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Ooka R, Nanki Y, Yamagami W, Kawaida M, Nagai S, Hirano T, Sakai K, Makabe T, Chiyoda T, Kobayashi Y, Kataoka F, Aoki D. Evaluation of the role of intraoperative frozen section and magnetic resonance imaging in endometrial cancer. Int J Gynaecol Obstet 2023; 160:554-562. [PMID: 35929845 DOI: 10.1002/ijgo.14389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/03/2022] [Accepted: 07/28/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the accuracy of preoperative endometrial biopsy and magnetic resonance imaging (MRI) of endometrial cancer compared with that of intraoperative frozen section. METHODS This retrospective study included 264 patients who underwent surgery with intraoperative frozen section for endometrial cancer at our institution between 2014 and 2018. Diagnosis was determined by histologic type, grade, and myometrial invasion. Concordance rate, sensitivity, and specificity of preoperative diagnosis and intraoperative frozen diagnosis were calculated, in comparison to the final pathologic diagnosis. RESULTS Preoperative and intraoperative diagnoses showed no statistically significant difference in determining histologic type and grade (P = 0.152). Intraoperative diagnosis showed higher sensitivity for endometrioid carcinoma grade 3 and other types, and higher specificity for grade 1. For myometrial invasion, intraoperative diagnosis showed significantly higher concordance rate than preoperative MRI findings (P < 0.01). Intraoperative diagnosis showed higher sensitivity and specificity in patients with and without myometrial invasion, respectively. CONCLUSION Higher agreement between intraoperative and final diagnoses, especially in myometrial invasion, suggests that intraoperative frozen section is a good indicator for appropriate surgical procedure decision making.
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Affiliation(s)
- Reina Ooka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiko Nanki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Wataru Yamagami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Miho Kawaida
- Department of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan
| | - Shimpei Nagai
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Takuro Hirano
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kensuke Sakai
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Makabe
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuyuki Chiyoda
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Kobayashi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Fumio Kataoka
- Department of Obstetrics and Gynecology, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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Institutional Accuracy Matters: How the Correlation between Frozen Section and Final Pathology Depends on Institutes while Evaluating Lymph Node Involvement in Endometrial Adenocarcinoma. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1102375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background and Purpose: The frozen section analysis results help determine the appropriate surgery and treatment for patients with endometrial adenocarcinoma. This study investigates the degree of compliance between the results of frozen section analysis and final pathology reports in patients with endometrial cancer.
Methods: This study included 357 patients with endometrial adenocarcinoma who underwent operation, follow-up, and treatment at our hospital. The patients’ demographic, clinical, surgical, and pathological data were retrospectively analyzed. We compared the results of the frozen section and pathological specimens in terms of final pathology, tumor grade, myometrial invasion, tumor size, and lymphovascular system involvement (LVSI).
Results: The frozen section analysis and final pathology results for tumor size and LVSI were significantly correlated when patients were divided by tumor type (tumor size: P=0.006, LVSI: P=0.024) or by risk for lymph node involvement (P=0.000).
Overall, the frozen section analysis had an accuracy of 70% for tumor grades.
The histological results of the frozen section analysis had an accuracy of 77.1% for type 1 tumors and 72.7% for type 2 tumors. Overall, the frozen section analysis had an accuracy of 95% for myometrial invasion.
Conclusion: Intraoperative frozen section analysis can prevent unnecessary lymph node dissection when performed at qualified institutions.
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Clinical biomarkers to predict preoperative lymph node metastasis in endometrial cancer. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.882342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Prospective Non-randomized Control Trial on Role of Systematic High Para-Aortic Lymphadenectomy in Endometrial Cancer: Indian Study. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-020-00482-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Brooks RA, Fleming GF, Lastra RR, Lee NK, Moroney JW, Son CH, Tatebe K, Veneris JL. Current recommendations and recent progress in endometrial cancer. CA Cancer J Clin 2019; 69:258-279. [PMID: 31074865 DOI: 10.3322/caac.21561] [Citation(s) in RCA: 238] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Endometrial cancer is the most common gynecologic cancer in the United States, and its incidence is rising. Although there have been significant recent advances in our understanding of endometrial cancer biology, many aspects of treatment remain mired in controversy, including the role of surgical lymph node assessment and the selection of patients for adjuvant radiation or chemotherapy. For the subset of women with microsatellite-instable, metastatic disease, anti- programmed cell death protein 1 immunotherapy (pembrolizumab) is now approved by the US Food and Drug Administration, and numerous trials are attempting to build on this early success.
