Accuracy of Intraoperative Frozen-Section Diagnosis in Stage I Endometrial Adenocarcinoma

Kucera, E; Kainz, Ch.; Reinthaller, Alexander; Sliutz, Gerhard; Leodolter, Sepp; Kucera, H; Breitenecker, G.

doi:10.1159/000010215

Cited by 78 publications

(50 citation statements)

References 14 publications

(25 reference statements)

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“…The accuracy rate of grade that is detected with probe curettage in accordance with the results of paraffin blocks ranges between 36%-96% (2,(23)(24)(25). Intraoperatively, grade could be defined with an accuracy of 58%-98%; with FS, according to postoperative pathology, these rates for DMI and cervical invasion are 54%-95% and 95%, respectively (26)(27)(28)(29)(30)(31)(32)(33)(34). In contrast, others argue that FS could not predict lymphatic spread well, meaning that all patients with endometrium cancer should be staged systematically (27).…”

Section: Introductionmentioning

confidence: 99%

Prediction of staging with preoperative parameters and frozen/section in patients with a preoperative diagnosis of grade 1 endometrioid tumor in endometrial cancer

Karalök¹,

Üreyen²,

Reis³

et al. 2014

J Turkish German Gynecol Assoc

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Objective:To investigate the likelihood of the detection of the necessity of staging preoperatively with the use of clinical parameters and frozen/ section (FS). Material and Methods:219 patients were included who were operated on between 1996 and 2010 with a diagnosis of grade 1 endometrioid adenocarcinoma in probe curettage. Results:Among the clinical characteristics, only age and body mass index (BMI) predicted staging preoperatively. The probability of staging increased as age increased and BMI decreased. The concordance between preoperative diagnosis and FS was 89.5%. The diagnosis was upgraded at postoperative evaluation for 13 patients (5.9%), and downgraded for 2 patients (0.9%) compared with FS. The wrong diagnosis regarding grade, the depth of myometrial invasion DMI, tumour type and cervical invasion in FS was clinically significant and affected the decision of staging in 10 patients. In conclusion, only 7 patients (3.2%) who acquired staging surgery were missed in FS. Conclusion:It was shown that preoperative clinical parameters could not effectively predict the patients who should be staged. FS predicted the lymphatic involvement with high accuracy. The patient with a preoperative diagnosis of grade 1 endometrium cancer should be operated upon in centres where FS is utilised and oncologic staging surgery can be performed. (J Turk Ger Gynecol Assoc 2014; 15: 41-8) Key words: Endometrial cancer, body mass index, age, frozen/section, staging Received: 19 July, 2013 Accepted: 20 September, 2013 Available Online Date: 30 January, 2014 Original Investigation 41 IntroductionEndometrium cancer is usually diagnosed at an early stage (1). It is still controversial whether routine lymphadenectomy should be involved in surgical staging of this tumour that has been staged surgically in accordance with the guidelines of FIGO (International Federation of Gynecology and Obstetrics) since 1988. Some authors suggested routine lymphadenectomy in order to define lymphatic spread and to improve survival (2, 3). Nevertheless, it was shown that lymphadenectomy in addition to total abdominal hysterectomy and bilateral salpingo-oophorectomy in patients with early stage endometrium cancer did not improve survival (4, 5). Additionally, pelvic and para-aortic lymphadenectomy increases surgical morbidity (6, 7). Therefore, it is clear that performing lymphadenectomy for all of the patients with endometrium cancer will cause overtreatment and an increase in morbidity.Determination of the risk factors that may indicate lymphatic spread in endometrium cancer and performing lymphadenectomy for patients with these risk factors will be an appropriate option. These risk factors are tumour type, cervical involvement, grade and depth of myometrial invasion (DMI) (8-12). These factors could be defined intraoperatively with frozen/section (FS). Preoperatively, age, body mass index (BMI), serum Ca-125, haemoglobin and platelet levels could be utilised as risk factors for lymphatic metastasis. Age is associated with advanced disea...

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Section: Introductionmentioning

confidence: 99%

Prediction of staging with preoperative parameters and frozen/section in patients with a preoperative diagnosis of grade 1 endometrioid tumor in endometrial cancer

Karalök¹,

Üreyen²,

Reis³

et al. 2014

J Turkish German Gynecol Assoc

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“…Intraoperative evaluation of the hysterectomy specimen by frozen-section in women with endometrioid type endometrial cancer has been shown to successfully reveal tumor characteristics including grade, size and depth of myometrial invasion. The extent of surgery may be decided accordingly (15,16). The same principle may be adapted into the surgical management of patients with EIn.…”

Section: Discussionmentioning

confidence: 99%

“…A decision to proceed with staging at the time of surgery depends on the presence and depth of myometrial invasion, the grade of disease, and the diameter of the tumor (14). Frozen-section examination was used in several studies to accurately reveal such tumor characteristics and therefore guide the extent of surgery in patients with endometrioid type endometrial carcinoma (15,16). However, very little data exists in the literature regarding the performance of intraoperative frozen-section consultation in women with endometrial precancers (4).…”

Section: Introductionmentioning

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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“…[27][28][29][30][31][32][33][34] Routine MRI scanning of all patients with AEH to identify those patients with deep myometrial invasion would have such a low yield that it would not be cost-effective. In our review, only 6% of patients would have benefited from such an approach.…”

Section: Discussionmentioning

confidence: 99%

“…29,30 Concurrent use of frozen section analysis can further enhance intraoperative risk determination in patients with endometrial cancer. [31][32][33][34] However, in a review of 23 patients, only four of 11 patients found to have concurrent EC were identified by frozen section assessment. 31 The limitations of our study arise from the relatively small number of patients and the retrospective collection of data.…”

Section: Discussionmentioning

confidence: 99%

Significance of Concurrent Endometrial Cancer in Women With a Preoperative Diagnosis of Atypical Endometrial Hyperplasia

Giede

Yen

Chibbar

et al. 2008

Journal of Obstetrics and Gynaecology Canada

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Objectives-Our objectives were (1) to review the rate of concurrent endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia (AEH); (2) to determine the proportion of patients with concurrent endometrial cancer who have high-risk disease; and (3) to re-evaluate our surgical management of AEH.Methods-We performed a retrospective chart review of all patients who had surgery on the basis of a preoperative diagnosis of atypical endometrial hyperplasia between January 2001 and December 2006. Demographic data, the method of preoperative diagnosis, postoperative grade of tumour, and other postoperative findings were recorded. When applicable, this included cancer stage, lymph node status, and presence of lymphovascular space invasion. In postoperative review, patients were considered to be high risk if they had disease beyond the uterus or a combination of other risk factors.Results-Of 70 patients, 25 (35.7%) were found to have concurrent endometrial cancer. This was higher than the commonly accepted rate of 25% (P = 0.03). Of the 25 patients upgraded, 4 (16%) had high-risk cancer on final pathologic evaluation.Conclusion-Simple hysterectomy in women with AEH may result in inadequate surgical management. Simple methods are required to identify patients with a preoperative diagnosis of AEH who may harbour significant cancers.

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Accuracy of Intraoperative Frozen-Section Diagnosis in Stage I Endometrial Adenocarcinoma

Cited by 78 publications

References 14 publications

Prediction of staging with preoperative parameters and frozen/section in patients with a preoperative diagnosis of grade 1 endometrioid tumor in endometrial cancer

Prediction of staging with preoperative parameters and frozen/section in patients with a preoperative diagnosis of grade 1 endometrioid tumor in endometrial cancer

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

Significance of Concurrent Endometrial Cancer in Women With a Preoperative Diagnosis of Atypical Endometrial Hyperplasia

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