ENDOMETRİUM KANSERİNDE MYOMETRİAL İNVAZYONUN İNTRAOPERATİF DİGİTAL GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ

Abstract

Amaç: Endometrium kanseri grade I - II vakalarda cerrahi tedavi tip 1 histerektomi ve bilateral salpingoooferektomi şeklinde olup ayrıca myometrial invazyon ≥½ olduğunda pelvik/paraaortik lenfadenektomi ile yapılmaktadır. İntraoperatif myometrial invazyon değerlendirilmesinde dijital görüntüleme/büyütme tekniğinin kullanılmasının duyarlılık, özgüllük ve tanısal doğruluk açısından araştırılması amaçlanmıştır. Materyal ve metot: 01.Ocak.2012-01.Eylül. 2012 tarihleri arasında endometrium kanseri nedeniyle cerrahi evreleme yapılan olgular çalışma evrenini oluşturdu. Cerrahi evreleme sırasında histerektomi yapıldıktan sonra histerektomi piyesi koronal planda servikal kanal boyunca stile eşliğinde kesilerek açıldı, kavite ve myometrium incelendi, olası en derin invazyon öngörülen alandan uterin duvara ikinci bir kesi yapıldı. Myometrial kesit yüzeyinden dijital görüntü ‘‘I- phone 4S (8MP)’’ ile alındı. X3 büyütme elde edilerek görüntü değerlendirildi. Myometrial invazyon <½ ve ≥½ olarak tanımlandı. Materyal frozen kesi ile değerlendirildi. Frozen kesi değerlendirme sonuçlanana kadar pelvik/paraaortik lenf nodu örneklemesi yapıldı. Frozen kesi sonucu myometrial invazyon ≥½ olarak değerlendirilen olgularda lenf nodu diseksiyonu tamamlandı. Parafin blok histopatoloji sonuçları altın standart kabul edilerek dijital görüntüleme/büyütme ve frozen kesi ile belirlenen myometrial invazyon sonuçlarının duyarlılık, özgüllük ve tanısal doğruluğu hesaplandı. Bulgular: Toplamda 34 hasta değerlendirildi. Dijital görüntüleme/büyütme tekniği ile 15, frozen kesi inceleme ile 15, parafin kesi ile 16 olguda ≥½ myometrial invazyon saptandı. Dijital görüntüleme/büyütme tekniğinin duyarlılığı %81.25, özgüllüğü %88.89 ve tanısal doğruluğu %85.29 olarak hesaplandı. Frozen kesi değerlendirme ile duyarlılık %93.75, özgüllük %100 ve tanısal doğruluk %97.06 olarak belirlendi. Sonuç: Çalışma halen devam etmekte olup ön sonuçlar bildirilmiştir. İntraoperatif myometrial invazyon değerlendirilmesinde dijital görüntüleme/büyütme tekniğinin duyarlılık, özgüllük ve tanısal doğruluğu yüksek alternatif bir yöntem olarak kullanılabileceği görülmüştür

Keywords

• Endometrium kanseri, myometrial invazyon.

THE INTRA-OPERATIVE DIGITAL IMAGING EVALUATION OF MYOMETRIAL INVASION ON ENDOMETRIAL CANCER PATIENTS

Abstract

Aim: For endometrial cancer gradeI-II cases, standard surgical treatment is type1 hysterectomy and bilaterally salphingooophorectomy, besides when myometrial invasion is ≥½, pelvic/paraaortic lymphadenectomy is added. We aimed to determine the sensitivity, specifity, and diagnostic accuracy of digital imaging/magnification of the myometrial invasion intraoperatively. Material and methods: Patients who underwent surgical staging for endometrial cancer composed the universe of the study between 01/January/2012 and 01.September/2012. After hysterectomy, the uterus was opened by cutting with a style along the cervical canal, cavity and myometrium was examined, and then another incision was made at the area of the deepest possible invasion. Digital images of the myometrial cross-sectional surface was obtained by ‘‘I-phon 4S(8MP)’’cell-phone. The images were evaluated by x3magnification. Myometrial invasion was defined as <½ and ≥½. The specimen was also evaluated by frozensection methods. Pelvic/paraarortic lymph node sampling was performed until the end of the frozen-section evaluation. In patients whose myometrial invasion was reported to be ≥½ by frozen-section, the lymph node dissections were completed. As the hystopathologic results of paraffin blocks were accepted as gold standard, the sensitivity, specifity, and diagnostic accuracy of the results of myometrial invasion obtained by digital imaging/magnification and frozen-section methods were calculated. Results: In total, 34 patients were evaluated. ≥½ myometrial invasion were established in 15 patients with digital imaging/ magnification technique, 15 patients with frozen-section technique, and 16 patients with paraffin technique. Sensitivity, specifity, and diagnostic accuracy of the digital imaging/magnification technique were calculated as 81.25%, 88.89%, 85.29% respectively. Sensitivity, specifity, and diagnostic accuracy of the frozen-section technique were calculated as 93.75%, 100%, and 97.06% respectively. Conclusion: The study is still ongoing and preliminary results have been reported. For the intraoperative assessment of myometrial invasion, the digital imaging/magnification technique can be used as an alternative method with high sensitivity, specifity and diagnostic accuracy

Keywords

• Endometrial cancer, myometrial invasion

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