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Affiliation(s)
- Rebecca A Brooks
- Associate Professor, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
- Dr. Brooks is now the Associate Professor and Chief of the Division of Gynecologic Oncology, University of California Davis School of Medicine, Davis, CA
| | - Gini F Fleming
- Professor of Medicine and Director, Medical Oncology Breast Program, Department of Medical Oncology, The University of Chicago, Chicago, IL
| | - Ricardo R Lastra
- Assistant Professor, Department of Pathology, The University of Chicago, Chicago, IL
| | - Nita K Lee
- Assistant Professor of Obstetrics and Gynecology, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
| | - John W Moroney
- Associate Professor of Obstetrics and Gynecology, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
| | - Christina H Son
- Assistant Professor, Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Ken Tatebe
- Resident, Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Jennifer L Veneris
- Instructor of Medicine, Division of Gynecologic Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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Nardone V, Tini P, Marciello L, Battaglia G, Pastina P, Crociani M, Cancemi C, Vannini M, Sebaste L, Pirtoli L. Role of the Appropriateness of the Pelvic Lymphadenectomy and Adjuvant Radiation Therapy in Early-Stage Poorly Differentiated Endometrial Carcinoma. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2018. [DOI: 10.1007/s40944-018-0240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sarı ME, Meydanlı MM, Yalçın I, Şahin H, Çoban G, Çelik H, Kuşçu E, Gungor T, Ayhan A. Risk Factors for Lymph Node Metastasis among Lymphovascular Space Invasion-Positive Women with Endometrioid Endometrial Cancer Clinically Confined to the Uterus. Oncol Res Treat 2018; 41:750-754. [DOI: 10.1159/000492585] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/31/2018] [Indexed: 01/15/2023]
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Is Tumor Size Really Important for Prediction of Lymphatic Dissemination in Grade 1 Endometrial Carcinoma With Superficial Myometrial Invasion? Int J Gynecol Cancer 2018; 27:1393-1398. [PMID: 28604451 DOI: 10.1097/igc.0000000000001025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Selection of patients with endometrioid endometrial cancer (EEC), in whom systematic lymph node dissection (LND) is indicated, is an important part of management to maintain optimal oncological outcomes, while avoiding unnecessary morbidities. According to the current approach, LND is recommended for the patients with International Federation of Gynecology and Obstetrics (FIGO) grade 1 to 2 tumors and a primary tumor diameter (PTD) greater than 2 cm, even with myometrial invasion (MMI) of less than 50%. We aimed to determine incidence of LN metastasis in this particular group of patients with grade 1 tumors, superficial MMI, and a PTD greater than 2 cm. MATERIALS AND METHODS This study only focused on women with FIGO grade 1 EEC having less than 50% MMI. Therefore, women with grade 2 or 3 tumors were excluded, as well as patients with 50% or greater MMI. We also excluded women with macroscopic extrauterine disease, as well as patients with cervical stromal involvement. Patients were divided into subgroups with regard to PTD; group 1 was composed of patients with PTD of 20 mm or less, whereas group 2 was composed of patients with PTD greater than 20 mm. All clinical and pathological variables were compared between the groups. RESULTS Final pathology reports of 484 women with EEC who underwent surgical staging were analyzed. Among these women, there were 123 women in group 1 (PTD ≤ 20 mm) and 120 women in group 2 (PTD > 20 mm), with FIGO grade 1 tumors and superficial MMI. The median number of total LNs removed was 54 (range, 20-151). There were no women with pelvic and/or para-aortic LN metastasis in group 2, as well as in group 1. CONCLUSIONS Our results suggest that lymphadenectomy may be omitted in women with FIGO grade 1 EEC having superficial MMI regardless of PTD. Deferral of systematic LND in this subgroup of patients may lead to reductions in costs and surgical morbidity.
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Risk factors for paraaortic lymph node metastasis in endometrial cancer. Int J Clin Oncol 2017; 22:937-944. [DOI: 10.1007/s10147-017-1139-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
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Giede C, Le T, Power P. Rôle de la chirurgie en matière de cancer de l'endomètre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S197-S207. [PMID: 28063535 DOI: 10.1016/j.jogc.2016.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Intraoperative Gross Examination and Intraoperative Frozen Section in Patients With Endometrial Cancer for Detecting Deep Myometrial Invasion. Int J Gynecol Cancer 2016; 26:407-15. [DOI: 10.1097/igc.0000000000000618] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Wu Y, Zhu H, Sun J, Wang X. Accuracy of frozen section in management and prediction of lymph node metastasis in endometrial carcinoma. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2015.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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AlHilli MM, Mariani A. Preoperative selection of endometrial cancer patients at low risk for lymph node metastases: useful criteria for enrollment in clinical trials. J Gynecol Oncol 2015; 25:267-9. [PMID: 25310031 PMCID: PMC4195293 DOI: 10.3802/jgo.2014.25.4.267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Mariam M AlHilli
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrea Mariani
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
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Gholkar NS, Saha SC, Prasad G, Bhattacharya A, Srinivasan R, Suri V. The Accuracy of Integrated [(18)F] Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Detection of Pelvic and Para-aortic Nodal Metastasis in Patients with High Risk Endometrial Cancer. World J Nucl Med 2014; 13:170-7. [PMID: 25538488 PMCID: PMC4262875 DOI: 10.4103/1450-1147.144817] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Lymph nodal (LN) metastasis is the most important prognostic factor in high-risk endometrial cancer. However, the benefit of routine lymphadenectomy in endometrial cancer is controversial. This study was conducted to assess the accuracy of [18F] fluorodeoxyglucose-positron emission tomography/computed tomography ([18F] FDG-PET/CT) in detection of pelvic and para-aortic nodal metastases in high-risk endometrial cancer. 20 patients with high-risk endometrial carcinoma underwent [18F] FDG-PET/CT followed by total abdominal hysterectomy, bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy. The findings on histopathology were compared with [18F] FDG-PET/CT findings to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of [18F] FDG-PET/CT. The pelvic nodal findings were analyzed on a patient and nodal chain based criteria. The para-aortic nodal findings were reported separately. Histopathology documented nodal involvement in two patients (10%). For detection of pelvic nodes, on a patient based analysis, [18F] FDG-PET/CT had a sensitivity of 100%, specificity of 61.11%, PPV of 22.22%, NPV of 100% and accuracy of 65% and on a nodal chain based analysis, [18F] FDG-PET/CT had a sensitivity of 100%, specificity of 80%, PPV of 20%, NPV of 100%, and accuracy of 80.95%. For detection of para-aortic nodes, [18F] FDG-PET/CT had sensitivity of 100%, specificity of 66.67%, PPV of 20%, NPV of 100%, and accuracy of 69.23%. Although [18F] FDG-PET/CT has high sensitivity for detection of LN metastasis in endometrial carcinoma, it had moderate accuracy and high false positivity. However, the high NPV is important in selecting patients in whom lymphadenectomy may be omitted.
