The role of intraoperative consultation in lymph node dissection in endometrioid carcinoma: 4 years of experience

Öz

Aim: The aim of this study is to compare the results of intraoperative consultation and final diagnosis in cases of endometrioid carcinoma. Methods: We included 157 cases diagnosed with endometrioid carcinoma who underwent intraoperative consultation between 2019 and 2022 in our study. We accessed the histological grade, myometrial invasion, cervical involvement, and tumor size parameters of the cases from both the intraoperative consultation and final diagnosis pathology reports through the hospital automation system. The correlation between these parameters and how intraoperative consultation guided lymph node dissection were analyzed using statistical tests. Results: The average age of the cases was found to be 60.8 years. The average tumor size was measured at 3.61 cm. Lymph node dissection was performed in 67 cases (42.7%), while it was not performed in 90 cases (57.3%). When comparing the intraoperative consultation reports with the final reports in terms of concordance, the concordance rates were found to be 85.2%, 82.1%, and 92% for histological grade, myometrial invasion, and cervical invasion, respectively. Among the cases where discrepancies were detected, it was found that lymph node dissection was necessary according to the parameters reported in the final report in nine cases, but it could not be performed due to the parameters reported during intraoperative consultation. In two cases, unnecessary dissection was performed. Conclusion: In endometrioid carcinoma, intraoperative consultation conducted under appropriate conditions and with clinical-pathological communication is crucial in reducing morbidity and mortality. Comparing and analyzing the consistency between intraoperative consultation results and final reports is valuable for preventing potential discrepancies in the future.

Anahtar Kelimeler

• Endometrioid carcinoma
• intraoperative consultation
• myometrial invasion
• lymph node dissection

Endometriod karsinomda intraoperatif konsültasyonun lenf nodu diseksiyonundaki yeri: 4 yıllık deneyim

Öz

Amaç: Bu çalışmanın amacı Endometrioid karsinom olgularında intraoperatif konsültasyon ve nihai inceleme sonuçlarını karşılaştırmaktır. Yöntem: 2019-2022 yılları arasında intraoperatif konsültasyon gerçekleştirilen 157 endometrioid karsinom tanılı olgu çalışmaya dahil edildi. Olguların intraoperatif konsültasyon ve nihai tanı patoloji raporlarına hastane otomasyon sisteminden ulaşılarak histolojik derece, myometrial invazyon, serviks tutulumu ve tümör boyutu parametreleri karşılaştırıldı. Bu parametrelerin birbirleriyle ilişkileri ve intraoperatif konsültasyonun lenf nodu diseksiyonuna nasıl yön verdiği istatistiksel testlerle analiz edildi. Bulgular: Olguların yaş ortalaması 60.8’di. Tümör boyutu ortalaması 3.61 cm’di. 67 vakaya (%42.7) lenf nodu diseksiyonu uygulanırken, 90 vakaya (%57.3) uygulanmadığı görüldü. İntraoperatif konsültasyon raporları ile nihai raporlar uyum açısından karşılaştırıldığında uyum oranları histolojik derece, myometrial invazyon, servikal invazyon için sırasıyla %85.2, %82.1, %92 bulundu. Uyumsuzluk saptanan olgulardan dokuzunda nihai rapor parametrelerine göre lenf nodu diseksiyonu yapılması gerekirken intraoperatif konsültasyonda bildirilen parametreler nedeniyle yapılamadığı, iki vakada ise gereksiz diseksiyon yapıldığı tespit edildi. Sonuç: Endometrioid karsinomda, uygun şartlarda ve klinikopatolojik iletişimle yapılan intraoperatif konsültasyon morbidite ve mortaliteleri azaltmada önem taşımaktadır. İntraoperatif konsültasyon sonuçları ile nihai raporların tutarlılıklarının karşılaştırılması ve analiz edilmesi ileride oluşabilecek uyumsuzlukların önüne geçilmesi açısından kıymetlidir.

