OC06.01: Agreement between preoperative transvaginal ultrasound and intraoperative frozen section for estimating myometrial invasion in low-risk endometrial cancer

2014 ◽  
Vol 44 (S1) ◽  
pp. 13-13
Author(s):  
J. Alcazar ◽  
L. Pineda ◽  
C. Vilhena ◽  
L. Juez ◽  
J. Utrilla-Layna ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Frozen Section ◽  
Transvaginal Ultrasound ◽  
Myometrial Invasion ◽  
Low Risk ◽  
Intraoperative Frozen Section

scholarly journals Preoperative and intraoperative assesment of myometrial invasion and histological grade in endometrial cancer: Role of MRI and frozen section

2016 ◽  
Author(s):  
Rohit Raghunath Ranade
Keyword(s):  
Endometrial Cancer ◽  
Tumor Size ◽  
Early Stage ◽  
Frozen Section ◽  
Myometrial Invasion ◽  
Tumor Grade ◽  
Endometrial Biopsy ◽  
Intraoperative Frozen Section ◽  
Cervical Involvement

Introduction: The role of systematic lymphadenectomy in clinically early stage endometrial cancer is controversial. A number of factors can predict lymph node metastasis including myometrial invasion, tumor grade in endometrial cancers. The purpose of the present study is to evaluate the accuracy of preoperative MRI and intraoperative frozen section in determining the depth of myometrial invasion, cervical involvement, tumor size and lymph nodal status. We also studied the accuracy of preoperative endometrial biopsy and intraoperative frozen section in determining the grade of the tumor. Materials and Methods: Medical records of 235 consecutive cases of clinically early stage endometrial cancer were reviewed retrospectively. A record of depth of myometrial invasion, tumor size, cervical involvement and presence of enlarged lymph nodes was made on a preoperative MRI. Similarly depth of myometrial invasion, tumor size, cervical involvement and grade of the tumor were recorded on an intraoperative frozen section. The grade of the tumor was also recorded on a preoperative endometrial biopsy. Standard statistical calculations were used. Results: The sensitivity and specificity of MRI for myometrial invasion for the first 160 cases were 81.3 and 75%, respectively while that for frozen section were 80 and 96.2%, respectively. For tumor grade the sensitivity and specificity of preoperative endometrial biopsy were 60 and 95.6%, respectively while that of frozen section were 53.8 and 97.6%, respectively. For cervical involvement the sensitivity of MRI and frozen section was 62.5 and 98.4%, respectively. Updated results of the entire cohort of 235 cases will be presented at the conference if selected. Conclusion: Although the sensitivity of both frozen section and MRI for predicting deep myometrial invasion was similar (80 vs 81.3%) but the specificity (96.2 vs 75%) and negative predictive value (92.7 vs 88.2%) of frozen section were superior to MRI. Both preoperative biopsy and intraoperative frozen section had low sensitivity (60 vs 53.8%) for detecting a high grade lesion.

Assessment of the Role of Intraoperative Frozen Section in Guiding Surgical Staging for Endometrial Cancer

2016 ◽  
Vol 26 (5) ◽  
pp. 918-923 ◽  
Author(s):  
Xiaoyuan Wang ◽  
Li Li ◽  
Janiel M. Cragun ◽  
Setsuko K. Chambers ◽  
Kenneth D. Hatch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
Tumor Size ◽  
Frozen Section ◽  
Medical Center ◽  
Myometrial Invasion ◽  
Surgical Staging ◽  
Endometrioid Adenocarcinoma ◽  
Intraoperative Frozen Section

ObjectiveThe aim of this study was to assess the role of intraoperative frozen section (FS) in guiding decision making for surgical staging of endometrioid endometrial cancer (EC).MethodsMedical records were collected retrospectively on 112 patients with endometrioid EC, who underwent total hysterectomy and bilateral salpingo-oophorectomy at the University of Arizona Medical Center from January 1, 2010, to December 31, 2014. Only patients with endometrioid adenocarcinoma, grade 1, less than 50% myometrial invasion, and tumor size less than 2 cm determined by intraoperative FS omitted lymphadenectomy; otherwise, surgical staging was performed with lymph node dissection. The FS results were compared with the permanent paraffin sections (PSs) to assess the diagnostic accuracy.ResultsThe concordance rate of different variables between FS and PS in EC was 100%, 89.3% (100/112), 97.3% (109/112), and 95.5% (107/112), respectively, with respecting to histological subtype, grade, myometrial invasion, and tumor size. Diagnostic accurate rate of combined risk factors deciding surgical staging at the time of FS was 95.5% (107/112), and the discordance rate of all risk factors considered between FS and PS was 4.5%, resulting 3 cases (2.7%) undertreated and 2 cases (1.8%) overtreated.ConclusionsDespite nonideal FS evaluation, intraoperative FS diagnosis for EC is highly reliable by providing guidance for the intraoperative decisions of surgical staging at our institution, and such guidelines may be referenced by the institutions with sufficient gynecologic pathology expertise.

