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

Abstract

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...

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

“…Regarding the intraoperative gross and microscopic examination of the depth of myometrial invasion, it can be considered a relatively fast and accurate method, useful for identifying cancers at high risk for extrauterine metastases [17, 18]. With an 89.1% concordance rate between FS and PS regarding MI assessment, our study confirmed these results.…”

Correlation Between Frozen Section and Definitive Diagnosis in High-Risk Endometrial Carcinoma: Retrospective Analysis

“…1,4,[12][13][14] Karalok et al reported 5.9% of the cases with higher grade at the final diagnosis and 0.9% with a lower grade. 15 In our study, 7.7% of the cases had lower tumor grade and 15.5% had higher tumor grade at de-finitive diagnosis. Endometrioid carcinomas comprised 66.6% of these cases.…”

The Multifunctional Faces of T-Cell Intracellular Antigen 1 in Health and Disease

“…This involves transcriptional and post-transcriptional regulation of gene expression of immunesystem components and effector molecules (IL1-β, IL-6, IL-8 and TGF-β) [31,40,42,69,70,73] and of the vascular system, including early angiogenic targets, (i.e., PTGS/COX-2, VEGF and ELAVL1/HuR) [31,41,42,90]. In many cases, TIA1-mediated inflammatory responses have pathophysiological consequences associated with disorders such as arthritis, phagocytosis/autophagy, atherosclerosis, angiogenesis, neuroinflammation, obesity, myopathy, tauopathy and cancer [32,40,92,93,97,[128][129][130][131] (Figures 5 and 6). The pro-inflammatory cytokine TNF-α is a fundamental factor in the activation of proliferation and cytotoxicity, as well as in apoptosis.…”

“…TNF-α is transcriptionally and post-transcriptionally regulated by TIA1, among other RBPs [40,68,69]. TNF-α is involved in many inflammatory processes in the body, including food allergies, rheumatic diseases such as arthritis or lupus, incompatibility in transplantation or difficulties in operations, as well as endometriosis due to cytokine regulation of endometrial stem cells, where TIA1 shows a differential and cyclic concentration [97,129,131]. Additionally, a TIA1-associated neuronal inflammatory phenotype has been described in tauopathies in the P301S mouse model mediated by a cytotoxic process of the central nervous system via TNF-α, IL-6 and IL1-β [97].…”