ENDOMETRİAL KANSERLERİN İNTRAOPERATİF DEĞERLENDİRİLMESİNİN GÜVENİLİRLİĞİ

Yıl 2024, , 46 - 50, 18.03.2024

Sevil Sayhan , Ayşe Gül Tavukçu , Duygu Ayaz , Gamze Aköz , Esra Canan Kelten Talu , Tuğba Karadeniz

https://doi.org/10.57221/izmirtip.1306811

Öz

Amaç: Endometrial kanser gelişmiş ülkelerde jinekolojik maligniteler arasında ilk sıradadır.
Bilateral salpingooferektomiyle birlikte total histerektomi; erken evre endometrial
karsinomlarda standart tedavidir. Histolojik tip, myometrial invazyon, tümörün histolojik
derecesi ve servikal tutulum ek cerrahi prosedürleri gerektirir. Patoloğun intraoperatif tanısı
bu süreçte yol göstericidir. Bu çalışmanın amacı; laboratuvarımızda, endometrial karsinomun
evreleme cerrahi prosedürü sırasında intraoperatif frozen tanının güvenilirliğini
değerlendirmektir.
Gereç ve Yöntem: Çalışmamızda 2019 ocak ayı ile 2022 nisan ayı arasında, endometrial
karsinom ve atipili endometrial hiperplazi ön tanısı ile frozen çalışılan olguların hepsi
taranmış olup; 212 olgudan, frozen raporlarına ulaşılabilen 151 olgu değerlendirilmeye
alınmıştır. Histolojik tip ve derece, tümör çapı, myometrial invazyon, servikal ve adneksiyal
tutulum; frozen ve parafin kesitlerinde retrospektif olarak değerlendirilmiştir. Tümör çapı <2
cm ve ≥2 cm olarak , myometrial invazyon ise %50’den yüzeyel ve %50’den derin olarak
kategorize edilmiştir.
Bulgular: Frozen kesitlerin parafin kesitlerle uyumluluğu; histolojik tip için %98.6,
histolojik derece için %74.8, myometriyal invazyon için %82.8, tümör çapı için %90.7,
servikal invazyon için %91.4 ve over metastazı için %99.3 olarak bulunmuştur.
Sonuç: Bölümümüzde uygulanan endometrial kanserlerin intraoperatif frozen tanı sonuçları,
parafin tanı sonuçları ile büyük oranda uyumludur. Bu durum şimdiye kadar ortaya konan
ilgili literatür ile benzerlik göstermektedir. Sonuçta hastaların morbiditesi yüksek olan
gereksiz lenfadenektomiye maruz kalmaması için intraoperatif frozen prosedürü gerekli ve
güvenilir bir uygulamadır.

Anahtar Kelimeler

endometrial karsinom, frozen kesit, endometrial kanser

RELIABILITY OF INTRAOPERATIVE ASSESSMENT OF ENDOMETRIAL CANCERS

Öz

Aim: Endometrial cancer is the most common gynecological malignancies in developed
countries. Total hysterectomy with bilateral salpingoophorectomy is the standard treatment
for early stage endometrial carcinomas. Histological type, myometrial invasion, histological
grade of tumor, and cervical involvement require additional surgery. The pathologist’s
intraoperative diagnosis provides guidance in this process. The aim of this study is to assess
the reliability of intraoperative frozen diagnosis in our laboratory during surgical operations
for staging endometrial carcinoma.
Materials and Methods: We screened all cases between January 2019 and April 2022, which
we applied frozen sectioning with preliminary diagnosis of endometrial carcinoma and
endometrial hyperplasia with atypia. Out of 212 cases, we focused on 151, whose frozen
section reports were accessible. Histological type and grade, tumor diameter, myometrial
invasion, cervical and adnexal involvement were evaluated retrospectively in frozen and
paraffin sections. Tumor diameter was categorized as <2 cm and ≥2 cm, myometrial invasion
was categorized as more superficial than 50% and deeper than 50%.
Results: Compatibility of frozen sections with paraffin sections are found as 98.6% for
histological type, 74.8% for histological grade, 82.8% for myometrial invasion, 90.7% for
tumor diameter, 91.4% for cervical invasion, and 99.3% for ovarian metastasis.
Conclusion: The results of intraoperative frozen diagnosis of endometrial cancers performed
in our department are largely consistent with the results of paraffin diagnosis. This result is
concordant with what has been shown in the literature. Intraoperative frozen procedure is
necessary and reliable to avoid unnecessary lymphadenectomy in patients with high
morbidity.

