BibTex RIS Cite

ENDOMETRİUM KANSERİNDE MYOMETRİAL İNVAZYONUN İNTRAOPERATİF DİGİTAL GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ

Year 2014, Volume: 17 Issue: 1, 0 - 0, 01.01.2014

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

References

  • 1. FIGO Announcements stages –1988 Revision. Gynecol Oncol. 1989;35.
  • 2. Bertelsen K, Ortoft G, Hansen E. Survival of Danish patients with endometrial cancer in the intermediate-risk group not given postoperative radiotherapy: the Danish Endometrial Cancer Study (DEMCA). Int J Gynecol Cancer. 2011; 2: 1191-9.
  • 3. Hacker N. In: Berek JS, Hacker NF, eds. Practical Gynecologic Oncology. 4th edn. Philadelphia: Lippincott Williams &Wilkins, 2005. pp. 397- 442.
  • 4. Sirisabya N, Manchana T, Worasethsin P, Khemapech N, Lertkhachonsuk R, Sittisomwong T et al. Is complete surgical staging necessary in clinically early stage endometrial carcinoma? Int J Gynaecol Cancer 2009;19:1057-1061.
  • 5. Kucera E, Kainz C, Reinthaller A, Sliutz G, Leodolter S, Kucera H, Breitenecker G. Accuracy of intraoperative frozen section diagnosis in stage 1 endometrial adenocarcinoma. Gynecol Obstet Invest 2000; 49:62-6.
  • 6. Hardesty LA, Sumkin JH, Nath ME, Edwards RP, Price FV, Chang TS, et al. Use of preoperative MR imaging in the management of endometrial carcinoma: cost analysis. Radiology. 2000; 215:45-9.
  • 7. Yahata T, Aoki Y, Tanaka K. Prediction of myometrial invasion in patients with endometrial carcinoma: comparison of magnetic resonance imaging, transvaginal ultrasonography and gross visual inspection. Eur J Gynaecol Oncol 2007;28:193-5.
  • 8. Savelli L, Testa AC, Mabrouk M, Zannoni L, Ludovisi M,Seracchioli R, Scambia g, De laco P. A prospective blinded comparision of the accuracy of transvaginal sonography and frozen section in the assessment of myometrial invasion in endometrial cancer. Gynecol Oncol 2012;124:549-52.
  • 9. Mavromatis ID, Antonopoulos CN, Matsoukis IL, Frangos CC, Skalkidou A, Creatsas G, Petridou ET. Validity of intraoperative gross examination of myometrial invasion in patients with endometrial cancer: a meta-analysis. Acta Obstet Gynecol Scand 2012;91:779-93
  • 10. Kayikcioglu F, Boran N, Meydanli MM, Tulunay G, Kose FM, Bulbul D. Is frozen-section diagnosis a reliable guide in surgical treatment of stage I endometrial carcinoma? Acta Oncol 2002;41:444- 446
  • 11. Attard Montalto S, Coutts M, Devaja O, Summers J, Jyothirmayi R, Papadopoulos A. Accuracy of frozen section diagnosis at surgery in pre-malignant and malignant lesions of the endometrium. Eur J Gynaecol Oncol 2008;29:435-40.
  • 12. Celik C, Ozdemir S, Esen H, Balci O, Yılmaz O. the clinical value of preoperative and intraoperative assessments in the management of endometrial cancer Int J Gynecol Cancer 2010;20:358-62

