1
|
Bell S, Smith K, Kim H, Orellana T, Harinath L, Rush S, Olawaiye A, Lesnock J. Hysterectomy with sentinel lymph node dissection in the setting of preoperative endometrial intraepithelial neoplasia and an endometrial stripe ≥20 mm: a cost-effectiveness analysis . Int J Gynecol Cancer 2024:ijgc-2024-005658. [PMID: 39107049 DOI: 10.1136/ijgc-2024-005658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVES Routine lymph node assessment in patients with endometrial intraepithelial neoplasia is institution and surgeon-dependent without clear guidelines. We sought to determine if routine sentinel lymph node (SLN) dissection at the time of laparoscopic hysterectomy for patients with a preoperative diagnosis of endometrial intraepithelial neoplasia and a preoperative ultrasound with endometrial stripe ≥20 mm is cost-effective. METHODS A decision model was created to perform two cost-effectiveness analyses: (1) hysterectomy with frozen section versus hysterectomy with SLN dissection in patients with a preoperative diagnosis of endometrial intraepithelial neoplasia and an endometrial stripe of 20 mm or greater, and (2) the same options in all patients with a preoperative diagnosis of endometrial intraepithelial neoplasia. Costs obtained from Centers for Medicare and Medicaid Services and event probabilities and quality of life utility values were obtained through literature review. RESULTS In the case of preoperative endometrial stripe ≥20 mm, hysterectomy with SLN dissection cost $2469 more than hysterectomy with frozen section and gained 0.010 quality adjusted life years, or $44,997/quality-adjusted life years gained. In one-way sensitivity analyses, SLN dissection remained the favored strategy at a willingness to pay threshold of $100,000/quality-adjusted life years unless chronic lower extremity lymphedema after full lymphadenectomy had a likelihood <13.1% (base case value 18.1%); otherwise, SLN dissection was favored with individual variation of all other parameters over plausible ranges. When considering all patients with endometrial intraepithelial neoplasia, hysterectomy with frozen section was favored, with results most sensitive to variation of lymphedema risk after full lymphadenectomy. CONCLUSION Hysterectomy with SLN dissection in patients with a preoperative endometrial stripe ≥20mm on ultrasound is cost-effective when compared with hysterectomy with frozen section.
Collapse
Affiliation(s)
- Sarah Bell
- Gynecologic Oncology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Kenneth Smith
- General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Haeyon Kim
- Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Taylor Orellana
- Gynecologic Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lakshmi Harinath
- Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shannon Rush
- Gynecologic Oncology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Alexander Olawaiye
- Gynecologic Oncology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Jamie Lesnock
- Gynecologic Oncology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
2
|
Harms JWA, Streckert EMS, Kiolbassa NM, Thomas C, Grauer O, Oertel M, Eich HT, Stummer W, Paulus W, Brokinkel B. Confounders of intraoperative frozen section pathology during glioma surgery. Neurosurg Rev 2023; 46:286. [PMID: 37891361 DOI: 10.1007/s10143-023-02169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/31/2023] [Accepted: 09/24/2023] [Indexed: 10/29/2023]
Abstract
Although frozen section pathology (FSP) is commonly performed during surgery for glioma-suspicious lesions, confounders of accuracy are largely unknown. FSP and final diagnosis were compared in 398 surgeries for glioma-suspicious lesions. Diagnostic accuracy, risk factors for diagnostic shift from neoplastic to non-neoplastic tissue and vice versa according to the final diagnosis, and the impact on intraoperative and postoperative decision-making were analyzed. Diagnostic shift occurred in 70 cases (18%), and sensitivity, specificity, and the positive (PPV) and negative (NPV) predictive value of FSP were 82.5%, 77.8%, 99.4%, and 9.3%, respectively. No correlations between shift and patients' age and sex, sample fluorescence or volume, tumor location, correct information on the pathology form, final high- or low-grade histology, or molecular alterations were found (p > .05, each). Shift was more common after irradiation (25% vs 15%; p = .025) or chemotherapy (26% vs 15%; p = .022) than in treatment naïve cases and correlated with the type of surgery (p = .002). FSP altered intraoperative decision-making in 25 cases (6%). Postoperative shift led to repeated surgery in 12 patients (3%). In 45 cases, in which FSP and final diagnosis based on the same tissue, shift occurred in only 5 patients (11%), and sensitivity, specificity, PPV, and NPV for FSP were 77.4%, 78.6%, 88.9%, and 61.1%, respectively. No correlations between diagnostic shift and any of the analyzed variables were found (p > .05, each). Although accuracy of FSP during glioma surgery is sufficient, moderate NPV should be considered during intraoperative decision-making. While confounders are sparse, accuracy might be increased by repeated sampling. Diagnostic shift rarely alters postoperative treatment strategy.
Collapse
Affiliation(s)
| | | | | | - Christian Thomas
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Oliver Grauer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Michael Oertel
- Department of Radiation Oncology, University Hospital Münster, Münster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Benjamin Brokinkel
- Department of Neurosurgery, University Hospital Münster, Münster, Germany.
