Abstract
Purpose
To evaluate the accuracy of endometrial biopsy (EB), transvaginal ultrasonography (TVS) and intraoperative frozen section (FS) for assessment of myometrial invasion and histologic grade to predict more conservative surgery in endometrial carcinoma.
Methods
Demographic and clinical data of 220 patients with endometrial carcinoma were retrospectively reviewed. Preoperatively, the subjects were evaluated by EB and TVS. Intraoperatively, FS was also performed to evaluate histological grading and myometrial invasion. All patients underwent surgical–pathological staging after removal of the uterus, adnexa and pelvic lymph nodes. Sensitivity and specificity values were calculated for EB, TVS and FS with regard to detection of histological grading and neoplastic invasion of the myometrium according to the final histopathologic examination.
Results
Bilateral pelvic and common iliac lymphadenectomy was performed in 80 patients without performing intraoperative biopsy because of preoperative high risk. Evaluation of the tumor grade by preoperative EB showed a sensitivity, specificity and accuracy of 73, 97 and 91%, respectively. Evaluation of the tumor grade by intraoperative biopsy showed a sensitivity, specificity and accuracy of 73, 96 and 90%, respectively. Evaluation of the depth of myometrial invasion with TVS showed a sensitivity, specificity and accuracy of 52, 91 and 79%, respectively. Evaluation of the depth of myometrial invasion with intraoperative biopsy showed a sensitivity, specificity and accuracy of 86, 94 and 92%, respectively.
Conclusions
Evaluation of the histologic grade by EB and of the depth of myometrial invasion by intraoperative biopsy is a good option for deciding the necessity of lymphadenectomy.
Similar content being viewed by others
References
International Federation of Gynecology and Obstetrics (1971) Classification and staging of malignant tumors in the female pelvis. Int J Gynaecol Obstet 9:172
International Federation of Gynecology and Obstetrics (1989) Corpus cancer staging. Int J Gynaecol Obstet 28:190
Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer. Cancer 60:2035–2041
Fleischer AC, Dudley BS, Entman SS, Baxter JW, Kalemeris GC, James AE Jr (1987) Myometrial invasion by endometrial carcinoma: sonographic assessment. Radiology 162:307–310
Cacciatore B, Lehtovirta P, Wahlstrom T, Ylostalo P (1989) Preoperative sonographic evaluation of endometrial cancer. Am J Obstet Gynecol 160:133–137
Sirisabya N, Manchana T, Worasethsin P, Khemapech N, Lertkhachonsuk R, Sittisomwong T et al (2009) Is complete surgical staging necessary in clinically early stage endometrial carcinoma? Int J Gynaecol Cancer 19:1057–1061
Creutzberg CL, Van Putten WLJ, Koper CPM, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC et al (2000) Surgery and postoperative radiotherapy versus surgery alone for patients with stage-I endometrial carcinoma: multicentre randomised trial. Lancet 355:1404–1411
Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, Podratz KC (2008) Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol 109:11–18
Panici PB, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G et al (2008) Systematic pelvic lymphadenectomy versus no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100:1707–1716
Traen K, Hølund B, Mogensen O (2007) Accuracy of preoperative tumor grade and intraoperative gross examination of myometrial invasion in patients with endometrial cancer. Acta Obstet Gynecol Scand 86:739–741
Wang X, Zhang H, Di W, Li W (2009) Clinical factors affecting the diagnostic accuracy of assessing dilation and curettage vs frozen section specimens for histologic grade and depth of myometrial invasion in endometrial carcinoma. Am J Obstet Gynecol 20:194.e1–194.e10
Celik C, Ozdemir S, Esen H, Balci O, Ylmaz O (2010) The clinical value of preoperative and intraoperative assessments in the management of endometrial cancer. Int J Gynecol Cancer; 20:358–362
Sanjuan A, Cobo T, Pahisa J, Escaramís G, Ordi J, Ayuso JR et al (2006) Preoperative and intraoperative assessment of myometrial invasion and histologic grade in endometrial cancer: role of magnetic resonance imaging and frozen section. Int J Gynecol Cancer 16:385–390
Quinlivan JA, Petersen RW, Nicklin JL (2001) Accuracy of frozen section for the operative management of endometrial cancer. BJOG 108:798–803
Altintas A, Cosar E, Vardar MA, Demir C, Tuncer I (1999) Intraoperative assessment of depth of myometrial invasion in endometrial carcinoma. Eur J Gynaecol Oncol 4:329–331
Zorlu CG, Kuscu E, Ergun Y, Aydoghu T, Cobanoglu O, Erdas O (1993) Intraoperative evaluation of prognostic factors in stage 1 endometrial cancer by frozen section: how reliable? Acta Obstet Gynecol Scand 73:382–385
Fanning J, Tsukada Y, Piver MS (1990) Intraoperative frozen section diagnosis of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 37:47–50
Shim JU, Rose PG, Reale FR, Soto H, Tak WK, Hunter RE (1992) Accuracy of frozen section diagnosis at surgery in clinical stage 1 and 2 endometrial carcinoma. Am J Obstet Gynecol 166:1335–1338
Kucera E, Kainz C, Reinthaller A, Sliutz G, Leodolter S, Kucera H, Breitenecker G (2000) Accuracy of intraoperative frozen section diagnosis in stage 1 endometrial adenocarcinoma. Gynecol Obstet Invest 49:62–66
Kayikçioğlu F, Boran N, Meydanli MM, Tulunay G, Köse FM, Bülbül D (2002) Is frozen-section diagnosis a reliable guide in surgical treatment of stage I endometrial carcinoma? Acta Oncol 41:444–446
Savelli L, Ceccarini M, Ludovisi M, Fruscella E, De Iaco PA, Salizzoni E, Mabrouk M, Manfredi R, Testa AC, Ferrandina G (2008) Preoperative local staging of endometrial cancer: transvaginal sonography vs. magnetic resonance imaging. Ultrasound Obstet Gynecol 31:560–566
Pektas MK, Gungor T, Mollamahmutoglu L (2007) The evaluation of endometrial tumors by transvaginal and Doppler ultrasonography. Arch Obstet Gynecol 277:495–499
Develioğlu OH, Bilgin T, Yalçin OT, Ozalp S, Ozan H (1999) Adjunctive use of the uterine artery resistance index in the preoperative prediction of myometrial invasion in endometrial carcinoma. Gynecol Oncol 72:26–31
Fishman A, Altaras M, Bernheim J, Cohen I, Beyth Y, Tepper R (2000) The value of transvaginal sonography in the preoperative assessment of myometrial invasion in high and low grade endometrial cancer and in comparison to frozen section in grade 1 disease. Eur J Gynaecol Oncol 21:128–130
Artner A, Bösze P, Gonda G (1994) The value of ultrasound in preoperative assessment of the myometrial and cervical invasion in endometrial carcinoma. Gynecol Oncol 54:147–151
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ozturk, E., Dikensoy, E., Balat, O. et al. Intraoperative frozen section is essential for assessment of myometrial invasion but not for histologic grade confirmation in endometrial cancer: a ten-year experience. Arch Gynecol Obstet 285, 1415–1419 (2012). https://doi.org/10.1007/s00404-011-2135-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-011-2135-z