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

Year 2014, Volume: 17 Issue: 1, 0 - 0, 01.01.2014

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

References

  • 1. FIGO Announcements stages –1988 Revision. Gynecol Oncol. 1989;35.
  • 2. Bertelsen K, Ortoft G, Hansen E. Survival of Danish patients with endometrial cancer in the intermediate-risk group not given postoperative radiotherapy: the Danish Endometrial Cancer Study (DEMCA). Int J Gynecol Cancer. 2011; 2: 1191-9.
  • 3. Hacker N. In: Berek JS, Hacker NF, eds. Practical Gynecologic Oncology. 4th edn. Philadelphia: Lippincott Williams &Wilkins, 2005. pp. 397- 442.
  • 4. Sirisabya N, Manchana T, Worasethsin P, Khemapech N, Lertkhachonsuk R, Sittisomwong T et al. Is complete surgical staging necessary in clinically early stage endometrial carcinoma? Int J Gynaecol Cancer 2009;19:1057-1061.
  • 5. Kucera E, Kainz C, Reinthaller A, Sliutz G, Leodolter S, Kucera H, Breitenecker G. Accuracy of intraoperative frozen section diagnosis in stage 1 endometrial adenocarcinoma. Gynecol Obstet Invest 2000; 49:62-6.
  • 6. Hardesty LA, Sumkin JH, Nath ME, Edwards RP, Price FV, Chang TS, et al. Use of preoperative MR imaging in the management of endometrial carcinoma: cost analysis. Radiology. 2000; 215:45-9.
  • 7. Yahata T, Aoki Y, Tanaka K. Prediction of myometrial invasion in patients with endometrial carcinoma: comparison of magnetic resonance imaging, transvaginal ultrasonography and gross visual inspection. Eur J Gynaecol Oncol 2007;28:193-5.
  • 8. Savelli L, Testa AC, Mabrouk M, Zannoni L, Ludovisi M,Seracchioli R, Scambia g, De laco P. A prospective blinded comparision of the accuracy of transvaginal sonography and frozen section in the assessment of myometrial invasion in endometrial cancer. Gynecol Oncol 2012;124:549-52.
  • 9. Mavromatis ID, Antonopoulos CN, Matsoukis IL, Frangos CC, Skalkidou A, Creatsas G, Petridou ET. Validity of intraoperative gross examination of myometrial invasion in patients with endometrial cancer: a meta-analysis. Acta Obstet Gynecol Scand 2012;91:779-93
  • 10. Kayikcioglu F, Boran N, Meydanli MM, Tulunay G, Kose FM, Bulbul D. Is frozen-section diagnosis a reliable guide in surgical treatment of stage I endometrial carcinoma? Acta Oncol 2002;41:444- 446
  • 11. Attard Montalto S, Coutts M, Devaja O, Summers J, Jyothirmayi R, Papadopoulos A. Accuracy of frozen section diagnosis at surgery in pre-malignant and malignant lesions of the endometrium. Eur J Gynaecol Oncol 2008;29:435-40.
  • 12. Celik C, Ozdemir S, Esen H, Balci O, Yılmaz O. the clinical value of preoperative and intraoperative assessments in the management of endometrial cancer Int J Gynecol Cancer 2010;20:358-62
There are 12 citations in total.

Details

Other ID JA99ER65JG
Journal Section Research Article
Authors

Hakan Yetimalar This is me

İncim Bezcioğlu This is me

Derya Kılıç Sakarya This is me

Seyran Yiğit This is me

Publication Date January 1, 2014
Submission Date January 1, 2014
Published in Issue Year 2014 Volume: 17 Issue: 1

Cite

APA Yetimalar, H., Bezcioğlu, İ., Kılıç Sakarya, D., Yiğit, S. (2014). ENDOMETRİUM KANSERİNDE MYOMETRİAL İNVAZYONUN İNTRAOPERATİF DİGİTAL GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ. Türk Jinekolojik Onkoloji Dergisi, 17(1).
AMA Yetimalar H, Bezcioğlu İ, Kılıç Sakarya D, Yiğit S. ENDOMETRİUM KANSERİNDE MYOMETRİAL İNVAZYONUN İNTRAOPERATİF DİGİTAL GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ. TRSGO Dergisi. January 2014;17(1).
Chicago Yetimalar, Hakan, İncim Bezcioğlu, Derya Kılıç Sakarya, and Seyran Yiğit. “ENDOMETRİUM KANSERİNDE MYOMETRİAL İNVAZYONUN İNTRAOPERATİF DİGİTAL GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ”. Türk Jinekolojik Onkoloji Dergisi 17, no. 1 (January 2014).
EndNote Yetimalar H, Bezcioğlu İ, Kılıç Sakarya D, Yiğit S (January 1, 2014) ENDOMETRİUM KANSERİNDE MYOMETRİAL İNVAZYONUN İNTRAOPERATİF DİGİTAL GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ. Türk Jinekolojik Onkoloji Dergisi 17 1
IEEE H. Yetimalar, İ. Bezcioğlu, D. Kılıç Sakarya, and S. Yiğit, “ENDOMETRİUM KANSERİNDE MYOMETRİAL İNVAZYONUN İNTRAOPERATİF DİGİTAL GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ”, TRSGO Dergisi, vol. 17, no. 1, 2014.
ISNAD Yetimalar, Hakan et al. “ENDOMETRİUM KANSERİNDE MYOMETRİAL İNVAZYONUN İNTRAOPERATİF DİGİTAL GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ”. Türk Jinekolojik Onkoloji Dergisi 17/1 (January 2014).
JAMA Yetimalar H, Bezcioğlu İ, Kılıç Sakarya D, Yiğit S. ENDOMETRİUM KANSERİNDE MYOMETRİAL İNVAZYONUN İNTRAOPERATİF DİGİTAL GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ. TRSGO Dergisi. 2014;17.
MLA Yetimalar, Hakan et al. “ENDOMETRİUM KANSERİNDE MYOMETRİAL İNVAZYONUN İNTRAOPERATİF DİGİTAL GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ”. Türk Jinekolojik Onkoloji Dergisi, vol. 17, no. 1, 2014.
Vancouver Yetimalar H, Bezcioğlu İ, Kılıç Sakarya D, Yiğit S. ENDOMETRİUM KANSERİNDE MYOMETRİAL İNVAZYONUN İNTRAOPERATİF DİGİTAL GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ. TRSGO Dergisi. 2014;17(1).