- Institute of Neuropathology, University Hospital Münster, Münster, Germany.
| |
Collapse
|
3
|
Begum D, Barmon D, Baruah U, Ahmed S, Gupta S, Bassetty KC. Intraoperative frozen section in gynaecology cancers with special reference to ovarian tumours: time to "unfreeze" the pitfalls in the path of the Derby horse of Oncology. J Cancer Res Clin Oncol 2023; 149:9767-9775. [PMID: 37247079 DOI: 10.1007/s00432-023-04866-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE In an oncological set up the role of frozen section biopsy is undeniable. They serve as an important tool for surgeon's intraoperative decision making but the diagnostic reliability of intraoperative frozen section may vary from institute to institute. The surgeon should be well aware of the accuracy of the frozen section reports in their setup to enable them to take decisions based on the report. This is why we had conducted a retrospective study at Dr B. Borooah Cancer Institute, Guwahati, Assam, India to find out our institutional frozen section accuracy. METHODS The study was conducted from 1st January 2017 to 31st December 2022 (5 years). All gynaecology oncology patients who were operated on during the study period and had an intraoperative frozen section done were included in the study. Patients who had incomplete final histopathological report (HPR) or no final HPR were excluded from the study. Frozen section and final histopathology report were compared and analysed and discordant cases were analysed based on the degree of discordancy. RESULTS For benign ovarian disease, the IFS accuracy, sensitivity and specificity are 96.7%, 100% and 93%, respectively. For borderline ovarian disease the IFS accuracy, sensitivity and specificity are 96.7%, 80% and 97.6%, respectively. For malignant ovarian disease the IFS accuracy, sensitivity and specificity are 95.4%, 89.1% and 100%, respectively. Sampling error was the most common cause of discordancy. CONCLUSION Intraoperative frozen section may not have 100% diagnostic accuracy but still it is the running horse of our oncological institute.
Collapse
Affiliation(s)
- Dimpy Begum
- Gynaecological Oncology, Dr B. Borooah Cancer Institute, Guwahati, India
| | - Debabrata Barmon
- Gynaecological Oncology, Dr B. Borooah Cancer Institute, Guwahati, India
| | - Upasana Baruah
- Gynaecological Oncology, Dr B. Borooah Cancer Institute, Guwahati, India
| | - Shiraj Ahmed
- Oncopathology, Dr B. Borooah Cancer Institute, Guwahati, India
| | - Sakshi Gupta
- Oncopathology, Dr B. Borooah Cancer Institute, Guwahati, India
| | | |
Collapse
|
4
|
Yang X, Yin J, Fu Y, Shen Y, Zhang C, Yao S, Xu C, Xia M, Lou G, Liu J, Lin B, Wang J, Zhao W, Zhang J, Cheng W, Guo H, Guo R, Xue F, Wang X, Han L, Li X, Zhang P, Zhao J, Li W, Dou Y, Wang Z, Liu J, Li K, Chen G, Sun C, Wang B, Yang X. It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large-scale, multi-center, and retrospective study. Cancer Med 2023; 12:8897-8910. [PMID: 36718983 PMCID: PMC10134352 DOI: 10.1002/cam4.5643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Stage IB (deep myometrial invasion) high-grade endometrioid adenocarcinoma (EA), regardless of LVSI status, is classified into high-intermediate risk groups, requiring surgical lymph node staging. Intraoperative frozen section (IFS) is commonly used, but its adequacy and reliability vary between reports. Hence, we determined the utility of IFS in identification of high-risk factors, including deep myometrial invasion and high-grade. METHOD We retrospectively analyzed 9,985 cases operated with hysterectomy and diagnosed with FIGO stage I/II EA in postoperative paraffin section (PS) results at 30 Chinese hospitals from 2000 to 2019. We determined diagnostic performance of IFS and investigated whether the addition of IFS to preoperative biopsy and imaging could improve identification of high-risk factors. RESULTS IFS and postoperative PS presented the highest concordance in assessing deep myometrial invasion (Kappa: 0.834), followed by intraoperative gross examination (IGE Kappa: 0.643), MRI (Kappa: 0.395), and CT (Kappa: 0.207). IFS and postoperative PS presented the highest concordance for high-grade EA (Kappa: 0.585) compared to diagnostic curettage (D&C 0.226) and hysteroscope (Hys 0.180). Sensitivity and specificity for detecting deep myometrial invasion were 86.21 and 97.20% for IFS versus 51.72 and 88.81% for MRI, 68.97 and 94.41% for IGE. These figures for detecting high-grade EA were 58.21 and 96.50% for IFS versus 16.42 and 98.83% for D&C, 13.43 and 98.64% for Hys. Parallel strategies, including MRI-IFS (Kappa: 0.626), D&C-IFS (Kappa: 0.595), and Hys-IFS (Kappa: 0.578) improved the diagnostic efficiencies of individual preoperative examinations. Based on the high sensitivity of IFS, parallel strategies improved the sensitivities of preoperative examinations to 89.66% (MRI), 64.18% (D&C), 62.69% (Hys), respectively, and these differences were statistically significant (p = 0.000). CONCLUSION IFS presented reasonable agreement rates predicting postoperative PS results, including deep myometrial invasion and high-grade. IFS helps identify high-intermediate risk patients in preoperative biopsy and MRI and guides intraoperative lymphadenectomy decisions in EA.