Anahtar Kelimeler

frozen section, endometrial cancer, endometrial carcinoma

Kaynakça

• 1. 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. Archives of Gynecology and Obstetrics. 2019;300:169-74.
• 2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71: 209-49.
• 3. Uharcek P. Prognostic factors in endometrial carcinoma. J Obstet Gynaecol Res. 2008;34:776-83.
• 4. Berek JS, Matias-Guiu X, Creutzberg C, Fotopoulou C, Gaffney D, Kehoe S, et al. FIGO staging of endometrial cancer: 2023. Endometrial cancer staging subcommittee, FIGO women's cancer committee. Int J Gynaecol Obstet. 2023 Aug;162:383-94.
• 5. 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.
• 6. Larson DM, Connor GP, Broste SK, Krawisz BR, Johnson KK. Prognostic significance of gross myometrial invasion with endometrial cancer. Obstet Gynecol. 1996; 88:394–8.
• 7. Announcements; FIG0 Stages-1988 Revision. Gynecol Oncol. 1989;35:125-7.
• 8. Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100:1707– 16.
• 9. Kitchener, H, Swart, AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125–36.
• 10. Iitsuka C, Asami Y, Hirose Y, Nagashima M, Mimura T, Miyamoto S. et al. Preoperative magnetic resonance imaging versus intraoperative frozen section diagnosis for predicting the deep myometrial invasion in endometrial cancer: our experience and literature review. Journal of Obstetrics and Gynaecology Research. 2021;47:3331-8.
• 11. Acikalin A, Gumurdulu D, Bagir EK, Torun G, Guzel AB, Zeren H. et al. The guidance of intraoperative frozen section for staging surgery in endometrial carcinoma: frozen section in endometrial carcinoma. Pathology & Oncology Research. 2015;21:119-22.
• 12. Mariani A, Webb M J, Keeney GL, Haddock MG, Calori G, Podratz KC. Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary?. American Journal of Obstetrics and Gynecology. 2000;182:1506-19.
• 13. Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecologic Oncology. 2008;109:11-.
• 14. Convery PA, Cantrell LA, Di Santo N, Broadwater G, Modesitt SC, Secord AA et al. Retrospective review of an intraoperative algorithm to predict lymph node metastasis in low-grade endometrial adenocarcinoma. Gynecologic Oncology. 2011;123:65–70.
• 15. Milam MR, Java J, Walker JL, Metzinger DS, Parker LP, Coleman RL et al. Nodal metastasis risk in endometrioid endometrial cancer. Obstetrics and Gynecology, 2012;119:286-92.
• 16. 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. International Journal of Gynecologic Cancer. 2016;26:918-23.
• 17. Taşkın S, Ortaç F, Kahraman K, Göç G, Öztuna D, Güngör M. Cervical stromal involvement can predict survival in advanced endometrial carcinoma: a review of 67 patients. International Journal of Clinical Oncology, 2013;18:105-9.
• 18. Doğan DG, Alemdaroğlu S, Aka BF, Yılmaz BŞ, Yüksel ŞS, Çelik H. Accuracy of intra-operative frozen section in guiding surgical staging of endometrial cancer. Archives of Gynecology and Obstetrics. 2021;304:725-32.
• 19. 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. Surgical Oncology. 2020;35:229-35.
• 20. Santoro A, Piermattei A, Inzani F, Angelico G, Valente M, Arciuolo D et al. Frozen section accurately allows pathological characterization of endometrial cancer in patients with a preoperative ambiguous or inconclusive diagnoses: our experience. BMC Cancer, 2019;19:1096.
• 21. Kumar S, Bandyopadhyay, Semaan A, Shah JP, Mahdi H, Morris R,. et al. The role of frozen section in surgical staging of low risk endometrial cancer. PLoS One. 2011;6,e21912. Karabagli P, Ugras S, Yilmaz BS, Celik, C. The evaluation of reliability and contribution of frozen section pathology to staging endometrioid adenocarcinomas. Archives of Gynecology and Obstetrics. 2015;292:391-7.