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Affiliation(s)
- Nikhil Shirish Gholkar
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhas Chandra Saha
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Grv Prasad
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynae Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Stephan JM, Hansen J, Samuelson M, McDonald M, Chin Y, Bender D, Reyes HD, Button A, Goodheart MJ. Intra-operative frozen section results reliably predict final pathology in endometrial cancer. Gynecol Oncol 2014; 133:499-505. [DOI: 10.1016/j.ygyno.2014.03.569] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/28/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
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Bogani G, Dowdy SC, Cliby WA, Ghezzi F, Rossetti D, Mariani A. Role of pelvic and para-aortic lymphadenectomy in endometrial cancer: current evidence. J Obstet Gynaecol Res 2014; 40:301-11. [PMID: 24472047 PMCID: PMC4364412 DOI: 10.1111/jog.12344] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 11/02/2013] [Indexed: 01/02/2023]
Abstract
The aim of the present review is to summarize the current evidence on the role of pelvic and para-aortic lymphadenectomy in endometrial cancer. In 1988, the International Federation of Obstetrics and Gynecology recommended surgical staging for endometrial cancer patients. However, 25 years later, the role of lymph node dissection remains controversial. Although the findings of two large independent randomized trials suggested that pelvic lymphadenectomy provides only adjunctive morbidity with no clear influence on survival outcomes, the studies have many pitfalls that limit interpretation of the results. Theoretically, lymphadenectomy may help identify patients with metastatic dissemination, who may benefit from adjuvant therapy, thus reducing radiation-related morbidity. Also, lymphadenectomy may eradicate metastatic disease. Because lymphatic spread is relatively uncommon, our main effort should be directed at identifying patients who may potentially benefit from lymph node dissection, thus reducing the rate of unnecessary treatment and associated morbidity. This review will discuss the role of lymphadenectomy in endometrial cancer, focusing on patient selection, extension of the surgical procedure, postoperative outcomes, quality of life and costs. The need for new surgical studies and efficacious systemic drugs is recommended.
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Affiliation(s)
- Giorgio Bogani
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean C. Dowdy
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - William A. Cliby
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Fabio Ghezzi
- Division of Obstetrics and Gynecology, University of Insubria, Varese, and
| | - Diego Rossetti
- Division of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Andrea Mariani
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Fiorelli JL, Herzog TJ, Wright JD. Current treatment strategies for endometrial cancer. Expert Rev Anticancer Ther 2014; 8:1149-57. [DOI: 10.1586/14737140.8.7.1149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sentinel lymph node mapping with pathologic ultrastaging: a valuable tool for assessing nodal metastasis in low-grade endometrial cancer with superficial myoinvasion. Gynecol Oncol 2013; 131:714-9. [PMID: 24099838 DOI: 10.1016/j.ygyno.2013.09.027] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/12/2013] [Accepted: 09/27/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To report the incidence of nodal metastases in patients presenting with presumed low-grade endometrioid adenocarcinomas using a sentinel lymph node (SLN) mapping protocol including pathologic ultrastaging. METHODS All patients from 9/2005 to 12/2011 who underwent endometrial cancer staging surgery with attempted SLN mapping for preoperative grade 1 (G1) or grade 2 (G2) tumors with <50% invasion on final pathology, were included. All lymph nodes were examined with hematoxylin and eosin (H&E). Negative SLNs were further examined using an ultrastaging protocol to detect micrometastases and isolated tumor cells. RESULTS Of 425 patients, lymph node metastasis was found in 25 patients (5.9%) on final pathology-13 cases on routine H&E, 12 cases after ultrastaging. Patients whose tumors had a DMI <50% were more likely to have positive SLNs on routine H&E (p<0.005) or after ultrastaging (p=0.01) compared to those without myoinvasion. CONCLUSIONS Applying a standardized SLN mapping algorithm with ultrastaging allows for the detection of nodal disease in a presumably low-risk group of patients who in some practices may not undergo any nodal evaluation. Ultrastaging of SLNs can likely be eliminated in endometrioid adenocarcinoma with no myoinvasion. The long-term clinical significance of ultrastage-detected nodal disease requires further investigation as recurrences were noted in some of these cases.