Collapse
Affiliation(s)
- Xiaohang Yang
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Department of Gynecology and ObstetricsTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Jingjing Yin
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Department of Gynecology and ObstetricsTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Yu Fu
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Department of Gynecology and ObstetricsTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Yuanming Shen
- Women's Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Chuyao Zhang
- Department of Gynecologic OncologySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Shuzhong Yao
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Congjian Xu
- Department of GynecologyObstetrics and Gynecology Hospital of Fudan UniversityShanghaiChina
| | - Min Xia
- Department of Gynecology and ObstetricsThe Affiliated Yantai Yuhuangding Hospital of Qingdao UniversityYantaiShandongChina
| | - Ge Lou
- Department of Gynecology OncologyHarbin Medical University Cancer HospitalHarbinChina
| | - Jihong Liu
- Department of Gynecologic OncologySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Bei Lin
- Department of Obstetrics and GynecologyShengjing Hospital Affiliated to China Medical UniversityShenyangLiaoningChina
| | | | - Weidong Zhao
- Division of Life Sciences and MedicineThe First Affiliated Hospital of USTC, University of Science and Technology of ChinaHefeiAnhuiChina
| | - Jieqing Zhang
- Department of Gynecologic OncologyGuangxi Medical University Cancer HospitalNanningGuangxiChina
| | - Wenjun Cheng
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Hongyan Guo
- The Third Hospital of Peking UniversityBeijingChina
| | - Ruixia Guo
- Department of Gynecology and Obstetricsthe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Fengxia Xue
- Department of Gynecology and ObstetricsTianjin Medical University General HospitalTianjinChina
| | - Xipeng Wang
- Department of Gynecology and ObstetricsXinHua Hospital, Shanghai JiaoTong University School of MedicineShanghaiChina
| | - Lili Han
- Department of GynecologyPeople's Hospital of Xinjiang Uygur Autonomous RegionUrumqiChina
| | - Xiaomao Li
- Department of Gynecology and ObstetricsThe Third Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Ping Zhang
- Department of GynecologyThe Second Hospital of Shandong UniversityJinanShandongChina
| | - Jianguo Zhao
- Department of Gynecologic OncologyTianjin Central Hospital of Gynecology and Obstetrics, Affiliated Hospital of Nankai University; Tianjin Clinical Research Center For Gynecology and Obstetrics; Branch of National Clinical Research Center For Gynecology and ObstetricsTianjinChina
| | - Wenting Li
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Department of Gynecology and ObstetricsTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Yingyu Dou
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Department of Gynecology and ObstetricsTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Zizhuo Wang
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Department of Gynecology and ObstetricsTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Jingbo Liu
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Department of Gynecology and ObstetricsTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Kezhen Li
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Department of Gynecology and ObstetricsTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Gang Chen
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Department of Gynecology and ObstetricsTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Chaoyang Sun
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Department of Gynecology and ObstetricsTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Beibei Wang
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Department of Gynecology and ObstetricsTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Xingsheng Yang
- Department of Obstetrics and Gynecology, Qilu HospitalCheeloo College of Medicine, Shandong UniversityJinanShandongChina
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Yang X, Yin J, Fu Y, Shen Y, Zhang C, Yao S, Xu C, Xia M, Lou G, Liu J, Lin B, Wang J, Zhao W, Zhang J, Cheng W, Guo H, Guo R, Xue F, Wang X, Han L, Li X, Zhang P, Zhao J, Li W, Dou Y, Wang Z, Liu J, Li K, Chen G, Sun C, Sun P, Lu W, Yao Q. Preoperative and intraoperative assessment of myometrial invasion in patients with FIGO stage I non-endometrioid endometrial carcinoma-a large-scale, multi-center, and retrospective study. Diagn Pathol 2023; 18:8. [PMID: 36698195 PMCID: PMC9878924 DOI: 10.1186/s13000-023-01294-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Myometrial invasion is a prognostic factor for lymph node metastases and decreased survival in non-endometrioid endometrial carcinoma patients. Herein, we explored the mode of myometrial invasion diagnosis in FIGO stage I non-endometrioid carcinoma and evaluated the differences in diagnostic efficiency among intraoperative frozen section (IFS), intraoperative gross examination (IGE), magnetic resonance imaging (MRI), and computed tomography (CT) in clinical practice. Finally, we suggested which test should be routinely performed. METHOD This was a historical cohort study nationwide with 30 centers in China between January 2000 and December 2019. Clinical data, including age, histology, method of myometrial invasion evaluation (MRI, CT, IGE, and IFS), and final diagnosis of postoperative paraffin sections, were collected from 490 non-endometrioid endometrial carcinoma (serous, clear cell, undifferentiated, mixed carcinoma, and carcinosarcoma) women in FIGO stage I. RESULTS Among the 490 patients, 89.59% presented myometrial invasion. The methods reported for myometrial invasion assessment were IFS in 23.47%, IGE in 69.59%, MRI in 37.96%, and CT in 10.20% of cases. The highest concordance was detected between IFS and postoperative paraffin sections (Kappa = 0.631, accuracy = 93.04%), followed by IGE (Kappa = 0.303, accuracy = 82.40%), MRI (Kappa = 0.131, accuracy = 69.35%), and CT (Kappa = 0.118, accuracy = 50.00%). A stable diagnostic agreement between IFS and the final results was also found through the years (2000-2012: Kappa = 0.776; 2013-2014: Kappa = 0.625; 2015-2016: Kappa = 0.545; 2017-2019: Kappa = 0.652). CONCLUSION In China, the assessment of myometrial invasion in non-endometrioid endometrial carcinoma is often performed via IGE, but the reliability is relatively low in contrast to IFS. In clinical practice, IFS is a reliable method that can help accurately assess myometrial invasion and intraoperative decision-making (lymph node dissection or not). Hence, it should be routinely performed in non-endometrioid endometrial carcinoma patients.
