical staging (0.73 vs 0.65 and 0.80 vs 0.78, respectively).ConclusionsPreoperative pelvic MRI is a moderately sensitive and specific method of identifying invasion to the outer half of myometrium in endometrial cancer. Addition of MRI to preoperative assessment leads to improved preoperative assessment, triage, and treatment.

Download Full-text

A Quick and Inexpensive Alternative to Frozen Section for Diagnosing Myometrial Invasion in Endometrial Cancer

Journal of Gynecologic Surgery ◽

10.1089/gyn.2017.0084 ◽

2018 ◽

Vol 34 (2) ◽

pp. 84-88

Author(s):

Alexander F. Burnett ◽

Rebecca L. Stone ◽

Mathew A. Jeffreys ◽

Kristin K. Zorn ◽

C. Mathew Quick

Keyword(s):

Endometrial Cancer ◽

Frozen Section ◽

Myometrial Invasion

Download Full-text

No Association Between Statin Use and the Prognosis of Endometrial Cancer in Women With Type 2 Diabetes

Frontiers in Pharmacology ◽

10.3389/fphar.2021.621180 ◽

2021 ◽

Vol 12 ◽

Author(s):

Elina Urpilainen ◽

Anne Ahtikoski ◽

Reetta Arima ◽

Ulla Puistola ◽

Peeter Karihtala

Keyword(s):

Type 2 Diabetes ◽

Endometrial Cancer ◽

Cancer Diagnosis ◽

Progression Free Survival ◽

Epidemiological Studies ◽

University Hospital ◽

Type I ◽

Statin Use

Preclinical studies have suggested statins have antiproliferative and anti-metastatic effects on endometrial cancer cells. Similarly, most previous epidemiological studies have reported a better prognosis of endometrial cancer in patients who used statins. In this study, we explored the role of statins in the prognosis of endometrial cancer in women with type 2 diabetes in a hospital-based cohort. This retrospective cohort consisted of 119 women with type 2 diabetes who were diagnosed and treated for endometrial cancer at Oulu University Hospital, Finland, between 2007 and 2014. The patients were classified as statin users (n = 58) and nonusers (n = 61) based on the type of medication they were using at the time of endometrial cancer diagnosis. Statin use showed no association with progression-free survival or overall survival in the whole cohort nor the subgroups with type I or type II histology, in lower or higher body mass index groups, or at an early or advanced stage. The results remained similar in the multivariate analysis after adjusting for the patient’s age, cancer stage, and histology. Furthermore, statin use seemed not to have any association with most of the prognostic factors at the time of endometrial cancer diagnosis.

Download Full-text