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

2016 ◽  
Vol 26 (5) ◽  
pp. 918-923 ◽  
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.

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

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.

scholarly journals Possible Risk Factors of Pulmonary Metastases in Patients With International Federation of Gynecology and Obstetrics Stage I Endometrioid-Type Endometrial Cancer

2017 ◽  
Vol 27 (6) ◽  
pp. 1206-1215 ◽  
Author(s):  
Wei Jiang ◽  
Jun Chen ◽  
Xiang Tao ◽  
Feifei Huang ◽  
Menghan Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
Tumor Size ◽  
Gene Mutations ◽  
Myometrial Invasion ◽  
Epithelial Differentiation ◽  
Stage I ◽  
Primary Tumors ◽  
Significant Difference ◽  
Deep Myometrial Invasion

ObjectiveLimited data have been obtained in regard to pulmonary metastasis (PM) in patients with stage I endometrial cancer. The aims of the study were (1) to present the clinical and pathological characteristics of patients with PM in the setting of stage I endometrioid-type endometrial cancer (EEC) and (2) to define possible factors that may be used to predict PM.MethodsSix hundred thirty patients with stage I EEC, including 12 with PM, 19 with extra-PM (EPM), and 599 with no recurrence, were observed. Paired samples of primary and metastatic tumors from a patient were used for exome sequencing to identify potential gene mutations associated with PM.ResultsThere was no significant difference in the age, Ki-67, lymphatic vascular space invasion, and grade 3 among the 3 groups (P > 0.05). More squamous epithelial differentiation was observed in PM (7/12), as compared with patients with EPM (1/19) (P < 0.05) and no recurrence (20/599) (P < 0.05). The tumor size of the patients with PM was bigger than that of nonrecurrent patients (29.8 ± 16.6 vs 18.5 ± 16.3 mm, P < 0.05). More percentage of patients with deep myometrial invasion (IB) were found in PM (6/12) (P < 0.05) as compared with patients with EPM (3/19) (P < 0.05) and no recurrence (76/599). CDH10, ARID1A, and EMT-associated gene mutations were identified in metastatic tumor tissue but not in primary tumors from a patient with EEC and lung metastases.ConclusionsSquamous epithelial differentiation, large tumor size, and deep myometrial invasion might be risk factors for PM in patients with stage I EEC. CDH10, ARID1A, and EMT-associated gene mutation may promote the initiation of lung recurrence. However, further studies are needed to determine the precise mechanisms associated with lung metastasis in these patients.

scholarly journals The Role of Frozen Section in Surgical Staging of Low Risk Endometrial Cancer

PLoS ONE ◽  
2011 ◽  
Vol 6 (9) ◽  
pp. e21912 ◽  
Author(s):  
Sanjeev Kumar ◽  
Sudeshna Bandyopadhyay ◽  
Assaad Semaan ◽  
Jay P. Shah ◽  
Haider Mahdi ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Frozen Section ◽  
Low Risk ◽  
Surgical Staging

Role of Laparoscopic Surgery in the Management of Endometrial Cancer

2009 ◽  
Vol 7 (5) ◽  
pp. 559-567 ◽  
Author(s):  
Meaghan Tenney ◽  
Joan L. Walker
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
Laparoscopic Surgery ◽  
Metastatic Disease ◽  
Frozen Section ◽  
Error Rates ◽  
Adverse Outcomes ◽  
Surgical Staging ◽  
Medical Decision ◽  
Metastatic Sites

Minimum surgical treatment for endometrial cancer is removal of the uterus. The operative approach to achieve that goal ranges from vaginal hysterectomy alone to laparotomy with radical hysterectomy, bilateral salpingoophorectomy, bilateral pelvic and para-aortic lymphadenectomy with possible omentectomy, and resection of all metastatic disease. Stratifying the risk factors for predicting presence of metastatic disease has error rates exceeding tolerance for many gynecologic oncologists. Most accept routine laparoscopic surgical staging with hysterectomy, pelvic and para-aortic lymphadenectomy, and removal of adnexa as standard care for patients with endometrial cancer. Modifying the extent of surgical staging for low-risk intrauterine findings or excessive risk for postoperative morbidity is also accepted. Laparoscopic surgery has become the ideal initial surgical approach for this disease, allowing for visual inspection of common metastatic sites, biopsy of abnormal areas, and cytology from peritoneal surfaces. The extent of staging can be altered depending on frozen section findings from the uterus, adnexa, and peritoneal surfaces. Intraoperative medical decision-making can be individualized, encompassing all known risk factors for metastases and balancing comorbidities and potential adverse outcomes. This article documents how laparoscopic surgery satisfies the needs of individual patients and surgeons treating this disease.

Sign in / Sign up

Export Citation Format

Share Document