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Turan T, Oguz E, Unlubilgin E, Tulunay G, Boran N, Demir OF, Kose MF. Accuracy of frozen-section examination for myometrial invasion and grade in endometrial cancer. Eur J Obstet Gynecol Reprod Biol 2013; 167:90-5. [DOI: 10.1016/j.ejogrb.2012.11.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 08/14/2012] [Accepted: 11/21/2012] [Indexed: 11/29/2022]
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Preoperative biopsy and intraoperative tumor diameter predict lymph node dissemination in endometrial cancer. Gynecol Oncol 2013; 128:294-9. [DOI: 10.1016/j.ygyno.2012.10.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 10/04/2012] [Accepted: 10/06/2012] [Indexed: 11/21/2022]
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Kumar S, Medeiros F, Dowdy SC, Keeney GL, Bakkum-Gamez JN, Podratz KC, Cliby WA, Mariani A. A prospective assessment of the reliability of frozen section to direct intraoperative decision making in endometrial cancer. Gynecol Oncol 2012; 127:525-31. [PMID: 22940491 DOI: 10.1016/j.ygyno.2012.08.024] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 08/17/2012] [Accepted: 08/22/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the reliability of intraoperative frozen sections (IFSs) for surgical staging of endometrial cancer (EC). METHODS Data were collected prospectively on 784 consecutive patients with EC who were undergoing a hysterectomy at our institution from January 1, 2004, to December 31, 2008. The need for surgical staging was decided through IFS using 4 variables: tumor size, histologic grade, histologic subtype, and depth of myometrial invasion (MI). The IFS results were compared with the permanent paraffin sections (PSs) to assess for discordances. RESULTS In 30 of the 784 cases (4%), the PS pathology report was amended with discordant results. In addition, a definitive diagnosis of the 4 parameters was deferred to PS in 53 cases (7%), of which 30 (4%) were concordant and 23 (3%) were discordant. IFS-related deviations from the prescribed surgical algorithm occurred in 10 cases (1.3%; 95% confidence interval, 0.6%-2.3%). Of these 10 cases, 3 were amendments after PS review and 7 were IFS deferrals for definitive PS interpretation. CONCLUSIONS Clinically significant discordance between IFS and PS occurred in only 1.3% of cases. Despite skepticism expressed in the medical literature, IFS provides highly reliable data to guide intraoperative treatment decisions at institutions with sufficient pathologic expertise.
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Affiliation(s)
- Sanjeev Kumar
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Savelli L, Testa AC, Mabrouk M, Zannoni L, Ludovisi M, Seracchioli R, Scambia G, De Iaco P. A prospective blinded comparison of the accuracy of transvaginal sonography and frozen section in the assessment of myometrial invasion in endometrial cancer. Gynecol Oncol 2012; 124:549-52. [DOI: 10.1016/j.ygyno.2011.11.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 11/09/2011] [Accepted: 11/11/2011] [Indexed: 10/15/2022]
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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 2011; 285:1415-9. [DOI: 10.1007/s00404-011-2135-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 10/27/2011] [Indexed: 10/15/2022]
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Marcickiewicz J, Sundfeldt K. Accuracy of intraoperative gross visual assessment of myometrial invasion in endometrial cancer. Acta Obstet Gynecol Scand 2011; 90:846-51. [PMID: 21534933 DOI: 10.1111/j.1600-0412.2011.01166.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the accuracy of gross visual assessment of myometrial invasion in endometrial carcinoma. DESIGN Prospective, descriptive study. SETTING University hospital. POPULATION Two hundred and fourteen consecutive patients operated between 2005 and 2008. All patients were preoperatively diagnosed with endometrial carcinoma or complex atypical hyperplasia considered by the pathologist to be at the border of highly differentiated endometrial cancer. METHODS Intraoperative gross visual assessment of myometrial tumor invasion (<50 or ≥50%), cervical tumor engagement and tumor diameter in millimeters were noted for all patients. MAIN OUTCOME MEASURES The collected data were compared with final histopathology. RESULTS Intraoperative gross visual assessment of myometrial tumour invasion correlated well with final histology, with an accuracy of 87%. Agreement between gross visual assessment and final histology was reached in 91% of grade 1 tumors. Additionally, we found that 98.5% of tumors with a diameter <20mm had <50% myometrial invasion, regardless of grade. CONCLUSIONS Intraoperative gross visual assessment of myometrial tumor invasion and tumor size measurements are simple, fast and inexpensive methods that may provide important information for the surgeon to decide upon the extent of staging when other more accurate methods are not at hand.
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Affiliation(s)
- Janusz Marcickiewicz
- Institute for Clinical Sciences, Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Sweden.
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Loubeyre P, Undurraga M, Bodmer A, Petignat P. Non-invasive modalities for predicting lymph node spread in early stage endometrial cancer? Surg Oncol 2011; 20:e102-8. [DOI: 10.1016/j.suronc.2011.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 01/19/2011] [Indexed: 11/25/2022]
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Yanazume S, Saito T, Eto T, Yamanaka T, Nishiyama K, Okadome M, Ariyoshi K. Reassessment of the utility of frozen sections in endometrial cancer surgery using tumor diameter as an additional factor. Am J Obstet Gynecol 2011; 204:531.e1-7. [PMID: 21420065 DOI: 10.1016/j.ajog.2011.01.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 12/09/2010] [Accepted: 01/31/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to improve the reliability of frozen section with the use of tumor diameter (TD) as an additional factor and intraoperatively to identify a subgroup of early endometrial cancers that would not require lymphadenectomy. STUDY DESIGN Data for 228 patients who underwent surgery with frozen section were analyzed retrospectively. Lymphadenectomy was performed in 86% of patients; the nodes were positive in 8%. RESULTS The accuracy of frozen section for myometrial invasion, grade, and low-risk prediction significantly increased with decreasing TD (P = .036) and was 98%, 95%, and 95%, respectively, when the TD was ≤3 cm. Patients with a TD of ≤2 cm and patients with a TD of 2-3 cm who had low-risk predictors had no nodal metastasis; patients with a TD of 2-3 cm who had intermediate-high risk predictors and a TD of >3 cm with any level of risk predictors were at risk of nodal metastases. CONCLUSION When the TD was ≤3 cm, the low-risk group that is defined by frozen section can be predicted accurately and safely to remain lymph-node metastasis free.
