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.
Highlights
The 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
Our data indicated that from 180 lesions intraoperatively classified as Endometrioid Cancer, 175 were confirmed in final surgical reports as Endometrioid adenocarcinoma (EA); the remaining 5 cases were Non-Endometrioid Carcinoma (NEC) that were intraoperatively misdiagnosed as EA G3, but this type of misdiagnoses did not impact the classification as ‘high-risk’ cancer
Of the 22 frozen section (FS) defined as NEC lesions, including serous cancer and clear cell carcinoma, 13 were confirmed in the same class
Summary
The 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. Information regarding tumoral grading and histotype can be obtained in most cases from preoperative diagnostic endometrial biopsies or curettage intraoperative pathological examination (IOE) increases the sensitivity and specificity for the patient risk classification and, plays a fundamental role in the evaluation of surgical decision [3,4,5]. Before being compared with the final result, the frozen endometrial tissue obtained during surgery provides an important prognostic tool for the prediction of the final diagnosis as well as for the decision of final extended surgical staging, identifying high riskpatients requiring pelvic/para-aortic lymphadenectomy. IOE is important for the evaluation of lymh-nodes status; the use of sentinel node, as intraoperative surgical staging tool, has been implemented in the last years in order to avoid staging lymphadenectomy in low-risk EC patients according to ‘Mayo criteria’ grade 1 or 2 disease, < 50% myometrial invasion, and tumor diameter < 2 cm) [6]. In high risk patients (endometrioid grade 3, clear cell, serous, and carcinosarcoma) the same procedure has no impact in the choice of adjuvant therapy and more studies are still needed to determine if SLN mapping could replace total lymphadenectomy [7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
