Comparison of frozen section accuracy with final pathology results in early clinical stage of endometrioid type endometrial cancer

Abstract

Objectives: We aimed to compare the accuracy of the depth of myometrial invasion determined by intraoperative frozen section in the early clinical stage of endometrioid type endometrial cancer, with the result of the final postoperative paraffin section.

Methods: The study was carried out with 102 patients who were diagnosed with type 1-2 endometrioid endometrial cancer in the gynecology clinic of the state hospital between January 2015 and 2019. Retrospective demographic data, clinical characteristics, and pathology results of the patients who underwent surgical staging were recorded.

Results: The mean age of the patients was 59.3 ± 9.1 years and 82.3% of the patients were in the postmenopausal period. The mean age of patients with a depth of myometrial invasion<1/2 was lower than myometrial invasion>1/2, which was statistically significant (p < 0.001). According to the final postoperative pathology results, 93.1% (n = 95) of the cases were diagnosed as FIGO stage 1. The subgroups were 66.7% stage 1a and 26.4% stage 1b. When the stage and grade distribution was made according to the final postoperative pathology result, stage 1a grade 2 endometrial cancer was the most common with a rate of 43.1%. Concordance of the intraoperative and postoperative pathology results for the depth of myometrial invasion was 84.3%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 86.76%.

Conclusions: The accuracy of the intraoperative frozen section in endometrial cancers is quite higher. For this reason, intraoperative pathological examination results are important in terms of minimizing the complications of unnecessary surgery.

Keywords

• Endometrial cancer
• frozen section
• myometrial invasion

References

1. 1. Wang X, Li L, Cragun JM, Chambers SK, Hatch KD, Zheng W. Assessment of the role of intraoperative frozen section inguiding surgical staging for endometrial cancer. Int J Gynecol Cancer 2016;26:918-23.
2. 2. Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, et al. Uterine neoplasms, version 1. 2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2018;16:170-99.
3. 3. Setiawan VW, Yang HP, Pike MC, Mc Cann SE, Yu H, Xiang YB, et al. Type I and II endometrial cancers: have they different risk factors? J Clin Oncol 2013;31:2607-18.
4. 4. Ko EM, Walter P, Clark L, Jackson A, Franasiak J, Bolac C, et al. The complex triad of obesity, diabetes and race in type I and II endometrial cancers: prevalence and prognostic significance. Gynecol Oncol 2014;133:28-32.
5. 5. Stephan JM, Hansen J, Samuelson M, McDonald M, Chin Y, Bender D, et al. Intraoperative frozen section results reliably predict final pathology in endometrial cancer. Gynecol Oncol 2014;133:499-505.
6. 6. Ganesan R, Brown LJ, Kehoe S, McCluggage WG, El-Bahrawy MA. The role of frozen sections in gynaecological oncology: survey of practice in the United Kingdom. Eur J Obstet Gynecol Reprod Biol 2013;166:204-8.
7. 7. Karabagli P, Ugras S, Yilmaz BS, Celik C. The evaluation of reliability and contribution of frozen section pathology to staging endometrioid adenocarcinomas. Arch Gynecol Obstet 2015;292:391-7.
8. 8. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer: a gynecologic oncology group study. Cancer 1987;60:2035-41.

9. 9. Polan RM, Rossi EC, Barber EL. Extent of lymphadenectomy and postoperative major complications among women with endometrial cancer treated with minimally invasive surgery. Am J Obstet Gynecol 2019;220:263.e1-e8.
10. 10. Leon-Castillo A, Horeweg N, Peters EE, Rutten T, Ter Haar N, Smit VT. Prognostic relevance of the molecular classification in high-grade endometrial cancer for patients staged by lymphadenectomy and without adjuvant treatment. Gynecol Oncol 2022;164:577-86.
11. 11. Haltia UM, Butzow R, Leminen A, Loukovaara M. FIGO 1988 versus 2009 staging for endometrial carcinoma: A comparative study on prediction of survival and stage distribution according to histologic subtype. J Gynecol Oncol 2014;25:30-5.
12. 12. Kasius JC, Pijnenborg JMA, Lindemann K, Forsse D, van Zwol J, Kristensen GB, et al. Risk stratification of endometrial cancer patients: FIGO stage, biomarkers and molecular classification. Cancers 2021;13:5848.
13. 13. Ladbury C, Li R, Shiao J, Liu J, Cristea M, Han E, et al. Characterizing impact of positive lymph node number in endometrial cancer using machine-learning: a better prognostic indicator than FIGO staging? Gynecol Oncol 2022;164:39-45.
14. 14. Gómez-Raposo C, Merino Salvador M, Aguayo Zamora C, Casado Saenz E. Adjuvant chemotherapy in endometrial cancer. Cancer Chemother Pharmacol 2020;85:477-86.
15. 15. Ravegnini G, Gorini F, De Crescenzo E, De Leo A, De Biase D, Di Stanislao M, et al. Can miRNAs be useful biomarkers in improving prognostic stratification in endometrial cancer patients? An update review. Int J Cancer 2022;150:1077-90.
16. 16. Barczyński B, Frąszczak K, Wnorowski A, Kotarski J. Menopausal status contributes to overall survival in endometrial cancer patients. Cancers 2023:15:451.
17. 17. Wang T, Jiang R, Yao Y, Wang Y, Liu W, Qian L, et al. Endometrial cytology in diagnosis of endometrial cancer: a systematic review and meta-analysis of diagnostic accuracy. J Clin Med 2023;12:2358.
18. 18. Raffone A, Raimondo D, Travaglino A, Rovero G, Maletta M, Raimondo I, et al. Sentinel lymph node biopsy in surgical staging for high-risk groups of endometrial carcinoma patients. Int J Environ Res Public Health 2022;19:3716.
19. 19. Abdallah R, Khalil A, Ghunaim S, El Housheimi A, Khalife D, Sassine D, et al. The accuracy and clinical impact of intraoperative frozen section in determining the extent of surgical intervention in patients with early stage endometrial cancer. J Obstet Gynaecol 2022;42:1474-81.
20. 20. Fanning J, Tsukada Y, Piver, MS. Intraoperative frozen section diagnosis of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 1990;37:47-50.
21. 21. Furukawa N, Takekuma M, Takahashi N, Hirashima Y. Intraoperative evaluation of myometrial invasion and histological type and grade in endometrial cancer: diagnostic value of frozen section. Arch Gynecol Obstet 2010;281:913-7.
22. 22. 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;304:725-32.
23. 23. Mandato VD, Torricelli F, Mastrofilippo V, Palicelli A, Ciarlini G, Pirillo D, et al. Accuracy of preoperative endometrial biopsy and intraoperative frozen section in predicting the final pathological diagnosis of endometrial cancer. Surg Oncol 2020;35:229-35.
24. 24. Gitas G, Proppe L, Alkatout I, Rody A, Kotanidis, C, Tsolakidis D, et al. Accuracy of frozen section at early clinical stage of endometrioid endometrial cancer: a retrospective analysis in Germany. Arch Gynecol Obstet 2019;300:169-74