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Affiliation(s)
- Shintaro Yanazume
- Gynecology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
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Total Laparoscopic Hysterectomy in Early-Stage Endometrial Cancer Using an Intrauterine Manipulator: Is It a Bias for Frozen Section Analysis? Case-Control Study. J Minim Invasive Gynecol 2011; 18:184-8. [DOI: 10.1016/j.jmig.2010.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 11/13/2010] [Accepted: 11/17/2010] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW Hysterectomy with bilateral salpingo-oophorectomy is the standard surgery for endometrial cancer. However, the indication and extent of surgical lymph node staging continues to be controversial if the carcinoma is confined to the uterus, even in the eyes of the experts. The survival benefit of this invasive staging technique has not been clearly demonstrated in this setting. RECENT FINDINGS We have focused our review on lymph node disease in patients with early endometrial cancer. We report on the important issues surrounding lymphadenectomy in endometrial cancer and the results of a recent large randomized trial that do not indicate a benefit of surgical staging. Other issues, including complications and the benefits of combining laparoscopy with lymphadenectomy, will also be discussed. SUMMARY Pelvic and para-aortic lymphadenectomies are not appropriate for low-risk patients with endometrioid uterine cancer. The risk-benefit balance for these patients seems rather in favor of not performing surgical staging. On the contrary, high-risk patients would seem to benefit from complete pelvic and para-aortic lymph node staging with adjuvant treatments tailored to the results of lymphadenectomy.
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Karube Y, Fujimoto T, Takahashi O, Nanjyo H, Mizunuma H, Yaegashi N, Sugiyama T, Kurachi H, Sato A, Tanaka T. Histopathological prognostic factors predicting para-aortic lymph node metastasis in patients with endometrioid uterine cancer. Gynecol Oncol 2010; 118:151-4. [DOI: 10.1016/j.ygyno.2010.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 05/03/2010] [Accepted: 05/05/2010] [Indexed: 10/19/2022]
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Çelik Ç, Özdemir S, Esen H, Balc O, Ylmaz O. The Clinical Value of Preoperative and Intraoperative Assessments in the Management of Endometrial Cancer. Int J Gynecol Cancer 2010; 20:358-62. [DOI: 10.1111/igc.0b013e3181cff1f3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Papadia A, Azioni G, Brusacà B, Fulcheri E, Nishida K, Menoni S, Simpkins F, Lucci JA, Ragni N. Frozen section underestimates the need for surgical staging in endometrial cancer patients. Int J Gynecol Cancer 2010; 19:1570-3. [PMID: 19955939 DOI: 10.1111/igc.0b013e3181bff64b] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare the risk status for lymph nodal metastasis at frozen section in endometrial cancer by applying a model based on tumor grade and myometrial involvement. STUDY DESIGN A retrospective analysis was performed on 174 early-stage endometrial cancer patients on whom an intraoperative frozen section was requested. Patients were retrospectively divided into low, intermediate, and high risk for lymph nodal involvement based on tumor grade and myometrial invasion based on Gynecologic Oncology Group 33 data. Concordance of risk status at frozen and permanent sections was performed. RESULTS Risk status at frozen and permanent sections were highly correlated (P < 0.01). Agreement between frozen and permanent sections was substantial (kappa = 0.625). In 16% of the cases, frozen section underestimated the risk when compared with permanent section. CONCLUSION Relying on intraoperative frozen section of the uterus to assess risk status for lymph nodal involvement in early-stage endometrial cancer patients leads to suboptimal management in a substantial number of cases.
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Affiliation(s)
- Andrea Papadia
- Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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Han SS, Lee SH, Kim DH, Kim JW, Park NH, Kang SB, Song YS. Evaluation of preoperative criteria used to predict lymph node metastasis in endometrial cancer. Acta Obstet Gynecol Scand 2010; 89:168-74. [PMID: 19916890 DOI: 10.3109/00016340903370114] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate whether we could accurately predict lymph node (LN) metastasis with preoperative tests in endometrial cancer. Design. Retrospective study. SETTING Seoul National University Hospital, South Korea. Population. Three hundred patients with endometrial cancer who underwent surgical staging including lymphadenectomy between January 1999 and July 2007. METHODS We reviewed the medical records of 300 patients with endometrial cancer. The preoperative factors used to predict LN metastasis were as follows: old age (> or = 55 years), serum CA-125 level [level > or = 20 U/mL (if age < 50 years), level > or = 28 U/mL (if age > or = 50 years)], non-endometrioid histologic type and Grade 3, metastatic LN assessed by pelvic MRI or CT, and deep myometrial invasion assessed by pelvic MRI only. Logistic regression analysis was used to determine the significant predictive factors. MAIN OUTCOME MEASURES Sensitivity/specificity and false positive/negative rates. RESULTS Thirty patients had LN metastasis. Although LN evaluation by pelvic MRI or CT and high CA-125 level were the significant independent predictors for LN metastasis, the sensitivity/specificity and false positive/negative rates for LN metastasis by these two combined preoperative tests were 86.7%/71.4% and 68.7%/2.7%, respectively. However, the sensitivity/specificity and false positive/negative rates for LN metastasis by six combined preoperative tests were 100%/28.9% and 84.6%/0%, respectively. CONCLUSIONS The six combined preoperative tests are useful in selecting patients without LN metastasis in endometrial cancer. Lymphadenectomy could be avoided in about 29% of patients with endometrial cancer who have no LN metastasis by using six combined preoperative tests.