Combination of sentinel lymph node mapping and uterine frozen section examination to reduce side-specific lymphadenectomy rate in endometrial cancer: a Turkish Gynecologic Oncology Group study (TRSGO-SLN-002)

2020 ◽  
Vol 30 (7) ◽  
pp. 1005-1011
Author(s):  
Duygu Altin ◽  
Salih Taşkın ◽  
Ilker Kahramanoglu ◽  
Dogan Vatansever ◽  
Nedim Tokgozoglu ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Frozen Section ◽  
Myometrial Invasion ◽  
Pelvic Lymphadenectomy ◽  
Low Risk ◽  
Tumor Diameter ◽  
Diagnostic Efficacy ◽  
Frozen Section Examination

ObjectiveThis study aimed to find out whether side-specific pelvic lymphadenectomy can be omitted without compromising diagnostic efficacy according to “reflex frozen section” analysis of the uterus in case of sentinel lymph node (SLN) mapping failure.MethodsPatients who underwent surgery for endometrial cancer with an SLN algorithm were stratified as low-risk or high-risk according to the uterine features on the final pathology reports. Two models for low-risk patients were defined to omit side-specific pelvic lymphadenectomy: strategy A included patients with endometrioid histology, grade 1–2, and <50% myometrial invasion irrespective of the tumor diameter; strategy B included all factors of strategy A with the addition of tumor diameter ≤2 cm. Theoretical side-specific pelvic lymphadenectomy rates were calculated for the two strategies, assuming side-specific pelvic lymphadenectomy was omitted if low-risk features were present on reflex uterine frozen examination, and compared with the standard National Comprehensive Cancer Network (NCCN) SLN algorithm.Results372 endometrial cancer patients were analyzed. 230 patients (61.8%) had endometrioid grade 1 or 2 tumors with <50% myometrial invasion (strategy A), and in 123 (53.4%) of these patients the tumor diameter was ≤2 cm (strategy B); 8 (3.5%) of the 230 cases had lymphatic metastasis. None of them were detected by side-specific pelvic lymphadenectomy and metastases were limited to SLNs in 7 patients. At least one pelvic side was not mapped in 107 (28.8%) cases in the entire cohort, and all of these cases would require a side-specific pelvic lymphadenectomy based on the NCCN SLN algorithm. This rate could have been significantly decreased to 11.8% and 19.4% by applying reflex frozen section examination of the uterus using strategy A and strategy B, respectively.ConclusionReflex frozen section examination of the uterus can be a feasible option to decide whether side-specific pelvic lymphadenectomy is necessary for all the patients who failed to map with an SLN algorithm. If low-risk factors are found on frozen section examination, side-specific pelvic lymphadenectomy can be omitted without compromising diagnostic efficacy for lymphatic spread.

Preoperative MRI and Intraoperative Frozen Section Diagnosis of Myometrial Invasion In Patients With Endometrial Cancer

2015 ◽  
Vol 25 (5) ◽  
pp. 879-883 ◽  
Author(s):  
Tomohito Tanaka ◽  
Yoshito Terai ◽  
Yoshihiro J. Ono ◽  
Satoe Fujiwara ◽  
Yoshimichi Tanaka ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Frozen Section ◽  
Myometrial Invasion ◽  
Intraoperative Frozen Section ◽  
Frozen Section Diagnosis

scholarly journals Transvaginal three-dimensional ultrasound for preoperative assessment of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Tatiana Costas ◽  
Rocío Belda ◽  
Juan Luis Alcazar
Keyword(s):  
Endometrial Cancer ◽  
Diagnostic Accuracy ◽  
Frozen Section ◽  
Meta Analysis ◽  
Transvaginal Ultrasound ◽  
Three Dimensional ◽  
Myometrial Invasion ◽  
Negative Likelihood Ratio ◽  
Preoperative Assessment ◽  
Standard Material

Aim: The aim of this meta-analysis is to evaluate the diagnostic accuracy of three-dimensional transvaginal ultrasound subjective assessment (3D-TVS) in the preoperative detection of deep myometrial invasion (MI) in patients with endometrial cancer, using definitive frozen section diagnosis after surgery as the reference standard. Material and methods: A search for studies evaluating the role of 3D-TVS for assessing myometrial invasion in endometrial cancer from January 1990 to Novem-ber 2020 was performed in PubMed/MEDLINE and Web of Science. The Quality Assessment of Diagnostic Accuracy Studies 2 evaluated the quality of the studies (QUADAS-2). All analyses were performed using MIDAS and METANDI commands. Results: Nine studies comprising 581 women were included. The mean prevalence of deep MI was 39.8%. QUADAS as-sessment showed that most studies had a high risk for the patient selection domain. Overall, the pooled estimated sensitivity, specificity, positive likelihood and negative likelihood ratio of 3D-TVS for detecting deep MI were 84% (95% CI, 73-90%), 82% (95% CI, 75-88%), 5 (95% CI, 3.1-7.1) and 0.20 95% CI, 0.11-0.35). respectively. Conclusions: 3D-TVS has an accept-able diagnostic performance for detecting MI in women with endometrial cancer.

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