Collapse
Affiliation(s)
- Xiaohang Yang
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Jingjing Yin
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Yu Fu
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Yuanming Shen
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000 China
| | - Chuyao Zhang
- grid.488530.20000 0004 1803 6191Department of Gynecologic Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng E Rd, Guangzhou, 510060 China
| | - Shuzhong Yao
- grid.412615.50000 0004 1803 6239Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, No 58. Zhong Shan ER Lu, Guangzhou, 510080 China
| | - Congjian Xu
- grid.412312.70000 0004 1755 1415Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Min Xia
- grid.440323.20000 0004 1757 3171Department of Gynecology and Obstetrics, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, NO 20 Yuhuangding East Road, Yantai, Shandong 264000 China
| | - Ge Lou
- grid.412651.50000 0004 1808 3502Department of Gynecology Oncology, Harbin Medical University Cancer Hospital, Harbin, 150086 China
| | - Jihong Liu
- grid.488530.20000 0004 1803 6191Department of Gynecologic Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng E Rd, Guangzhou, 510060 China
| | - Bei Lin
- grid.412467.20000 0004 1806 3501Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, Liaoning 110004 China
| | - Jianliu Wang
- grid.411634.50000 0004 0632 4559Peking University People’s Hospital, Beijing, 100044 China
| | - Weidong Zhao
- grid.59053.3a0000000121679639The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001 China
| | - Jieqing Zhang
- grid.256607.00000 0004 1798 2653Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, Guangxi 530021 China
| | - Wenjun Cheng
- grid.412676.00000 0004 1799 0784The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, Jiangsu 210029 China
| | - Hongyan Guo
- grid.411642.40000 0004 0605 3760The Third Hospital of Peking University, 49 North Garden Rd., Haidian District, Beijing, China
| | - Ruixia Guo
- grid.412633.10000 0004 1799 0733Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe East Road, Zhengzhou, 450052 China
| | - Fengxia Xue
- grid.412645.00000 0004 1757 9434Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154 Anshan Dao, Heping District, Tianjin, 300052 China
| | - Xipeng Wang
- grid.412987.10000 0004 0630 1330Department of Gynecology and Obstetrics, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200092 China
| | - Lili Han
- grid.410644.3Department of Gynecology, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Street, Tianshan District, Urumqi, 830001 China
| | - Xiaomao Li
- grid.412558.f0000 0004 1762 1794Department of Gynecology and Obstetrics, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, 510630 China
| | - Ping Zhang
- grid.452704.00000 0004 7475 0672Department of Gynecology, The Second Hospital of Shandong University, 247 Bei Yuan Street, Jinan, Shandong 250033 China
| | - Jianguo Zhao
- grid.410626.70000 0004 1798 9265Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Affiliated Hospital of Nankai University, No. 156, Sanma Road, Nankai District, Tianjin, 300100 China ,grid.216938.70000 0000 9878 7032Tianjin Clinical Research Center for Gynecology and Obstetrics, Affiliated Hospital of Nankai University, No. 156, Sanma Road, Nankai District, Tianjin, 300100 China ,grid.216938.70000 0000 9878 7032Branch of National Clinical Research Center for Gynecology and Obstetrics, Affiliated Hospital of Nankai University, No. 156, Sanma Road, Nankai District, Tianjin, 300100 China
| | - Wenting Li
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Yingyu Dou
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Zizhuo Wang
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Jingbo Liu
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Kezhen Li
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Gang Chen
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Chaoyang Sun
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Pengming Sun
- grid.256112.30000 0004 1797 9307Fujian Provincial Women & Children’s Hospital, Fujian Provincial Maternity & Children Health Hospital, Fujian Medical University, Fuzhou, Fujian 350000 China
| | - Weiguo Lu
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000 China
| | - Qin Yao
- grid.412521.10000 0004 1769 1119Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong 266003 China
| |
Collapse
|
7
|
Are blood parameters assessed before taking frozen sections useful in gynecological oncology? JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.7389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background/Aim: Inflammatory processes are often implicated in oncology, and inflammatory markers and indices have been much studied in this context. In gynecological surgery, frozen sections have proven valuable in decision-making. Here we aim to identify laboratory parameters that correlate with frozen section results and thus develop new indices in neoplastic decision-making.
Methods: In this retrospective cross-sectional study at Bursa Yüksek İhtisas Training and Research Hospital, we evaluated 139 patients diagnosed with adnexal mass and endometrial intraepithelial neoplasia. We divided the patients whose frozen sections were reported as malignant, borderline, or benign into three groups and compared the pre-operative complete blood parameters.
Results: The mean age of our patients was 57.3 (11.5) years, and frozen section reports were benign in 33 (23.7%), borderline in 43 (30.9%), and malignant in 63 (45.3%) patients. The mean corpuscular volume and mean platelet volume values were different, and this difference was significant between borderline and malignant groups in post-hoc analyses (P = 0.04 and P = 0.03, respectively). While the percentage of lymphocytes was lower in malignant groups, the percentage of neutrophils was higher (P = 0.01 and P = 0.03, respectively). According to post-hoc analysis, the percentage of neutrophils differs between benign and malignant groups (P = 0.05). The difference in lymphocyte percentage was significant between benign-borderline and benign-malignant groups (P = 0.02, P = 0.05; respectively). The blood neutrophil/lymphocyte ratio was higher in the malignant groups compared to the other two groups (P = 0.02). We used the Multi Linear Regression Analysis method to analyze the factors that play a role in predicting the frozen outcome as malignant. Accordingly, the model with the best performance used lymphocyte percentage, neutrophil/lymphocyte ratio, and Ca-125 parameters (P = 0.03).
Conclusion: This study indicates that inflammatory markers may give a clue about the character of the neoplastic mass before oncology surgery. Thus, we can make new contributions to the surgical and clinical approach in the literature by developing new malignancy indices.
Collapse
|
8
|
Santoro A, Travaglino A, Inzani F, Arciuolo D, Angelico G, D'Alessandris N, Scaglione G, Valente M, Martini M, Raffone A, Zannoni GF. Clear cell endometrial carcinoma precursors: presentation of two cases and diagnostic issues. Diagn Pathol 2021; 16:95. [PMID: 34689808 PMCID: PMC8543890 DOI: 10.1186/s13000-021-01154-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The precursors of clear cell endometrial carcinoma (CC-EC) are still undefined. Here, we deal with the diagnostic issues related to CC-EC precursors by presenting a morphological, immunophenotypical and molecular study of two representative cases and discussing the relevant literature. CASE PRESENTATION Our and previous cases suggest that clear cell endometrial intraepithelial carcinoma (CC-EIC) is a real entity, which may be distinguished from metaplastic/reactive changes and from its serous counterpart. CC-EIC appears associated with atrophic polyps and may be diagnosed based on morphological and immunophenotypical features of CC-EC in the absence of invasive disease. We described a p53-mutant putative precursor characterized by high-grade nuclei in the absence of other distinctive features. Two putative low-grade precursors resembled atypical tubal metaplasia and endometrial intraepithelial neoplasia, although immunohistochemistry could not support their relationship with CC-EC. CONCLUSIONS In conclusion, pathologists should be aware of the existence of CC-EIC, since its correct diagnosis may be crucial for a correct patient management. Although several putative earlier precursors have been described, they does not show univocal features that allow their recognition in the common practice. Further studies are necessary in this field.
