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Objectives:To examine the performance of preoperative magnetic resonance imaging (MRI) and intraoperative frozen sectioning in the assessment of myometrial invasion during the early stages of endometrial cancer. Material and methods:This retrospective study employed data from patients with endometrial cancer who were operated on between January 2013 and November 2018. Patients who underwent preoperative MRI and were of FIGO 2009 stage I were included in the study. Radiological staging and intraoperative staging by frozen sectioning were carried out. The data were analyzed to assess agreement of the overall results concerning myometrial invasion. Results:In total, 222 patients were enrolled. Their mean age was 58.3 ± 8.5 years. The accuracy of MRI for the detection of myometrial invasion was 88.7% and its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 91.6%, 82.1%, 92.2%, and 80.9%, respectively, with a kappa coefficient of 0.734 (95% confidence interval [CI], 0.684-0.784; p < 0.001). The accuracy of intraoperative frozen sectioning was 94.4%, and its sensitivity, specificity, PPV, and NPV were 97.7%, 85.7%, 94.7%, and 93.4%, respectively, with a kappa coefficient of 0.856 (95% CI, 0.812-0.900; p < 0.001). No significant difference in accuracy was observed between MRI and frozen sectioning (p = 0.057). MRI and frozen sectioning were sensitive for the detection of myometrial invasion, according to receiver operating curve analyses (areas under the curve, 0.869 and 0.917, respectively; p < 0.001). Conclusions:The assessment of myometrial invasion by preoperative MRI and intraoperative frozen sectioning during the early stages of endometrial carcinoma was highly accurate.

Aim To evaluate the effect of lymphadenectomy on surgical morbidity and survival in adult granulosa cell tumor (AGCT) of the ovary. Methods Patients who underwent surgical treatment for AGCT between January 1993 and January 2016 were identified. Data were collected for patient age, menopausal status, surgical staging, lymphadenectomy, postoperative complications (anemia, wound infection, incisional hernia), length of hospital stay, follow‐up duration, site and time for recurrence, management of recurrence and vital status. Histopathological records were also evaluated for number of cellular mitosis. Results Lymphadenectomy (pelvic–paraaortic) was performed in 53 (53%) of 98 patients. Decrease in postoperative hemoglobin level and increased wound infection and longer hospital stay were significantly higher in lymphadenectomy group (P = 0.003, 0.043 and <0.001, respectively). Tumor stage (HR 95% CI 14.9 [2.43–92.8]) and number of mitoses >5 (HR 95% CI 14.9 [2.43–92.8]) were significantly associated with recurrence (P = <0.001 and 0.02, respectively). Tumor stage was the only prognostic factor for predicting overall survival (HR 95% CI 8.47 [2.17–33.2]). Lymphadenectomy showed no effect on disease‐free survival and overall survival both in multivariate Cox regression analyses (P = 0.46 and 0.69, respectively). Disease‐free survival and overall survival were similar in lymphadenectomy and no lymphadenectomy groups (Log Rank P = 0.382, 0.741, respectively). Conclusion Lymphadenectomy had no improved effect on survival and had negative effect on surgical morbidity in patients with AGCT.

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Our study demonstrated that optimal cytoreduction, early-stage disease, and LVSI are the most significant factors affecting survival in women with SEOC.

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