Abstract
Purpose
The accuracy of intra-operative gross visual examination of myometrial invasion of uterine specimen has been evaluated in several studies with controversial results. The intra-operative frozen section (IFS) analysis is used to identify patients at high risk for pelvic and para-aortic nodal metastasis in order to avoid lymphadenectomy in low-risk patients. However, there is still some controversy concerning the efficiency of IFS. The aim of this study was to evaluate the accuracy and validity of frozen section diagnosis and gross examination of uterine specimen compared to the final histological results in patients with endometrial cancer.
Methods
The study group comprised 31 patients with a pre-operative histopathological diagnosis of endometrial carcinoma. Comprehensive surgical staging was performed in all patients. Intra-operative gross examination of the uterine cavity and wall with frozen section analysis was performed. Lymphadenectomy was performed in all patients. After frozen section analysis, the uterus together with removed lymph nodes was stored and subjected to final pathologic diagnoses.
Results
Gross examination accurately identified microscopic invasion of myometrium in 86.6% of the patients with 88.9% sensitivity, 85.7% specificity and negative and positive predictive values of 72.7 and 94.7%, respectively. The kappa was 0.70 (p < 0.0001) with a 95% CI 0.432–0.968. Frozen section in 90% of cases was correctly reporting final histopathological myometrial invasion with sensitivity 88.9%, specificity 90%, positive and negative predictive values 80 and 94.7%, respectively. The kappa was 0.76 (p < 0.0001) with a 95% CI 0.51–1.009.
Conclusion
These data confirm the previous reports for the accuracy of gross examination and frozen section diagnosis in early stage and low-grade tumors.
Similar content being viewed by others
References
Case AS, Rocconi RP, Straughn JM et al (2006) A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer. Obstet Gynecol 108:1375–1379
Mao Y, Wan X, Chen Y et al (2008) Evaluation of the accuracy of intra-operative gross examination for the surgical management of endometrial cancer. Eur J Obstet Gynecol Reprod Biol 141:179–182
Hacker NF (2005) Uterine cancer. In: Berek JS, Hacker NF (eds) Practical gynecologic oncology, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 397–442
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
Cornelison TL, Trimble EL, Kosary CL et al (1999) Corpus uteri cancer: treatment trends versus survival for FIGO stage II, 1988–1994. Gynecol Oncol 74:350–355
Franchi M, Ghezzi F, Melpignano M et al (2000) Clinical value of intraoperative gross examination in endometrial cancer. Gynecol Oncol 76:357–361
Quinlivan JA, Petersen RW, Nicklin JL (2001) Accuracy of frozen section for the operative management of endometrial cancer. BJOG 108(8):798–803
Kayikcioglu F, Boran N, Meydanli MM et al (2002) Is frozen-section diagnosis a reliable guide in surgical treatment of stage I endometrial carcinoma? Acta Oncol 41:444–446
Fanning J, Tsukada Y, Piver MS (1990) Intraoperative frozen section diagnosis of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 37(1):47–50
Egle D, Grissemann B, Zeimet AG et al (2008) Validation of intraoperative risk assessment on frozen section for surgical management of endometrial carcinoma. Gynecol Oncol 110(3):286–292
Kitchener H, Swart AM, ASTEC study group et al (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373(9658):125–136
FIGO Announcements, stages-1988 Revision (1989) Gynecol Oncol 35:125
Creasman WT, Morrow CP, Bundy BN et al (1987) Surgical pathologic spread patterns of endometrial cancer: a Gynecologic Oncology Group Study. Cancer 60:2035–2041
Doering DL, Barnhill DR, Weiser EB et al (1989) Intraoperative evaluation of depth of myometrial invasion in stage I endometrial adenocarcinoma. Obstet Gynecol 74:930–933
Larson DM, Connor GP, Broste SK et al (1996) Significance of gross myometrial invasion with endometrial cancer. Obstet Gynecol 88:394–398
Noumoff JS, Menzin A, Mikuta J et al (1991) The ability to evaluate prognostic variables on frozen section in hysterectomies performed for endometrial carcinoma. Gynecol Oncol 42:202–208
Horn LC, Schmidt D (2002) Hist opathologische Basisformen und orphologische Prognosefaktoren beim Endometriumkarzinom. Zentralbl Gynäkol 124:36–44
Boronow RC, Morrow CP, Creasman WT et al (1987) Surgical staging in endometrial cancer: clinical–pathologic findings of a prospective study. Obstet Gynecol 63(6):825–832
Piver MS, Barlow JJ, Lele SB (1982) Para-aortic lymph node metastasis in FIGO stage I endometrial carcinoma. Value of surgical staging and results of treatment. N Y State J Med 82(9):1321–1324
Larson DM, Johnson K, Olson KA (1992) Pelvic and para-aortic lymphadenectomy for surgical staging of endometrial cancer: morbidity and mortality. Obstet Gynecol 79(6):998–1001
Moore DH, Fowler WC, Walton LA et al (1989) Morbidity of lymph node sampling in cancers of the uterine corpus and cervix. Obstet Gynecol 74(2):180–184
Axtell AE, Kelley JL, Fader AN et al (2007) Percent surface area involvement is a predictor of lymph node metastasis in endometrial cancer. Gynecol Oncol 107(3):482–486
Conflict of interest statement
None of the authors have financial benefit from this work and have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ghaemmaghami, F., Aminimoghaddam, S., Modares-Gilani, M. et al. Assessment of gross examination and frozen section of uterine specimen in endometrial cancer patients. Arch Gynecol Obstet 282, 685–689 (2010). https://doi.org/10.1007/s00404-010-1387-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-010-1387-3