Collapse
Affiliation(s)
- Angela Santoro
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy
| | - Antonio Travaglino
- Department of Advanced Biomedical Sciences, Pathology Section, School of Medicine, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Frediano Inzani
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy
| | - Damiano Arciuolo
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy
| | - Giuseppe Angelico
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy
| | - Nicoletta D'Alessandris
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy
| | - Giulia Scaglione
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy
| | - Michele Valente
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy
| | - Maurizio Martini
- Division of Pathology, Policlinico Gemelli Foundation, Catholic University of the Sacred Heart, Rome, Italy.,Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Roma, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gian Franco Zannoni
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy. .,Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Roma, Italy.
| |
Collapse
|
9
|
Santoro A, Angelico G, Travaglino A, Inzani F, Arciuolo D, Valente M, D’Alessandris N, Scaglione G, Fiorentino V, Raffone A, Zannoni GF. New Pathological and Clinical Insights in Endometrial Cancer in View of the Updated ESGO/ESTRO/ESP Guidelines. Cancers (Basel) 2021; 13:2623. [PMID: 34073635 PMCID: PMC8198052 DOI: 10.3390/cancers13112623] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 12/18/2022] Open
Abstract
Endometrial carcinoma represents the most common gynecological cancer in Europe and the USA. Histopathological classification based on tumor morphology and tumor grade has played a crucial role in the management of endometrial carcinoma, allowing a prognostic stratification into distinct risk categories, and guiding surgical and adjuvant therapy. In 2013, The Cancer Genome Atlas (TCGA) Research Network reported a large scale molecular analysis of 373 endometrial carcinomas which demonstrated four categories with distinct clinical, pathologic, and molecular features: POLE/ultramutated (7% of cases) microsatellite instability (MSI)/hypermutated (28%), copy-number low/endometrioid (39%), and copy-number high/serous-like (26%). In the present article, we report a detailed histological and molecular review of all endometrial carcinoma histotypes in light of the current ESGO/ESTRO/ESP guidelines. In particular, we focus on the distribution and prognostic value of the TCGA groups in each histotype.
Collapse
Affiliation(s)
- Angela Santoro
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (A.T.); (F.I.); (D.A.); (M.V.); (N.D.); (G.S.); (V.F.)
| | - Giuseppe Angelico
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (A.T.); (F.I.); (D.A.); (M.V.); (N.D.); (G.S.); (V.F.)
| | - Antonio Travaglino
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (A.T.); (F.I.); (D.A.); (M.V.); (N.D.); (G.S.); (V.F.)
| | - Frediano Inzani
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (A.T.); (F.I.); (D.A.); (M.V.); (N.D.); (G.S.); (V.F.)
| | - Damiano Arciuolo
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (A.T.); (F.I.); (D.A.); (M.V.); (N.D.); (G.S.); (V.F.)
| | - Michele Valente
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (A.T.); (F.I.); (D.A.); (M.V.); (N.D.); (G.S.); (V.F.)
| | - Nicoletta D’Alessandris
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (A.T.); (F.I.); (D.A.); (M.V.); (N.D.); (G.S.); (V.F.)
| | - Giulia Scaglione
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (A.T.); (F.I.); (D.A.); (M.V.); (N.D.); (G.S.); (V.F.)
| | - Vincenzo Fiorentino
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (A.T.); (F.I.); (D.A.); (M.V.); (N.D.); (G.S.); (V.F.)
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy;
| | - Gian Franco Zannoni
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (A.T.); (F.I.); (D.A.); (M.V.); (N.D.); (G.S.); (V.F.)
- Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Roma, Italy
| |
Collapse
|
10
|
Ferrero A, Novara L, Perotto S, Capece R, Petey F, Perrini G, Mariani LL, DE Rosa G, Biglia N, Fuso L. Could a 2D/3D US based model be helpful in the assessment of myometrial invasion at time of intraoperative frozen section? A pilot study. Minerva Obstet Gynecol 2021; 73:362-368. [PMID: 34008391 DOI: 10.23736/s2724-606x.21.04777-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The assessment of myometrial invasion is a pivotal step in the preoperative staging of endometrial cancer. Intraoperative frozen section (FS) represents a reliable tool in directing surgeon's choices. Preoperative transvaginal ultrasound (US) showed high accuracy in evaluating myometrial invasion. This study aimed to understand if the application of a standardized ultrasonographic protocol for the pre-operative evaluation of myometrial invasion can help pathologists in improving the accuracy of FS. Furthermore, the agreement between US and FS in the assessment of myometrial invasion was assessed. METHODS Sixty-six patients who underwent surgery for endometrial cancer were analyzed. Preoperative 2D/3D ultrasound was performed in all the patients. Myometrial invasion was estimated by subjective assessment and objective measurement techniques. Data from US were reported to pathologists through a prefilled form with depth and site of the maximum myometrial invasion. Diagnostic performance of US and FS were compared having the definitive histological examination as the gold standard. RESULTS Influenced by the information given by our 3D US-model, FS showed a 90% sensitivity and a 93% specificity, with a 93% PPV and an 89% NPV. The agreement with histology was strong (K=0.824). Myometrial invasion was missed at the level of the isthmus by FS just in one case. Subjective assessment was confirmed as the most reliable ultrasonographic technique in assessing myometrial invasion, with 90% sensitivity, 78% specificity, 80% PPV and 89% NPV. The agreement with histology was substantial (K=0.68). CONCLUSIONS The application of a preoperative 2D/3D US assessment would seem to help pathologists in detecting myometrial invasion in difficult areas of the uterus such as the isthmus, reducing downstaging and overtreatment.