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Affiliation(s)
- Seung-Su Han
- Department of Obstetrics and Gynecology, Chung-Ang University College of Medicine, Seoul, Korea
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Furukawa N, Takekuma M, Takahashi N, Hirashima Y. Intraoperative evaluation of myometrial invasion and histological type and grade in endometrial cancer: diagnostic value of frozen section. Arch Gynecol Obstet 2009; 281:913-7. [DOI: 10.1007/s00404-009-1263-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 10/08/2009] [Indexed: 11/24/2022]
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[Is there an interest in para-aortic lymphadenectomy in operable endometrial cancer?]. Bull Cancer 2009; 97:199-209. [PMID: 19812008 DOI: 10.1684/bdc.2009.0956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The indication and extent of lymph node dissection in the surgical management of endometrial cancer remains controversial especially concerning the para-aortic lymph nodes. The therapeutic benefit of the lymph node dissection is criticized mainly for low-risk patients for extra-uterine spread. Surgically staging patients is the best method to predict node involvement and it allows an optimal decision for adjuvant therapy to be taken. The different prognostic factors for para-aortic lymph nodes metastasis are histological grade and size of the tumour, myometrial wall invasion and lymphovascular dissemination, as well as positive pelvic lymph nodes. However, these elements are not correctly evaluated before and during the surgery. Positive para-aortic lymph nodes can be found without a lymphatic spread to the pelvic area. Even though the prevalence of para-aortic node involvement is weak, it seems legitimate to propose in selected cases of important lymph node involvement, it's complete dissection if a pelvic lymphadenectomy is indicated and if it is surgically possible.
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Özdemir S, Çelik Ç, Emlik D, Kiresi D, Esen H. Assessment of Myometrial Invasion in Endometrial Cancer by Transvaginal Sonography, Doppler Ultrasonography, Magnetic Resonance Imaging and Frozen Section. Int J Gynecol Cancer 2009; 19:1085-90. [DOI: 10.1111/igc.0b013e3181ad3eb6] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective:We aimed to compare the diagnostic performance of transvaginal sonography (TVS), magnetic resonance imaging (MRI), and intraoperative frozen section in the assessment of myometrial invasion and to evaluate intratumoral blood flow in any myometrial invasion with transvaginal Color Doppler ultrasonography (TV-CDU).Methods:This prospective study included 64 women consecutively diagnosed with endometrial carcinoma. The subjects were evaluated by TVS, MRI, and TV-CDU by 2 radiologists with a special training in gynecology. Intraoperatively, a frozen section was obtained and processed for interpretation by a blinded pathologist. Sensitivity, specificity, negative, and positive predictive values were calculated for each imaging modality and frozen section with regard to assessment of myometrial invasion. The intratumoral blood flow was evaluated by TV-CDU.Results:Transvaginal sonography, MRI, and frozen section showed no statistical significant differences in overall diagnostic performance for the preoperative and intraoperative assessment of any myometrial invasion, although frozen section seemed to be slightly superior to the imaging techniques. The positive rate of intratumoral blood flow was higher in deep myometrial invasion, but statistical significance was not obtained. The mean value of resistance index was significantly lower in the cases with deep myometrial invasion.Conclusions:Transvaginal sonography with concomitant TV-UCD is low-cost, easily performed, and repeated technique for particularly deep myometrial invasion. Because of its high costs and time-consuming, MRI may be recommended in the cases with poor quality of TVS. Because depending solely on imaging methods could lead to insufficient treatment schedules, intraoperative frozen section should also be performed for myometrial assessment.
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Sato S, Itamochi H, Shimada M, Fujii S, Naniwa J, Uegaki K, Sato S, Nonaka M, Ogawa T, Kigawa J. Preoperative and Intraoperative Assessments of Depth of Myometrial Invasion in Endometrial Cancer. Int J Gynecol Cancer 2009; 19:884-7. [DOI: 10.1111/igc.0b013e3181a7a2d9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
PURPOSE OF REVIEW Many reports suggest the significance of pelvic lymph-node (PLN) adenectomy in patients with endometrial cancer. However, among these, there is controversy regarding not only what type of patients should have lymphadenectomy performed, but also what extent lymphadenectomy should be performed. RECENT FINDINGS It has been reported that PLN adenectomy has therapeutic significance in stage I grade 3 and more advanced endometrioid uterine cancer. However, the effects of para-aortic lymph-node adenectomy on its prognostic benefit have not been discussed. SUMMARY Patients with low-risk disease might not benefit from PLN adenectomy. However, PLN adenectomy might still have merit in low-risk patients, as there are inaccuracies of preoperative and intraoperative assessments. A complete lymphadenectomy is safe with minimum complications. At this point, hysterectomy and bilateral salpingo-oophorectomy with complete PLN adenectomy as the standard surgical procedure for endometrial cancer is thought to be reasonable. At present, the addition of p-aortic lymph-node adenectomy is regarded as an investigated protocol for endometrial cancer. However, p-aortic lymph-node adenectomy may have a therapeutic role for stage IIIC patients. Prospective randomized controlled trial composed of intermediate/high-risk patients should be conducted to clearly demonstrate prognostic improvement by p-aortic lymph-node adenectomy itself.
