Intraoperative evaluation of endometrial carcinoma staging

Abstract The new International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer is based on intraoperative examination of hysterectomy specimens not submitted to radiation. PURPOSE--This system aims to recognize the risk factors for intrabdominal lymph node metastases not detected by the earlier staging system, permitting to select the patients who must be submitted to lymphadenectomy. The major risks for metastases are: poorly differentiated neoplasms (grade 3), deep myometrial invasion (more than half of the thickness of the myometrium) and certain more aggressive histological types. METHODS--Intraoperative examination takes about 30 minutes. The uterus is laterally opened and several complete transversal cuts are made in order to choose the suspected deeper myometrial or cervical invasion areas for histological frozen examination. The findings were compared with the permanent slides. RESULTS--Good correlations between frozen and permanent sections were obtained, with an accuracy of about 90%. CONCLUSION--This new FIGO staging is under evaluation. The comparative results show a higher degree of confidence on the method performance. The complementary radiotherapic treatment is indicated according to the disease stage.