Collapse
Affiliation(s)
- Annamaria Ferrero
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
| | - Lorenzo Novara
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
| | - Stefania Perotto
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
| | - Roberto Capece
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
| | - Francesca Petey
- Department of Obstetrics and Gynecology SC2U, Sant'Anna Hospital, Turin, Italy
| | - Gaetano Perrini
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
| | - Luca L Mariani
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
| | | | - Nicoletta Biglia
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy -
| | - Luca Fuso
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
| |
Collapse
|
11
|
Travaglino A, Raffone A, Gencarelli A, Saracinelli S, Zullo F, Insabato L. Diagnostic Pitfalls Related to Morular Metaplasia in Endometrioid Carcinoma: An Underestimated Issue. Pathobiology 2021; 88:261-266. [PMID: 33887731 DOI: 10.1159/000515491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/25/2021] [Indexed: 11/19/2022] Open
Abstract
Here, we present a case that highlights the crucial pitfalls related to the presence of morular metaplasia (MM) in endometrioid carcinoma, which are insufficiently recognized in the routine pathology practice. A 45-year-old woman underwent hysterectomy with rectosigmoidectomy due to a 11-cm mass involving uterus, right ovary, and rectosigmoid colon. Histologically, the lesion appeared as a predominantly solid carcinoma with a minor glandular component. Results of the first immunohistochemical analysis suggested a colorectal origin (PAX8-, CK7-, WT1-, hormone receptors-, and CDX2+ in the absence of mucinous features). Subsequent immunohistochemistry (nuclear β-catenin+, CD10+, and low ki67 in the solid areas) supported a diagnosis of endometrioid carcinoma with diffuse MM. This case remarks that morphological and immunohistochemical features of MM may conceal the glandular architecture and the typical immunophenotype of endometrioid carcinomas. Acknowledging the diagnostic issues related to MM appears crucial to avoid misdiagnosis and inappropriate patient management.
Collapse
Affiliation(s)
- Antonio Travaglino
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Annarita Gencarelli
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Serena Saracinelli
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.,Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Luigi Insabato
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| |
Collapse
|
12
|
Doğan Durdağ G, Alemdaroğlu S, Aka Bolat F, Yılmaz Baran Ş, Yüksel Şimşek S, Çelik H. Accuracy of intra-operative frozen section in guiding surgical staging of endometrial cancer. Arch Gynecol Obstet 2021; 304:725-732. [PMID: 33608802 DOI: 10.1007/s00404-021-05979-y] [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: 05/14/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Surgery consists the main treatment of endometrial cancer; however, decision of lypmhadenectomy is controversial. Intra-operative frozen section (FS) is commonly used in guiding surgical staging; nevertheless, there are different reports regarding its adequacy and reliability. Aim of this study is to assess accuracy of FS in predicting paraffin section (PS) results in patients with endometrium cancer. METHODS Data of 223 cases, who were operated for endometrial cancer at a tertiary hospital in 2012-2019, were analyzed retrospectively. Histological type, grade, tumor diameter, depth of myometrial invasion, and cervical and adnexal involvement in frozen and paraffin section were evaluated. Positive and negative predictive values and accuracy of frozen results in predicting paraffin results for each parameter was assessed. Statistical significance was taken as 0.05 in all tests. RESULTS Accuracy of FS in predicting PS results were 76.23% for histology, 75.45% for grade, 85.31% for depth of myometrial invasion, and 95.45% for tumor diameter. Surgery, based on FS results, caused undertreatment in 4 patients, while metastatic lymph node ratios were found in only 35.3-50.0% of cases who had high risk parameters at FS. CONCLUSION Our FS results have reasonable accuracy rates in predicting PS results, in comparison with the previous literature. However, even if the high risk parameters detected in FS predict PS accurately, absence of lymph node involvement in all cases with high risk parameters indicates that FS-based triage cannot prevent unnecessary lymphadenectomies.
Collapse
Affiliation(s)
- Gülşen Doğan Durdağ
- Faculty of Medicine, Department of Gynecology and Obsterics, Başkent University, Adana Application and Research Hospital, Adana, Turkey.