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Lee KB, Ki KD, Lee JM, Lee JK, Kim JW, Cho CH, Kim SM, Park SY, Jeong DH, Kim KT. The Risk of Lymph Node Metastasis Based on Myometrial Invasion and Tumor Grade in Endometrioid Uterine Cancers: A Multicenter, Retrospective Korean Study. Ann Surg Oncol 2009; 16:2882-7. [DOI: 10.1245/s10434-009-0535-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 02/05/2009] [Accepted: 02/05/2009] [Indexed: 11/18/2022]
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Fotiou S, Vlahos N, Kondi-Pafiti A, Zarganis P, Papakonstantinou K, Creatsas G. Intraoperative gross assessment of myometrial invasion and cervical involvement in endometrial cancer: Role of tumor grade and size. Gynecol Oncol 2009; 112:517-20. [DOI: 10.1016/j.ygyno.2008.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Revised: 11/05/2008] [Accepted: 11/09/2008] [Indexed: 10/21/2022]
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Giede KC, Yen TW, Chibbar R, Pierson RA. Significance of concurrent endometrial cancer in women with a preoperative diagnosis of atypical endometrial hyperplasia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:896-901. [PMID: 19038073 PMCID: PMC2891955 DOI: 10.1016/s1701-2163(16)32969-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Our objectives were (1) to review the rate of concurrent endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia (AEH); (2) to determine the proportion of patients with concurrent endometrial cancer who have high-risk disease; and (3) to re-evaluate our surgical management of AEH. METHODS We performed a retrospective chart review of all patients who had surgery on the basis of a preoperative diagnosis of atypical endometrial hyperplasia between January 2001 and December 2006. Demographic data, the method of preoperative diagnosis, postoperative grade of tumour, and other postoperative findings were recorded. When applicable, this included cancer stage, lymph node status, and presence of lymphovascular space invasion. In postoperative review, patients were considered to be high risk if they had disease beyond the uterus or a combination of other risk factors. RESULTS Of 70 patients, 25 (35.7%) were found to have concurrent endometrial cancer. This was higher than the commonly accepted rate of 25% (P = 0.03). Of the 25 patients upgraded, 4 (16%) had high-risk cancer on final pathologic evaluation. CONCLUSION Simple hysterectomy in women with AEH may result in inadequate surgical management. Simple methods are required to identify patients with a preoperative diagnosis of AEH who may harbour significant cancers.
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Affiliation(s)
- Kurt Christopher Giede
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan, Saskatoon SK
| | - Tin-Wing Yen
- Faculty of Medicine University of Saskatchewan, Saskatoon SK
| | - Rajni Chibbar
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon SK
| | - Roger A Pierson
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan, Saskatoon SK
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Egle D, Grissemann B, Zeimet AG, Müller-Holzner E, Marth C. Validation of intraoperative risk assessment on frozen section for surgical management of endometrial carcinoma. Gynecol Oncol 2008; 110:286-92. [PMID: 18653219 DOI: 10.1016/j.ygyno.2008.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 04/24/2008] [Accepted: 05/15/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aimed to evaluate the accuracy of risk assessment in intraoperative frozen section (IFS) in order to direct surgical management and also attempted to validate the clinical significance of using five variables for classification as low- or intermediate high-risk endometrial carcinoma in routine practice. PATIENTS AND METHODS Charts of 410 patients who underwent surgery for endometrial cancer between January 1992 and December 2003 were retrospectively reviewed, and risk assignment on the basis of IFS was compared with final pathological reports. Clinical relevance of risk assessment and its surgical consequences were studied on the basis of patient survival data. RESULTS In 303 (95%) of 318 cases, IFS-assessed risk corresponded with that estimated from final paraffin sections, giving a positive predictive value of 99% and a negative predictive value of 92%. Unrecognized lymphovascular invasion in IFS was the main factor responsible for the discrepancies between the two examinations. Survival analysis showed a highly significantly better outcome for patients with low-risk as compared to intermediate high-risk carcinomas for recurrence-free (RFS) and overall survival (OS). However, survival in patients with intermediate high-risk carcinomas who underwent lymphadenectomy (LNE) was not significantly improved as compared to those who did not. Moreover, in multivariate analysis lymph node involvement did not emerge as a variable with significant impact on survival. Age, tumor stage and intraoperatively assessed risk were seen to be independent prognosticators in this study (p<0.0001). CONCLUSION Our data show that IFS, when performed by experienced gynecopathologists, is a reliable and applicable tool in estimating risk in endometrial cancer and that systematic LNE seems to not be superior to radiotherapy with regard to patient survival.
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Affiliation(s)
- Daniel Egle
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria.
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A Practical Approach to Intraoperative Consultation in Gynecological Pathology. Int J Gynecol Pathol 2008; 27:353-65. [DOI: 10.1097/pgp.0b013e31815c24fe] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yamazawa K, Shimada H, Hirai M, Hirashiki K, Ochiai T, Ishikura H, Shozu M, Isaka K. Serum p53 antibody as a diagnostic marker of high-risk endometrial cancer. Am J Obstet Gynecol 2007; 197:505.e1-7. [PMID: 17980190 DOI: 10.1016/j.ajog.2007.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 01/08/2007] [Accepted: 04/18/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the diagnostic impact of preoperative serum p53 antibody (S-p53 Ab) in patients with endometrial cancer. STUDY DESIGN A hospital-based series of 67 patients, comprising 58 endometrioid adenocarcinomas (EA) and 9 serous adenocarcinomas (SA) between 1998-2002 were included. First, preoperative pathology was compared with final pathology in terms of histologic classification and tumor grade. Second, S-p53 Ab and CA125 were measured using preoperative serum samples, and immunohistochemical staining for p53 protein was assessed using hysterectomy specimens. RESULTS There were discrepancies between preoperative and final pathology in terms of histologic classification (7%) and tumor grade in EAs (30%); other objective tests, therefore, were needed to minimize the diagnostic problems. S-p53 Ab titers varied from 0.27-786 (mean, 124) in SAs and from 0.1-7.47 (mean, 0.46) U/mL in EAs, respectively, and were positive in 6 (67%) SAs and in 3 (6%) EAs using 1.3 U/mL as cut-off. S-p53 Ab-positive rate was significantly correlated with SA histology and grade 3 EA tumor (odds ratio, 40; P = .005; 95% confidence interval, 3.04-525.43) with higher sensitivity and higher specificity than p53 staining and CA125, respectively. CONCLUSION S-p53 Ab could conveniently and specifically identify high-risk endometrial cancer.
