The Guidance of Intraoperative Frozen Section For Staging Surgery in Endometrial Carcinoma

Abstract

The objective of this study was to evaluate the reliability of an intraoperative frozen section during the endometrial carcinoma staging surgery procedure. The paraffin section reports of 291 cases with endometrial carcinoma were compared with intraoperative frozen section reports, which were diagnosed in the Pathology Department of Cukurova University, Medical Faculty between June 2006 and December 2012. The reports were reviewed for diagnostic accuracy of the frozen section in terms of histological subtype, grade, and myometrial invasion. Concordance values between frozen and paraffin section reports were 86, 84.3, and 91.6% for histological subtype, grade, and myometrial invasion, respectively. When collectively evaluated, two (0.7%) of 291 patients were inappropriately operated on due to frozen section reports. Intraoperative frozen section is a reliable guide for surgeons to evaluate the risk group of patients with endometrial cancer and prevent an unnecessary staging surgery operation.

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

“…One of the 5 studies used IGE 22 and 4 studies used IFS. 14,24,41,43 This number is too small to perform a meaningful meta-analysis. However, considering the 4 studies using IFS, pooled sensitivity, specificity, LR+, and LRj were 83% (95% CI, 73%Y90%), 97% (95% CI, 95%Y99%), 30.2 (95% CI, 15.6Y58.7), and 0.17 (95% CI, 0.11Y0.29), respectively.…”

“…Only 5 studies specifically described that high-risk patients (serous carcinoma, clear cells, carcinosarcoma, or undifferentiated carcinoma) were excluded, one using IGE 22 and 4 using IFS. 14,24,41,43 For the domain ''Index test'', in 26 of the 35 studies, index test was adequately described in 11 of 14 for studies using IGE and in 15 of 21 for studies using IFS. 9Y12,15Y23, 25Y30,32,33,35Y43 For the domain ''Reference standard'', in all studies, reference standard was final histopathology, which is correct, but only one described in detail how this was done.…”

“…Seven studies also included women with preoperative diagnosis of endometrial hyperplasia with atypia. 21,25,31,35,39,41,43 In 14 studies, IGE was the method used, 9,11,12,15,17Y20,22, 23,28,31,34,38 whereas IFS was used in 21 studies. 10,13,14,16,21, 24Y27,29,30,32,33,35Y37,39Y43 No single study used both methods.…”

Diagnostic performance of intraoperative assessment in grade 2 endometrioid endometrial carcinoma

“…In our study, the IOA had a 76% concordance rate with the final pathology report, with the best overall predictor being myometrial invasion. Studies have found myometrial invasion to be a good predictor of node metastasis, with a sensitivity as high as 86% [ 7 ]. Our overall accuracy for myometrial invasion was 82%.…”

“…If the intraoperative assessment (IOA) shows high-risk factors, complete surgical staging is recommended [ 6 ]. That is, as pelvic and paraaortic lymphadenectomy procedures increase morbidity and the surgical time, they are not performed routinely [ 7 ]. Furthermore, the final pathology report can differ from intraoperative findings, and IOAs could lead to unnecessary surgeries in women with low-risk disease [ 8 ].…”