Intraoperative assessment of depth of myometrial invasion in endometrial carcinoma.
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Abstract:
To evaluate the adequacy of intraoperative assessment of depth of myometrial invasion in patients with endometrial adenocarcinoma.Of the 58 evaluable cases, depth of myometrial invasion was estimated by gross examination of fresh tissue by an experienced surgeon and a pathologist and on the frozen section by the same pathologist. This was compared with the depth of invasion on the final microscopic examination performed by another pathologist.The depth of invasion was accurately predicted by the surgeon in 89.7% of the patients, while the pathologist's accurate prediction rates on fresh tissue and frozen section were 86.2% and 91.4%, respectively. The accurate prediction rate gradually diminished for both the surgeon and the pathologist as the histologic grade increased. Frozen section examination was reliable in grade I cancer (100%), while gross examination of the surgeon and the pathologist had a significant error rate in predicting accurate depth of invasion (7.6%-33%).If frozen section shows that myometrial invasion in patients with grade 1 endometrial carcinoma is less than 1/3, lymphadenectomy may be omitted. In all other cases radical surgery and surgical staging is mandatory to avoid undertreatment.Keywords:
Gross examination
Lymphadenectomy
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Transvaginal sonography
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specificity, and positive and negative predictive values of 33.4%, 78.4%, 33.3%, and 78.4%, respectively. Frozen section correctly identified (accuracy) 95.5% of cases with sensitivity, specificity, and positive and negative predictive values of 92.3%, 96.2%, 85.7%, and 98.1%, respectively. Conclusion: Frozen section appeared to be more effective than gross examination in assessing myometrial invasion and hence should be preferred as a basis for selective lymphadenectomy for clinical stage I endometrial cancer. Hong Kong J Gynaecol Obstet Midwifery 2015; 15(2):167-72
Lymphadenectomy
Gross examination
Positive predicative value
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To evaluate the adequacy of intraoperative assessment of depth of myometrial invasion in patients with endometrial adenocarcinoma.Of the 58 evaluable cases, depth of myometrial invasion was estimated by gross examination of fresh tissue by an experienced surgeon and a pathologist and on the frozen section by the same pathologist. This was compared with the depth of invasion on the final microscopic examination performed by another pathologist.The depth of invasion was accurately predicted by the surgeon in 89.7% of the patients, while the pathologist's accurate prediction rates on fresh tissue and frozen section were 86.2% and 91.4%, respectively. The accurate prediction rate gradually diminished for both the surgeon and the pathologist as the histologic grade increased. Frozen section examination was reliable in grade I cancer (100%), while gross examination of the surgeon and the pathologist had a significant error rate in predicting accurate depth of invasion (7.6%-33%).If frozen section shows that myometrial invasion in patients with grade 1 endometrial carcinoma is less than 1/3, lymphadenectomy may be omitted. In all other cases radical surgery and surgical staging is mandatory to avoid undertreatment.
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Lymphadenectomy
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Lymphadenectomy
Lymphovascular invasion
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Section (typography)
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Pathology plays a critical role in every step in the management of endometrial carcinoma patients. In this review, we describe the state of the art of pathological examination, including examination of endometrium biopsy; intra-operative evaluation with gross examination and frozen section; and grossing of hysterectomy specimen and its histological and immunohistochemistry study. The main pathologic findings in each step are described, as well as limitations and difficulties that may ensue. We highlight the important pathologic parameters that determine treatment options and prognosis of endometrial cancer patients.
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Anatomical pathology
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Gross examination
Lymphadenectomy
Myometrium
Positive predicative value
Kappa
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Is Frozen-Section Diagnosis a Reliable Guide in Surgical Treatment of Stage I Endometrial Carcinoma?
Frozen-section diagnoses and paraffin-section diagnoses were compared in 154 patients in stage I endometrial adenocarcinoma. In 134 (87%) of the 154 patients (p < 0.001), a corresponding depth of myometrial invasion was found, and in 132 (85.7%) patients the same tumor grade was established (p < 0.001). Frozen-section diagnosis of stage I endometrial adenocarcinoma is reliable for estimation of the extent of disease and accurately identifies patients who require surgical staging.
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Background: We evaluated whether an intraoperative frozen section is useful for judging the necessity of lymphadenectomy for treating endometrial cancer. Methods: We examined 106 patients with endometrial cancer in whom histological grade and uterine muscle layer invasion were evaluated using an intraoperative frozen section at our institution between 2012 and 2016. We compared the intraoperative frozen-section diagnosis with a preoperative evaluation regarding the accuracy of determining histological grade and uterine muscular invasion, which are considered risk factors for lymph-node metastasis. Results: The preoperative evaluation and intraoperative frozen section had 55% and 75% diagnostic accuracies, respectively (P = 0.002). The frozen-section diagnosis was superior to preoperative evaluation, particularly for detecting the presence of uterine muscular invasion. Conclusions: A frozen section is useful if the presence of muscular invasion is included in the criteria for determining whether lymphadenectomy should be performed. J Clin Gynecol Obstet. 2019;8(1):9-16 doi: https://doi.org/10.14740/jcgo537
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