218 Role of frozen section in surgical staging of early – stage endometrial cancer: experience at hospital sotero del rio

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.

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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.

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Comparison of laparoscopy and laparotomy in surgical staging of clinical early stage endometrial cancer: A report of early experiences from Turkey

Journal of Obstetrics and Gynaecology ◽

10.3109/01443615.2012.696156 ◽

2012 ◽

Vol 32 (7) ◽

pp. 687-690 ◽

Cited By ~ 2

Author(s):

S. Taşkın ◽

M. Güngör ◽

D. Öztuna ◽

F. Ortaç

Keyword(s):

Endometrial Cancer ◽

Early Stage ◽

Surgical Staging ◽

Early Experiences ◽

Early Stage Endometrial Cancer

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Controversies in the Treatment of Early Stage Endometrial Carcinoma

Obstetrics and Gynecology International ◽

10.1155/2012/578490 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 16

Author(s):

Joshua Z. Press ◽

Walter H. Gotlieb

Keyword(s):

Endometrial Cancer ◽

Adjuvant Chemotherapy ◽

Early Stage ◽

Sentinel Lymph Node Mapping ◽

Optimal Management ◽

Lymph Node Mapping ◽

Randomized Controlled ◽

Extent Of Surgery ◽

Early Stage Endometrial Cancer

Despite the publication of numerous studies, including some multicentered randomized controlled trials, there continues to be vigorous debate regarding the optimal management of early stage endometrial cancer, including the extent of surgery and the role of adjuvant chemotherapy and radiation. Resolving these questions has become increasingly important in view of the increase of endometrial cancer, related to the aging population and the alarming incidence of obesity. Furthermore, there are more surgical challenges encountered when operating on elderly patients or on patients with increased BMI and the associated comorbidities, such as diabetes, hypertension, heart disease, and pulmonary dysfunction. This paper will focus on the advantages of minimally invasive surgery, the value of lymphadenectomy including sentinel lymph node mapping, and some of the current controversies surrounding adjuvant chemotherapy and radiation.

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