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Background: Surgeons sometimes have difficulty determining which result to favor when preoperative results (MRI + preoperative endometrial biopsy [pre-op EB]) differ from intraoperative frozen section histology (FS) results. Investigation of how FS can complement ordinary preoperative examinations like MRI and pre-op EB in identification of patients at high risk of lymph node metastasis (high-risk patients) could provide clarity on this issue. Therefore, the aim of this study is to assess the utility of pre-op EB, MRI and FS results and determine how to combine these results in identification of high-risk patients.

Methods: The subjects were 172 patients with endometrial cancer. Patients with a histological high-grade tumor (HGT), namely, grade 3 endometrioid cancer, clear cell carcinoma or serous cell carcinoma, or with any type of cancer invading at least half of the uterine myometrium were considered high-risk. Tumors invading at least half of the uterine myometrium were classified as high-stage tumors (HST). We compared (a) detection of HGT using pre-op EB versus FS, (b) detection of HST using MRI versus FS, and (c) identification of high-risk patients using MRI + pre-op EB versus FS. Lastly, we determined to what degree addition of FS results improves identification of high-risk patients by routine MRI + pre-op EB.

Results: (a) Sensitivity, specificity, and accuracy for detecting HGT were 59.6, 98.4 and 87.8% for pre-op EB versus 55.3, 99.2 and 87.2% for FS (P = 0.44). (b) These figures for detecting HST were 74.4, 83.0 and 80.8% for MRI versus 46.5, 99.2 and 86.0% for FS (P < 0.001). (c) These figures for identifying high-risk patients were 78.3, 85.4 and 82.6% for MRI + pre-op EB versus 55.1, 99.0 and 81.2% for FS (P < 0.001). The high specificity of FS improved the sensitivity of MRI + pre-op EB from 78.3 to 81.2%, but this difference was not statistically significant (P < 0.16).

Conclusion: Frozen section enables identification of high-risk patients with nearly 100% specificity. This advantage can be used to improve sensitivity for identification of high-risk patients by routine MRI + pre-op EB, although this improvement is not statistically significant.