Anahtar Kelimeler

• Endometrial karsinom
• intraoperatif konsültasyon
• myometrial invazyon
• lenf nodu diseksiyonu

Destekleyen Kurum

Yoktur

Kaynakça

1. Moch H. Female genital tumours: WHO Classification of Tumours, Volume 4. Lyon: WHO Classification of Tumours; 2020;4.
2. Crosbie EJ, Kitson SJ, McAlpine JN, Mukhopadhyay A, Powell ME, Singh N. Endometrial cancer. The Lancet 2022;399:1412-1428. doi: 10.1016/S0140-6736(22)00323-3
3. Dörk T, Hillemanns P, Tempfer C, Breu J, Fleisch MC. Genetic susceptibility to endometrial cancer: Risk factors and clinical management. Cancers 2020;12:2407. doi: 10.3390/cancers12092407
4. Sari ME, Yalcin İ, Sahin H, Meydanli MM, Gungor T. Risk factors for paraaortic lymph node metastasis in endometrial cancer. Int J Clin Oncol. 2017;22:937-944. doi: 10.1007/s10147-017-1139-5
5. Teng F, Zhang YF, Wang YM, et al. Contrast‐enhanced MRI in preoperative assessment of myometrial and cervical invasion, and lymph node metastasis: Diagnostic value and error analysis in endometrial carcinoma. Acta Obstet Gynecol Scand Suppl. 2015;94:266-273. doi: 10.1111/aogs.12570
6. Alves I, Cunha TM. Clinical importance of second-opinion interpretations by radiologists specializing in gynecologic oncology at a tertiary cancer center: magnetic resonance imaging for endometrial cancer staging. Radiol Bras. 2018;51:26-31.doi: 10.1590/0100-3984.2016.0171
7. Alcazar JL, Pineda L, Corral TM-A, et al. Transvaginal/transrectal ultrasound for assessing myometrial invasion in endometrial cancer: a comparison of six different approaches. J Gynecol Oncol. 2015;26:201-207.doi: 10.3802/jgo.2015.26.3.201
8. Chung HH, Cheon GJ, Kim HS, Kim JW, Park N-H, Song YS. Preoperative PET/CT standardized FDG uptake values of pelvic lymph nodes as a significant prognostic factor in patients with endometrial cancer. Eur J Nucl Med Mol Imaging.2014;41:1793-1799.doi: 10.1007/s00259-014-2775-x

9. Concin N, Creutzberg CL, Vergote I, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Virchows Arch 2021;478:153-190.doi: 10.1136/ijgc-2020-002230
10. Yang X, Yin J, Fu Y, et al. It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large‐scale, multi‐center, and retrospective study. Cancer Med. 2023;12:8897-8910.doi: 10.1002/cam4.5643
11. Kitchener H, Swart A, Qian Q, Amos C, Parmar M. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet (London, England) 2008;373:125-136.doi: 10.10112.6/S0140-6736(08)61766-3
12. Turan T, Oguz E, Unlubilgin E, et al. Accuracy of frozen-section examination for myometrial invasion and grade in endometrial cancer. Eur J Obstet Gynecol Reprod Biol.2013;167:90-95. doi: 10.1016/j.ejogrb.2012.11.004
13. Stephan J-M, Hansen J, Samuelson M, et al. Intra-operative frozen section results reliably predict final pathology in endometrial cancer. Gynecol Oncol.2014;133:499-505.doi: 10.1016/j.ygyno.2014.03.569.
14. Case AS, Rocconi RP, Straughn Jr JM, et al. A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer. Obstet Gynecol.2006;108:1375-1379. doi: 10.1097/01.AOG.0000245444.14015.00.
15. Fanning J, Tsukada Y, Piver MS. Intraoperative frozen section diagnosis of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol. 1990;37:47-50.doi: 10.1016/0090-8258(90)90306-6.
16. 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:e21912. doi: 10.1371/journal.pone.0021912.
17. Santoro A, Piermattei A, Inzani F, 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;19:1-8. doi: 10.1186/s12885-019-6318-5
18. Mandato VD, Torricelli F, Mastrofilippo V, et al. Accuracy of preoperative endometrial biopsy and intraoperative frozen section in predicting the final pathological diagnosis of endometrial cancer. Surg Oncol. 2020;35:229-235. doi: 10.1016/j.suronc.2020.09.003.
19. 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;292:391-397. doi: 10.1007/s00404-015-3621-5.
20. Montalto SA, 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;29:435-440. doi: 10.12892/ejgo200805435
21. Celik C, Özdemir S, Kiresi D, Emlik D, Tazegül A, Esen H. Evaluation of cervical involvement in endometrial cancer by transvaginal sonography, magnetic resonance imaging and frozen section. J Obstet Gynaecol. 2010;30:302-307. doi: 10.3109/01443610903521890.