| | - Songül Alemdaroğlu
- Faculty of Medicine, Department of Gynecology and Obsterics, Başkent University, Adana Application and Research Hospital, Adana, Turkey
| | - Filiz Aka Bolat
- Faculty of Medicine, Department of Pathology, Başkent University, Adana Application and Research Hospital, Adana, Turkey
| | - Şafak Yılmaz Baran
- Faculty of Medicine, Department of Gynecology and Obsterics, Başkent University, Adana Application and Research Hospital, Adana, Turkey
| | - Seda Yüksel Şimşek
- Faculty of Medicine, Department of Gynecology and Obsterics, Başkent University, Adana Application and Research Hospital, Adana, Turkey
| | - Hüsnü Çelik
- Faculty of Medicine, Department of Gynecology and Obsterics, Başkent University, Adana Application and Research Hospital, Adana, Turkey
| |
Collapse
|
13
|
Angelico G, Santoro A, Rossi ED, Zannoni GF. The role of cytology in endometrial cancer: Diagnostic and clinical considerations from peritoneal/pelvic washings. Is it still a heated debate? Cancer Cytopathol 2021; 129:497-498. [PMID: 33481350 DOI: 10.1002/cncy.22407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Giuseppe Angelico
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angela Santoro
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.,Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Franco Zannoni
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
14
|
Reis-de-Carvalho C, Castro C, Osório F. Unusual endometriosis mimicking disseminated cancer after hysterectomy in a young woman. BMJ Case Rep 2021; 14:14/1/e241002. [PMID: 33462071 PMCID: PMC7813293 DOI: 10.1136/bcr-2020-241002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Catarina Reis-de-Carvalho
- PTCSRT, Harvard University, Cambridge, Massachusetts, USA,Obstetrics, Gynecology and Reproductive Medicine, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - Catarina Castro
- Obstetrics, Gynecology and Reproductive Medicine, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - Filipa Osório
- Obstetrics, Gynecology and Reproductive Medicine, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal,Obstetrics-Gynaecology, Hospital da Luz, Lisbon, Portugal
| |
Collapse
|
15
|
Bandala-Jacques A, Cantú-de-León D, Pérez-Montiel D, Salcedo-Hernández RA, Prada D, González-Enciso A, Gonzalez-Valdés A, Barquet-Muñoz SA. Diagnostic performance of intraoperative assessment in grade 2 endometrioid endometrial carcinoma. World J Surg Oncol 2020; 18:284. [PMID: 33126895 PMCID: PMC7602319 DOI: 10.1186/s12957-020-02056-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/19/2020] [Indexed: 01/30/2023] Open
Abstract
Abstract Background Endometrial carcinoma is the most common gynecologic malignancy in developed countries. Grade 2 carcinoma is associated with pelvic lymph-node metastasis, depending on selected risk factors. Intraoperative assessment (IOA) can identify patients at risk for lymph node metastasis who should undergo staging surgery. Our objective was to establish the diagnostic precision of IOA in determining the need for surgical staging in grade 2 endometrioid endometrial carcinoma. Methods Two hundred twenty-two patients underwent IOA. Results were compared to the final pathology report. The accuracy of the IOA parameters was calculated. Variables were evaluated in patients with positive versus negative IOA. Overall and disease-free survivals were calculated according to IOA, lymphadenectomy, and nodal metastasis. Results IOA was positive in 80 patients. It showed an accuracy of 76.13% when compared with the postoperative assessment. The best individual parameter was myometrial invasion. Nodal metastasis was observed in 16 patients in the positive IOA group and 7 patients in the negative group. Patients with lymph node metastasis had a 5-year overall survival rate of 80.9%, whereas patients without metastasis had a 5-year overall survival rate of 97.9%. Conclusions IOA is an adequate tool to identify high-risk patients in grade 2 endometrial carcinoma. Myometrial invasion is the individual parameter that yields the highest diagnostic precision.
Collapse
Affiliation(s)
- Antonio Bandala-Jacques
- Biomedical Cancer Research Unit, Instituto Nacional de Cancerología, Mexico City, Mexico.,Biomedical Investigations Institute, Universidad Nacional Autonóma de México, Mexico City, Mexico
| | | | - Delia Pérez-Montiel
- Department of Pathology, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Diddier Prada
- Biomedical Cancer Research Unit, Instituto Nacional de Cancerología, Mexico City, Mexico.,Department of Biomedical Informatics, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA
| | | | | | | |
Collapse
|
16
|
Dondi G, Coluccelli S, De Leo A, Ferrari S, Gruppioni E, Bovicelli A, Godino L, Coadă CA, Morganti AG, Giordano A, Santini D, Ceccarelli C, Turchetti D, De Iaco P, Perrone AM. An Analysis of Clinical, Surgical, Pathological and Molecular Characteristics of Endometrial Cancer According to Mismatch Repair Status. A Multidisciplinary Approach. Int J Mol Sci 2020; 21:E7188. [PMID: 33003368 PMCID: PMC7582893 DOI: 10.3390/ijms21197188] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 12/17/2022] Open
Abstract
Since 2016, our hospital has applied tumor testing with immunohistochemistry (IHC) in endometrial cancer in order to detect mutations of mismatch repair genes (MMR). All cases with MMR deficiency proteins expression are sent for genetic testing, except those with MLH1 protein deficiency, in which case genetic testing is performed if negative for promoter hypermethylation. The primary aim of this study was to investigate the ability of our algorithm to identify Lynch syndrome (LS). The Secondary aims were to investigate the relationship between MMR status and clinicopathological features and prognosis of primary endometrial cancer (EC). From January 2016 to December 2018, 239 patients with EC were retrospectively analyzed and subdivided according to MMR status. Patients were divided in three groups: MMR proficient, LS and Lynch-like cancer (LLC). LS was characterized by a lower age and BMI, more use of contraceptive and less use of hormonal replacement therapy, nulliparity and a trend versus a better prognosis. LLC appeared more related to MMR proficient than LS and exhibited a more aggressive behavior. Our multidisciplinary approach permitted a correct diagnosis of germline mutation in patients with newly diagnosis EC and it confirmed clinicopathologic and prognostic characteristics of LS.
Collapse
Affiliation(s)
- Giulia Dondi
- Gynecologic Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico di Sant’Orsola, 40138 Bologna, Italy; (G.D.); (S.C.); (A.B.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (A.D.L.); (A.G.M.); (D.S.); (C.C.); (D.T.)
| | - Sara Coluccelli
- Gynecologic Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico di Sant’Orsola, 40138 Bologna, Italy; (G.D.); (S.C.); (A.B.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (A.D.L.); (A.G.M.); (D.S.); (C.C.); (D.T.)
- Center for Applied Biomedical Research, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy;
| | - Antonio De Leo
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (A.D.L.); (A.G.M.); (D.S.); (C.C.); (D.T.)
