ENDOMETRİUM KANSERİNDE MYOMETRİAL İNVAZYONUN İNTRAOPERATİF DİGİTAL GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ

Yıl 2014, Cilt: 17 Sayı: 1, 0 - 0, 01.01.2014

Hakan Yetimalar İncim Bezcioğlu Derya Kılıç Sakarya Seyran Yiğit

Öz

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

Anahtar Kelimeler

Endometrium kanseri, myometrial invazyon.

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

Öz

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

Anahtar Kelimeler

Endometrial cancer, myometrial invasion

Kaynakça

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