Frozen section accurately allows pathological characterization of endometrial cancer in patients with a preoperative ambiguous or inconclusive diagnoses: our experience

Abstract

BackgroundThe aim of this study was to assess the agreement rate between intraoperative evaluation (IOE) and final diagnosis (FD) in a series of surgically resected endometrial carcinoma (EC), with a preoperative ambiguous or inconclusive diagnosis by endometrial biopsies and imaging.MethodsA retrospective study was performed selecting patients who underwent surgery with IOE for suspected EC at our institution from 2012 to 2018. A K coefficient was determined with respect to the histotype, tumor grade, myometrial infiltration and cervical involvement.ResultsData analysis has been performed on 202 women. The IOE evaluation was distributed as Endometrioid (n = 180) and Non-Endometrioid (n = 22). The comparison between the frozen section (FS) and the definitive histological subtype showed an overall agreement rate of 93,07% (k = 0.612) and an agreement of 97.2% for Endometrioid vs 59% for Non-Endometrioid tumors. The FIGO system grading was the same in 91,1% of patients, none was upgraded and in 8,9% downgraded. Observed agreements were 89,11% and 95,54% for myometrial and cervical involvement, respectively.ConclusionsThe good agreement between intraoperative grading, myometrial invasion and their histological definition on permanent sections highlights that FS is a good predictor for surgical outcome, in particular in presence of a preoperative ambiguous or inconclusive diagnostic evaluation.

An Analysis of Clinical, Surgical, Pathological and Molecular Characteristics of Endometrial Cancer According to Mismatch Repair Status. A Multidisciplinary Approach

“…The analysis showed that in all groups pre-operative biopsy had a good correspondence with final histology and grade and FS was superimposable to final histology for both parameters ( Table 4 ). This correspondence is conserved also in LS patients even if literature reports evidences about the heterogeneity of EC and this may lead to a greater difficulty in histopathological diagnosis, especially in pre-operative biopsies [ 45 , 46 ]. Our data implies the possibility to correctly assess pre-operative/intra-operative risk also in LS group.…”

New Pathological and Clinical Insights in Endometrial Cancer in View of the Updated ESGO/ESTRO/ESP Guidelines

“…There is frequently an overlap between histologic subtypes and grade determination complicating clinical decision making. Therefore, interobserver diagnostic agreement is still suboptimal, particularly among the high-grade histotypes and in frozen section specimens [ 10 , 11 ]. In 2013, The Cancer Genome Atlas (TCGA) Research Network reported a large scale, integrated genomic, transcriptomic, and proteomic analysis of 373 endometrial carcinomas, including 307 EECs, 53 SECs, and 13 mixed cases.…”

Diagnostic Pitfalls Related to Morular Metaplasia in Endometrioid Carcinoma: An Underestimated Issue

“…In fact, in young women who wish to preserve their fertility, a diagnosis of high-grade carcinoma on biopsy specimen precludes the possibility of a conservative management [15]. In the intraoperative assessment of frozen sections, a misdiagnosis of high-grade carcinoma may lead to unnecessary lymphadenectomy with related complications [16]. In the case of FIGO stage I on the final hysterectomy specimen, such pitfall may lead to unnecessary adjuvant treatment [15].…”