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Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Treatment modalities in endometrial cancer. Curr Opin Oncol 2007; 19:479-85. [PMID: 17762575 DOI: 10.1097/cco.0b013e32827853c0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Endometrial cancer is the most common malignancy of the female genital tract. This review highlights new insights and these will change current practice. RECENT FINDINGS Surgery is the cornerstone of the treatment of endometrial cancer but the metastatic pattern is different for types 1 and 2. The surgical staging procedure therefore depends on subtype. Type 2 endometrial cancers often metastasize to the lymph nodes and peritoneal cavity and patients should undergo a staging procedure similar to that performed for ovarian cancer. Laparoscopic staging and treatment for endometrial cancer appears to be safe and effective. Adequate staging also serves to appropriately tailor adjuvant treatment modalities that benefit high-risk patients only. Recent data suggest adequate staging to improve the overall survival. In addition, following complete surgical staging, recent studies emphasize the benefit for adjuvant chemotherapy in early stage serous endometrial cancer. Adjuvant chemotherapy appears to be more effective than radiotherapy for type 1 cancers. In the primarily advanced or recurrent setting, hormonal treatment may be beneficial. Doxorubicin-cisplatin is still the standard chemotherapy regime used in many centres; paclitaxel-containing regimes also appear to show promise. SUMMARY Recent data shed new light on the current concepts of tumour spread, surgical staging and adjuvant treatment modalities for endometrial cancer.
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Affiliation(s)
- Frederic Amant
- Leuven Cancer Institute (LKI), UZ Gasthuisberg, Katholieke Universiteit, Leuven, Belgium
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Abstract
Although surgical pathological staging is the standard of care for uterine carcinoma, the benefits of a complete lymphadenectomy remain controversial. Evidence suggests that this procedure provides prognostic information and directs the use of appropriate adjuvant treatment in patients who are node-positive. Furthermore, it eliminates the need for adjuvant treatment in low-risk patients with negative nodes and no extrauterine spread of disease. Although the complications associated with this procedure raise the question as to whether all low-risk patients need a complete lymphadenectomy, the limitations of preoperative and intraoperative pathological analyses mean that lymphadenectomy in low-risk patients might still have merit. Future advances are warranted to enhance preoperative radiological and intraoperative pathological assessment to establish the risk of nodal disease. In this review, we assess the evidence on the prognostic and therapeutic benefits of a complete versus selective lymphadenectomy. Moreover, we discuss the complications associated with lymphadenectomy and identify subsets of low-risk patients who might not need to undergo this procedure.
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Affiliation(s)
- John K Chan
- University of California, San Francisco Comprehensive Cancer Center, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, San Francisco, CA, USA.
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Todo Y, Okamoto K, Hayashi M, Minobe S, Nomura E, Hareyama H, Takeda M, Ebina Y, Watari H, Sakuragi N. A validation study of a scoring system to estimate the risk of lymph node metastasis for patients with endometrial cancer for tailoring the indication of lymphadenectomy. Gynecol Oncol 2007; 104:623-8. [PMID: 17097721 DOI: 10.1016/j.ygyno.2006.10.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 09/14/2006] [Accepted: 10/02/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to verify whether a preoperative scoring system to estimate the risk of lymph node metastasis (LNM) in endometrial carcinoma is clinically useful for tailoring the indication of lymphadenectomy. STUDY DESIGN LNM score was set up using volume index, serum CA125 level, and tumor grade/histology, which were found to be independent risk factors for LNM in a pilot study. Based on the LNM score before a validation study was started, the estimated rates of LNM (para-aortic LNM) were 3.4% (0.0%) in a low risk group, 7.7% (5.8%) in an intermediate group, 44.4% (30.6%) in a high risk group and 70.0% (50.0%) in an extremely high risk group. The validation study was carried out using data for 211 patients with endometrial carcinoma for whom three risk factors were preoperatively confirmed. Logistic regression analysis was used to determine whether these factors remain valid. The actual rate of LNM was investigated according to the LNM score. RESULTS Volume index, serum CA125 level, and tumor grade/histology were found to be independent risk factors for LNM in the cohort of this study. The actual rates of LNM (para-aortic LNM) were 3.2% (1.0%) in the low risk group, 15.3% (11.9%) in the intermediate group, 30.2% (23.8%) in the high risk group and 78.6% (57.1%) in the extremely high risk group. CONCLUSION The actual rate of LNM for each score was fairly consistent with the estimated rate of LNM. Para-aortic lymphadenectomy may not be necessary in cases of a low risk group. A large prospective multicenter clinical trial needs to be conducted to establish the clinical usefulness of our preoperative scoring system.
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Affiliation(s)
- Yukiharu Todo
- Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Kita-15, Nishi-7, Kita-Ku, Sapporo 060-8638, Japan.
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Sauer G, Herr D, Kurzeder C, Bäuerle M, Jäger C, Kreienberg R. Diagnostische Verfahren beim Endometriumkarzinom. GYNAKOLOGE 2007. [DOI: 10.1007/s00129-006-1928-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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