Titel:	Can addition of frozen section analysis to preoperative endometrial biopsy and MRI improve identification of high-risk endometrial cancer patients?
Autor/in / Beteiligte Person:	Nakai, G ; Tanaka, Y ; Yamada, T ; Ohmichi, M ; Yamamoto, K ; Osuga, K
Link:	Full Text Finder (Volltext)
Zeitschrift:	BMC cancer, Jg. 21 (2021-11-04), Heft 1, S. 1178
Veröffentlichung:	London : BioMed Central, [2001-, 2021
Medientyp:	academicJournal
ISSN:	1471-2407 (electronic)
DOI:	10.1186/s12885-021-08910-5
Schlagwort:	Adenocarcinoma, Clear Cell diagnostic imaging Adenocarcinoma, Clear Cell pathology Adult Aged Aged, 80 and over Cystadenocarcinoma, Serous diagnostic imaging Cystadenocarcinoma, Serous pathology Female Humans Lymph Node Excision statistics & numerical data Lymphatic Metastasis diagnostic imaging Lymphatic Metastasis pathology Magnetic Resonance Imaging methods Middle Aged Neoplasm Grading Neoplasm Invasiveness diagnostic imaging Neoplasm Invasiveness pathology Predictive Value of Tests Preoperative Care Risk Assessment Sensitivity and Specificity Biopsy statistics & numerical data Endometrial Neoplasms diagnostic imaging Endometrial Neoplasms pathology Endometrium pathology Frozen Sections statistics & numerical data Magnetic Resonance Imaging statistics & numerical data
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [BMC Cancer] 2021 Nov 04; Vol. 21 (1), pp. 1178. <i>Date of Electronic Publication: </i>2021 Nov 04. MeSH Terms: Biopsy / statistics & numerical data ; Endometrial Neoplasms / diagnostic imaging ; Endometrial Neoplasms / pathology ; Endometrium / pathology ; Frozen Sections / statistics & numerical data ; Magnetic Resonance Imaging / statistics & numerical data ; Adenocarcinoma, Clear Cell / diagnostic imaging ; Adenocarcinoma, Clear Cell / pathology ; Adult ; Aged ; Aged, 80 and over ; Cystadenocarcinoma, Serous / diagnostic imaging ; Cystadenocarcinoma, Serous / pathology ; Female ; Humans ; Lymph Node Excision / statistics & numerical data ; Lymphatic Metastasis / diagnostic imaging ; Lymphatic Metastasis / pathology ; Magnetic Resonance Imaging / methods ; Middle Aged ; Neoplasm Grading ; Neoplasm Invasiveness / diagnostic imaging ; Neoplasm Invasiveness / pathology ; Predictive Value of Tests ; Preoperative Care ; Risk Assessment ; Sensitivity and Specificity References: Lancet. 2009 Jan 10;373(9658):125-36. (PMID: 19070889) ; Cochrane Database Syst Rev. 2015 Sep 21;(9):CD007585. (PMID: 26387863) ; Radiology. 2015 Sep;276(3):797-808. (PMID: 25928157) ; Abdom Imaging. 2014 Oct;39(5):1021-6. (PMID: 24699937) ; Acta Obstet Gynecol Scand. 2007;86(6):739-41. (PMID: 17520409) ; Int J Gynecol Cancer. 2020 Jun;30(6):806-812. (PMID: 32284322) ; J Natl Cancer Inst. 2008 Dec 3;100(23):1707-16. (PMID: 19033573) ; Gynecol Oncol. 2013 Nov;131(2):294-8. (PMID: 23954595) ; Int J Gynecol Cancer. 2021 Jan;31(1):12-39. (PMID: 33397713) ; Eur J Radiol. 2015 Apr;84(4):581-9. (PMID: 25636389) ; Anticancer Res. 2016 Aug;36(8):4219-25. (PMID: 27466535) ; Gynecol Oncol. 2008 Apr;109(1):11-8. (PMID: 18304622) ; Int J Gynecol Cancer. 2006 Jan-Feb;16(1):385-90. (PMID: 16445663) ; Am J Obstet Gynecol. 2017 May;216(5):459-476.e10. (PMID: 27871836) ; Int J Gynecol Cancer. 2009 Jul;19(5):884-7. (PMID: 19574778) ; Am J Obstet Gynecol. 2009 Aug;201(2):194.e1-194.e10. (PMID: 19564019) ; PLoS One. 2011;6(9):e21912. (PMID: 21912633) ; Eur Radiol. 2019 Feb;29(2):792-805. (PMID: 29995239) ; Radiology. 2012 Feb;262(2):530-7. (PMID: 22114239) ; Int J Gynecol Cancer. 2018 Jun;28(5):875-881. (PMID: 29664845) ; Gynecol Oncol. 2012 May;125(2):400-3. (PMID: 22310644) ; Obstet Gynecol. 2006 Dec;108(6):1375-9. (PMID: 17138769) ; Int J Gynecol Cancer. 2011 Oct;21(7):1180-4. (PMID: 21795987) ; Cancers (Basel). 2021 May 26;13(11):. (PMID: 34073635) ; Arch Gynecol Obstet. 2012 May;285(5):1415-9. (PMID: 22068753) ; Obstet Gynecol. 2005 Aug;106(2):413-25. (PMID: 16055605) Contributed Indexing: Keywords: Endometrial cancer; Frozen section; MRI; Preoperative endometrial biopsy Entry Date(s): Date Created: 20211105 Date Completed: 20220208 Latest Revision: 20220208 Update Code: 20240513 PubMed Central ID: PMC8569997

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Can addition of frozen section analysis to preoperative endometrial biopsy and MRI improve identification of high-risk endometrial cancer patients?