Abstract
BackgroundThe role of frozen section (FS) in intraoperative decision making for surgical staging of endometrial cancer is controversial. Objective of this study is to assess the agreement rate between the FS and paraffin section (PS); and the potential impact of the role of FS in the intra-operative decision making for the complete surgical staging in low risk endometrial cancer.MethodsThis is a retrospective analysis of patients diagnosed with intra-operative FS stage I, grade I or II endometrial cancer from 1995–2004. FS results were compared with final pathology results with regard to tumor grade, depth of myometrial invasion, cervical involvement, lymphovascular invasion, and lymph node involvement. Agreement statistic with kappa was calculated using SPSS statistical software. Categorical variables were tested using chi-square test with p value of ≤0.05 being statistically significant.ResultsOf the 457 patients with endometrial cancer, 146 were evaluated by intra-operative FS and met inclusion criteria. FS results were in disagreement with permanent section in 35% for the grade (kappa 0.58, p = 0.003), 28% for depth of myometrial invasion (kappa 0.61, p<0.0001), 13% for cervical involvement (kappa 0.78, p = 0.002), and 32% for lymphovascular invasion (kappa 0.6, p = 0.01). Permanent pathology upstaged 31.9% & 23.2% of FS stage IA, & IB specimen respectively. Lymph node dissection was done in 56.8%. Lymph node metastasis was identified in 8.4%. Use of intraoperative FS would have resulted in suboptimal surgical treatment in 13% stage IA and 6.6% of stage IB patients respectively by foregoing lymphadenectomy.ConclusionA significant number of patients with low risk endometrial cancer by FS were upstaged and upgraded on final pathology. Before placing absolute reliance on intraoperative FS to undertake complete surgical staging, the inherent limitation of the same in predicting final stage and grade highlighted by our data need to be carefully considered.
Highlights
Endometrial cancer is the most common gynecologic malignancy in the United States, with an estimated 43,400 new cases diagnosed and 8000 deaths annually [1]
Still others take an intermediate path and believe that only a small fraction of patients with low risk endometrial cancer may benefit from routine and comprehensive surgical staging including a lymphadenectomy and the rest may be adequately managed by routine hysterectomy with bilateral salpingooophorectomy [11]
A total of 457 cases of endometrial carcinoma were treated by hysterectomy during this study period at our institution of which 177 cases were evaluated for tumor grade and depth of myometrial invasion by intra-operative frozen section (FS)
Summary
Endometrial cancer is the most common gynecologic malignancy in the United States, with an estimated 43,400 new cases diagnosed and 8000 deaths annually [1]. It is important to find the agreement rate of the FS with respect to its prediction of the final pathology in the paradigm of the complete surgical staging of the low risk endometrial cancer. The literature on this issue so far is controversial with some suggesting FS to be reliable [12] [13] whereas others refuting the same [14]. Objective of this study is to assess the agreement rate between the FS and paraffin section (PS); and the potential impact of the role of FS in the intra-operative decision making for the complete surgical staging in low risk endometrial cancer
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