Institutional Accuracy Matters: How the Correlation between Frozen Section and Final Pathology Depends on Institutes while Evaluating Lymph Node Involvement in Endometrial Adenocarcinoma

Year 2023, Volume: 7 Issue: 1, 293 - 300, 31.01.2023

Alpay Yılmaz Aysegul Gulbahar

https://doi.org/10.30621/jbachs.1102375

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.

Keywords

Endometrial cancer, neoplasm, tumor staging, frozen section, lymph node dissection

References

• https://gco.iarc.fr/today/online-analysis-dual-bars-2?v=2020&mode=cancer&mode_population=regions&population=250&populations=250&key=asr&sex=2&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&nb_items=10&group_cancer=1&include_nmsc=0&include_nmsc_other=1&dual_distribution=1&population1=250&population2=554&show_values=false&type_multiple=%257B%2522inc%2522%253Atrue%252C%2522mort%2522%253Atrue%252C%2522prev%2522%253Afalse%257D&type_sort=0 [accessed: 12.04.2022]
• Wang X, Zhang H, Di W, Li W. Clinical factors affecting the diagnostic accuracy of assessing dilation and curettage vs. frozen section specimens for histologic grade and depth of myometrial invasion in endometrial carcinoma Am J Obstet Gynecol 2009;201:194.e1-10. doi:10.1016/j.ajog.2009.05.003
• Kilgore LC, Partridge EE, Alvarez RD, et al. adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol 1995;56:29-33. DOI: 10.1006/gyno.1995.1005.
• Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 2009;105:103-4. DOI: 10.1016/j.ijgo.2009.02.012.
• https://www.uptodate.com/contents/adjuvant-treatment-of-high-risk-endometrial-cancers?csi=09897c32-5592-4353-a77a-689c66dc83b3&source=contentShae [accessed: 12.04.2022]
• Colombo N, Creutzberg C, Amant F, et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment, and Follow-up. Int J Gynecol Cancer 2016;26:2-30. DOI: 10.1093/annonc/mdv484
• Chu CS, Lin L, Rubin SC. Cancer of the uterine body. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 8th ed. DeVita VT, LawrenceTS, Rosenberg SA, editors. Philadelphia, PA: Wolters Kluwer/ Lippincott Williams and Wilkins; 2008:1543-63.
• Soliman PT, Frumovitz M, Spannuth W, et al. Lymphadenectomy during endometrial cancer staging: practice patterns among gynecologic oncologists. Gynecol Oncol. 2010;119(2):291-294. DOI: 10.1016/j.ygyno.2010.07.011
• Burke WM, Orr J, Leitao M, et al. Endometrial cancer: a review and current management strategies: part II. Gynecol Oncol. 2014;134(2):393-402. DOI: 10.1016/j.ygyno.2014.06.003
• Dowdy SC, Borah BJ, Bakkum-Gamez JN, et al. Prospective assessment of survival, morbidity, and cost associated with lymphadenectomy in low-risk endometrial cancer. Gynecol Oncol. 2012;127(1):5-10. DOI: 10.1016/j.ygyno.2012.06.035
• Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC. Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol. 2000;182(6):1506-1519. DOI: 10.1067/mob.[phone]
• Panici PB, Basile S, Maneschi F, et al. Systematic pelvic lymphadenectomy vs no lymphadenectomy in early-stage endometrial carcinoma: a randomized clinical trial. Journal of the National Cancer Institute. 2008;100(23):1707-1716. 10. DOI: 10.1093/jnci/djn397
• Seracchioli R, Solfrini S, Mabrouk M, et al. Controversies in surgical staging of endometrial cancer. Obstet Gynecol Int. 2010;2010: 181963. DOI: 10.1155/2010/181963. DOI: 10.1155/2010/181963
• Creasman WT, Morrow P, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical Pathological spread patterns of endometrial cancer, A Gynecologic Oncologic Group Study. Cancer 1987;60:2035-2041. DOI: 10.1002/1097-0142(19901015)60:8+<2035::aid-cncr2820601515>3.0.co;2-8
