A Prospective Blinded Evaluation of the Accuracy of Frozen Section for the Surgical Management of Endometrial Cancer

Case, Ashley S.; Straughn, J. Michael; Rocconi, Rodney P.; Huh, Warner K.

doi:10.1097/01.aog.0000257891.29611.32

Cited by 33 publications

(44 citation statements)

References 6 publications

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“…The method and extent of lymph node dissection (LND) have not been uniformly defined, and whether LND should be performed or not in EC patients remains controversial even among experts (Creasman et al, 1987;Case et al, 2006;Chan and Kapp 2007;Chi et al, 2008;Neubauer and Lurain 2011;Wilairat et al, 2012). It is not yet clearly known if LND should be performed in all patients (Case et al, 2006;Chi et al 2008), or if it is unnecessary in early stages of the disease (Mariani et al, 2000;Zuurendonk et al, 2006;Benedetti et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Lymph Node Metastases with Endometrial Carcinoma

Çetinkaya¹,

Atalay²,

Bacinoglu³

2014

Asian Pacific Journal of Cancer Prevention

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Background: The purpose of this study was to investigate and evaluate risk factors for lymph node metastases (LNM) in cases of endometrial cancer (EC). Materials and Methods: A retrospective single institution analysis of patients surgically staged for EC at Ankara Oncology Education and Research Hospital from 1996 to 2010 was performed. Roles of prognostic factors, such as age, histological type, grade, depth of myometrial invasion, cervical involvement, peritoneal cytology, and tumor size, in the prediction of LNM were evaluated. Fisher's exact test and logistic regression analysis were used to assess the effects of various factors on LNM. Results: LNM was observed in 22 out of 247 patients (8.9%) and was significantly more common in the presence of tumors of higher grade, deep myometrial invasion (DMI), cervical involvement, size >2cm, and with positive peritoneal cytology. Logistic regression analysis revealed that DMI remained the only independent risk factor for LNM. NPV, PPV, sensitivity, and specificity for satisfying LNM risk were 98.0, 19.5, 86.3, and 65.3%, respectively for DMI. Conclusions: The incidence of LNM is influenced independently by DMI. If data support a conclusion of DMI, LND should be seriously considered.

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Section: Introductionmentioning

confidence: 99%

Risk Factors of Lymph Node Metastases with Endometrial Carcinoma

Çetinkaya¹,

Atalay²,

Bacinoglu³

2014

Asian Pacific Journal of Cancer Prevention

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“…In that case, the frozen-section analysis missed high-risk endometrial cancer due to misinterpretation of the depth of myometrial invasion. Intraoperative assessment of myometrial invasion in endometrial cancer has already been reported as a debatable subject and such an assessment is congruent with the final diagnosis in approximately 70% of patients (28,29). Combination of preoperative magnetic resonance imaging and intraoperative frozen-section may help overcome this issue with added costs (30).…”

Section: Discussionmentioning

confidence: 99%

The role of frozen-section in the surgical management of patients with endometrial intraepithelial neoplasia

Salman¹,

Başaran²,

Usubütün³

et al. 2015

TJPATH

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Objective: Patients with endometrial intraepithelial neoplasia may have concurrent endometrial cancer if managed surgically or develop cancer in time if managed conservatively. Therefore, intraoperative assessment of the uterus may be helpful if a surgical approach is decided on. Our study aimed to investigate the role of frozen-section examination in patients with endometrial intraepithelial neoplasia. Material and Method:Patients with endometrial intraepithelial neoplasia who were subjected to hysterectomy with intraoperative frozen-section assessment were included. Main outcome measures were the rates of concurrent endometrial cancer and concurrent high-risk endometrial cancer as well as the efficacy of frozen-section in the detection of concurrent invasive disease and in the designation of low-risk and high-risk features. Results:The study group consisted of seventy-three patients. Permanent pathology revealed endometrial adenocarcinoma in 19.2% whereas only one patient (1.4%) had high-risk disease necessitating surgical staging. Frozen-section diagnoses were consistent with final pathology in 93.2% of patients in terms of the presence or absence of co-existent carcinoma. When frozen-section reports were further evaluated in terms of the presence or absence of high-risk endometrial carcinoma, consistency with the final pathology was seen in 98.6% of patients. Conclusion:Co-existent endometrial cancer is not uncommon in endometrial intraepithelial neoplasia. Intraoperative frozen-section evaluation should therefore be considered whenever possible. Frozen-section is effective in the detection of coexistent invasive disease and in the designation of low-risk features. Although coexistent high-risk cancer is extremely rare, frozen-section assessment is not successful in determining high-risk features. Therefore, a re-staging surgery may be required on rare occasions.Key Words: Endometrial hyperplasia, Intraepithelial neoplasm, Endometrial cancer, Frozen-section ÖZ Amaç: Endometrial intraepitelyal neoplazi tanısı olan hastalarda cerrahi sonrasında eşzamanlı endometrial kanser saptanabilir veya konservatif tedavi yaklaşımında zaman içinde kanser gelişebilir. Bu nedenle cerrahi yaklaşım kararı verilmiş ise uterusun intraoperatif değerlendirilmesi yararlı olabilir. Çalışmamızda endometrial intraepitelyal neoplazi olan hastalarda frozen kesit incelemesinin rolünün araştırılması amaçlanmıştır. Gereç ve Yöntem:Çalışmaya histerektomi sırasında intraoperatif frozen kesit değerlendirmesi yapılan endometrial intraepitelyal neoplazi tanılı hastalar dahil edildi. Değerlendirilen sonuçlar içinde esas olarak eşzamanlı endometrium kanseri ve eşzamanlı yüksek riskli endometrial kanser oranları yanı sıra eşzamanlı invaziv hastalığın saptanmasında ve düşük-yüksek riskli özelliklerin belirlenmesinde frozen kesit incelemenin etkinliği yer aldı. Bulgular: Çalışma grubu 73 hastadan oluştu. Kalıcı kesitlerin incelenmesi sonucunda %19,2 oranında endometrial adenokarsinom saptanırken bu hastaların sadece bir tanesinde (%1,4) cerr...

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“…Neither imaging nor frozen section is very accurate for assessing the depth of myometrial invasion. In a recent study by Case et al, concordance between frozen and final pathology was noted only in 67% patients for depth of myometrial invasion and 58% patients for tumor grade (Case et al 2006). The sensitivity of MRI has similarly been found to be only 54%-75% in this regard (Hricak et al 1991;Nakao et al 2006).…”

Section: Surgical Staging and Related Issuesmentioning

confidence: 96%