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

Alcázar, Juan Luis; Dominguez-Piriz, Jaime; Juez, L.; Caparrós, María José Ribal; Jurado, M.

doi:10.1097/igc.0000000000000618

Cited by 38 publications

(35 citation statements)

References 38 publications

(29 reference statements)

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“…A recent meta‐analysis of 6387 women undergoing intraoperative evaluation of hysterectomy specimens compared intraoperative gross evaluation with intraoperative frozen section. Sensitivity was higher for frozen section compared with gross evaluation (85% vs 71%; P = .0008) as was specificity (97% vs 91%; P = .0021) . Although frozen section can take significantly longer (from 20 minutes to greater than an hour in some instances), final pathology is upgraded from preoperative endometrial biopsy or curettage specimen in >23% of patients undergoing hysterectomy, and this discrepancy may incorrectly influence a decision about staging lymphadenectomy .…”

Section: Therapy‐surgerymentioning

confidence: 99%

“…Sensitivity was higher for frozen section compared with gross evaluation (85% vs 71%; P = .0008) as was specificity (97% vs 91%; P = .0021). 50 Although frozen section can take significantly longer (from 20 minutes to greater than an hour in some instances), final pathology is upgraded from preoperative endometrial biopsy or curettage specimen in >23% of patients undergoing hysterectomy, and this discrepancy may incorrectly influence a decision about staging lymphadenectomy. 51 Frozen section is not perfect, with one study reporting accuracy of 88% for depth of MMI and 84% for grade, and clinically relevant upstaging from frozen section to final pathology in 18% of patients, although other studies have shown higher concordance.…”

Section: Individualized Lymphadenectomymentioning

confidence: 99%

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Current recommendations and recent progress in endometrial cancer

Brooks

Fleming

Lastra

et al. 2019

CA A Cancer J Clinicians

439

372

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Endometrial cancer is the most common gynecologic cancer in the United States, and its incidence is rising. Although there have been significant recent advances in our understanding of endometrial cancer biology, many aspects of treatment remain mired in controversy, including the role of surgical lymph node assessment and the selection of patients for adjuvant radiation or chemotherapy. For the subset of women with microsatellite‐instable, metastatic disease, anti– programmed cell death protein 1 immunotherapy (pembrolizumab) is now approved by the US Food and Drug Administration, and numerous trials are attempting to build on this early success.

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Section: Therapy‐surgerymentioning

confidence: 99%

Section: Individualized Lymphadenectomymentioning

confidence: 99%

Current recommendations and recent progress in endometrial cancer

Brooks

Fleming

Lastra

et al. 2019

CA A Cancer J Clinicians

439

372

View full text Add to dashboard Cite

show abstract

“…Intraoperative examination modalities for endometrial tumors have been evaluated previously [14]. Tumor assessment by frozen sectioning has been found to have greater importance than gross examination [15]. However, the accuracy of frozen sectioning can be low [16].…”

Section: Introductionmentioning

confidence: 99%

Can preoperative magnetic resonance imaging replace intraoperative frozen sectioning in the evaluation of myometrial invasion for early-stage endometrial carcinoma?

et al. 2019

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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.

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“…A meta‐analysis of 35 studies compared the diagnostic accuracies of IGE and IFSE in assessing the depth of MI in EC and revealed that IFSE was superior to IGE with respect to both sensitivity (85% vs 71%) and specificity (97% vs 91%). Another meta‐analysis of 16 studies found that the sensitivity, specificity, and accuracy of IGE were 75%, 92%, and 87%, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…IGE performed by a pathologist specialized in gynecological cancer helps detect patients at a high risk of lymph node metastasis. 12,23 A meta-analysis 24 Although some clinics have all the necessary resources for patient treatment, the increased demand for health services may lead to significant delays in the initiation of treatment, which in practice corresponds to a lack of access to these services. Several studies [29][30][31] have shown that delayed treatment initiation after the detection of EC is associated with lower overall survival (OS).…”

Section: Is Intraoperative Gross Examination (Ige) Performed By a Surmentioning

confidence: 99%

Brazilian Society of Surgical Oncology guidelines for surgical treatment of endometrial cancer in regions with limited resources

Ribeiro

Cintra

Barrozo

et al. 2019

Journal of Surgical Oncology

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Background Approximately 70% of cancer‐related deaths occur in low‐ and middle‐income countries. In addition to social and racial inequalities, treatment options in these countries are usually limited because of the lack of trained staff and equipment, limited patient access to health services, and a small number of clinical guidelines. Objectives The Brazilian Society of Surgical Oncology developed this guideline to address these barriers and guide physicians treating patients with endometrial cancer (EC) in regions with limited resources and few specialized centers. Methods The guideline was prepared from 10 January to 25 October 20192019 by a multidisciplinary team of 56 experts to discuss the main obstacles faced by EC patients in Brazil. Thirteen questions considered critical to the surgical treatment of these patients were defined. The questions were assigned to groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments for presentations in meetings, classified the level of evidence, and voted on the recommendations. Results For all questions including staging, fertility spearing treatment, genetic testing, sentinel lymph node use, surgical treatment, and other clinical relevant questions, major agreement was achieved by the participants, always using accessible alternatives. Conclusions It is possible to provide adequate treatment for most EC patients in resource‐limited areas, but the first option should be referral to specialized centers with more resources.

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

Abstract: Intraoperative frozen section has better diagnostic performance than intraoperative gross evaluation for the intraoperative diagnosis of deep myometrial invasion in patients with endometrial cancer.

Cited by 38 publications

References 38 publications

Current recommendations and recent progress in endometrial cancer

Current recommendations and recent progress in endometrial cancer

Can preoperative magnetic resonance imaging replace intraoperative frozen sectioning in the evaluation of myometrial invasion for early-stage endometrial carcinoma?

Brazilian Society of Surgical Oncology guidelines for surgical treatment of endometrial cancer in regions with limited resources

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