• Mariani A, Dowdy SC, Cliby WA, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol 2008;109:11-8. DOI: 10.1016/j.ygyno.2008.01.023
• Java J, Walker J, Parker L, Metzinger D, Coleman R. Incidence of nodal metastasis in endometrioid endometrial cancer risk groups: A Gynecologic Oncology Group multicenter review. Gynecol Oncol 2011;120:S4. DOI: 10.1097/AOG.0b013e318240de51
• Dowdy SC, Borah BJ, Bakkum-Gamez JN, et al. Prospective assessment of survival, morbidity, and cost associated with lymphadenectomy in low-risk endometrial cancer. Gynecol Oncol 2012;127:5-10. DOI: 10.1016/j.ygyno.2012.06.035
• Creutzberg CL, van Putten WL, Koper PC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: A multicentre randomized trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet. 2000;355:1404-11. DOI: 10.1016/s0140-6736(00)02139-5
• https://www.cancer.org/cancer/endometrial-cancer/detection-diagnosis-staging/survival-rates.html [accessed: 12.04.2022]
• Konno Y, Todo Y, Minobe S, et al. A Retrospective Analysis of Postoperative Complications With or Without Para-aortic Lymphadenectomy in endometrial cancer.Int J Gynecol Cancer 2011;21(2):385-390. DOI: 10.1097/IGC.0b013e3182094e09
• Şenol T, Polat M, Özkaya E, Karateke A. Misinterpretation of frozen section in endometrial Cancer cases: does it have any effect on disease-free and overall survival? Int J Gynecol Pathol 2017;36:550-4. DOI: 10.1097/PGP.0000000000000367
• Kumar S, Bandyopadhyay S, Semaan A, et al. The role of frozen section in surgical staging of low risk endometrial cancer. PLoS One. 2011;6(2):e21912. DOI: 10.1371/journal.pone.0021912
• Wang X, Li L, Cragun JM, Chambers SK, Hatch KD, Zheng W. Assessment of the role of intraoperative frozen section in guiding surgical staging for endometrial cancer. Int J Gynecol Cancer. 2016;26(5):918-923. DOI: 10.1097/IGC.0000000000000692
• Shobeiri MJ, Asl NM, Tabrizi AD, et al. Comparing the Intraoperative Frozen Section With Permanent pathology in Assessing the Depth of Myometrial Invasion, Tumor Size, and Histological Subtype and Grade in Endometrial Cancer, Crescent Journal of Medical and Biological Sciences. 2019;6(2):221–225
• Malviya VK, Deppe G, Malone Jr JM, Sundareson AS, Lawrence WD. Reliability of frozen section examination in identifying poor prognostic indicators in stage I endometrial adenocarcinoma. Gynecol Oncol 1989;34:299e304. DOI: 10.1016/0090-8258(89)90162-5
• Noumoff JS, Menzin A, Mikuta J, Lusk EJ, Morgan M, LiVoisi VA. The ability to evaluate prognostic variables on the frozen section in hysterectomies performed for endometrial carcinoma. Gynecol Oncol 1991;42:202e208. DOI: 10.1016/0090-8258(91)90346-7
• Wu Yueqian, Zhu H, Sun J, Wang X. Accuracy of frozen section in management and prediction of lymph node metastasis in endometrial carcinoma. Gynecology and Minimally Invasive Therapy 2015;4:126-31.doi: 10.1016/j.gmit.2015.07.001
• Papadia A, Azioni G, Brusacà B, et al. Frozen section underestimates the need for surgical staging in endometrial cancer patients. Int J Gynecol Cancer 2009;19:1570-3. DOI: 10.1111/IGC.0b013e3181bff64b
• Case AS, Rocconi RP, Straughn JM Jr, et al. A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer. Obstet Gynecol 2006;108:1375-9. DOI: 10.1097/01.AOG.0000245444.14015.00
• Frumovitz M, Slomovitz BM, Singh DK, et al. Frozen section analyses as predictors of lymphatic spread in patients with early-stage uterine cancer. J Am Coll Surg 2004;199:388-93. DOI: 10.1016/j.jamcollsurg.2004.05.258
• Kucera E, Kainz C, Reinthaller A, et al. The accuracy of intraoperative frozen-section diagnosis in stage I endometrial adenocarcinoma. Gynecol Obstet Invest 2000;49:62e. DOI: 10.1080/01443615.2021.2004583