- Molecular Diagnostic Unit, Azienda USL Bologna, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy
| | - Simona Ferrari
- Unit of Medical Genetics, Azienda Ospedaliero-Universitaria Policlinico di Sant’Orsola, University of Bologna, 40138 Bologna, Italy; (S.F.); (L.G.)
| | - Elisa Gruppioni
- Laboratory of Oncologic and Transplantation Molecular Pathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy;
| | - Alessandro Bovicelli
- Gynecologic Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico di Sant’Orsola, 40138 Bologna, Italy; (G.D.); (S.C.); (A.B.); (P.D.I.)
| | - Lea Godino
- Unit of Medical Genetics, Azienda Ospedaliero-Universitaria Policlinico di Sant’Orsola, University of Bologna, 40138 Bologna, Italy; (S.F.); (L.G.)
| | - Camelia Alexandra Coadă
- Center for Applied Biomedical Research, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy;
| | - Alessio Giuseppe Morganti
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (A.D.L.); (A.G.M.); (D.S.); (C.C.); (D.T.)
- Radiation Oncology Center, Azienda Ospedaliero-Universitaria Policlinico di Sant’Orsola, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA;
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Donatella Santini
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (A.D.L.); (A.G.M.); (D.S.); (C.C.); (D.T.)
- Pathology Unit Azienda Ospedaliero-Universitaria Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Claudio Ceccarelli
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (A.D.L.); (A.G.M.); (D.S.); (C.C.); (D.T.)
- Molecular Diagnostic Unit, Azienda USL Bologna, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy
| | - Daniela Turchetti
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (A.D.L.); (A.G.M.); (D.S.); (C.C.); (D.T.)
- Unit of Medical Genetics, Azienda Ospedaliero-Universitaria Policlinico di Sant’Orsola, University of Bologna, 40138 Bologna, Italy; (S.F.); (L.G.)
| | - Pierandrea De Iaco
- Gynecologic Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico di Sant’Orsola, 40138 Bologna, Italy; (G.D.); (S.C.); (A.B.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (A.D.L.); (A.G.M.); (D.S.); (C.C.); (D.T.)
| | - Anna Myriam Perrone
- Gynecologic Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico di Sant’Orsola, 40138 Bologna, Italy; (G.D.); (S.C.); (A.B.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (A.D.L.); (A.G.M.); (D.S.); (C.C.); (D.T.)
| |
Collapse
|
17
|
Mandato VD, Torricelli F, Mastrofilippo V, Palicelli A, Ciarlini G, Pirillo D, Annunziata G, Aguzzoli L. Accuracy of preoperative endometrial biopsy and intraoperative frozen section in predicting the final pathological diagnosis of endometrial cancer. Surg Oncol 2020; 35:229-235. [PMID: 32932219 DOI: 10.1016/j.suronc.2020.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/19/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Histotype and grade of endometrial cancer (EC) are prognostic factors of nodal involvement and thus of survival. Preoperative biopsy (PB) and intraoperative frozen section (FS) are usually used to guide surgical staging on which the choice of adjuvant therapy will be based successively. OBJECTIVE The aim of this study was to assess the agreement rate between PB and FS with final diagnosis (FD) in a series of surgically resected EC. MATERIALS All patients submitted to hysterectomy for EC or atypical endometrial hyperplasia in the Reggio Emilia Province hospitals from 2007 to 2018 were included. Concordance rate differences in histotype, grading, myoinvasion, risk of recurrence between PB, FS and FD were assessed with Fisher's exact test and Mc Nemar contingency test. RESULTS A total of 352 patients were identified. For 345 patients it was possible to compare PB and FD results. FS examination was performed in 201/352 (57%) cases, while for 21/352 (6%) patients only an intraoperative macroscopic evaluation was done; in the remaining women, FS-exam was omitted. In 14/201 (7%) cases the tumor wasn't grossly identifiable and the random FS-sampling wasn't able to find the tumor site. High diagnostic concordance of tumor type between PB and FD was observed: no significant differences were registered in type 1 and type 2-endometrial cancer identification (83%, 73%, p = 0.121). Significant differences (p = 0.005) were observed comparing FS and FD results: 95% of type 1-ECs were correctly diagnosed by FS, while only 76% of type 2-ECs received a correct diagnosis on FS. PB showed a concordance with FD among tumor grading close to 55% whilst concordance achieved 71% grouping low grade (G1-G2) EC. No significant differences in FS and FD concordance rate were observed between tumor grades. Concordance for low grade was significantly higher than for high grade ECs (89% vs 50%, respectively, p value = 0.014). The concordance rate in evaluating the myoinvasion status between FS and FD was 80% (n: 199 patients), reaching 99% after combining the first 2 groups (0-49% vs ≥ 50%). Twenty-two cases underwent only intraoperative macroscopic evaluation of the myoinvasion, with an accuracy of 91%: only in 1 case the invasion of the cervical stroma was not detected (Stage II), and 1 case the patient was overstaged as Ib. Discrepancies were observed in FS capacity to correctly predict the final ESMO risk group in stage I patients: FS resulted particularly reliable in predicting a low-risk (concordance with FD: 91%) while the accuracy sharply decreased for intermediate- and high-risk patients (62% and 40%, respectively). To investigate the usefulness of FS in EC management, we compared patients who underwent FS (FS-group) or not (no-FS-group). Especially for low risk patients, the FS significantly increased the adequacy of surgical treatment from 53% (no-FS-group) to 72% (FS-group) (p = 0.016). CONCLUSIONS FS remains a useful tool to tailor surgery in EC-patients, avoiding secondary surgery to complete staging particularly in patients with AH + AHBA, low and intermediate risk ECs that could benefit from adjuvant therapy.
Collapse
Affiliation(s)
- Vincenzo Dario Mandato
- Unit of Obstetrics and Gynaecology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina Mastrofilippo
- Unit of Surgical Gynecol Oncology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gino Ciarlini
- Unit of Surgical Gynecol Oncology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Debora Pirillo
- Unit of Obstetrics and Gynaecology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gianluca Annunziata
- Unit of Obstetrics and Gynaecology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Unit of Surgical Gynecol Oncology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|