What Is The Accuracy Of Frozen Section For Risk Triage In Endometrial Cancer?

INTRODUCTION: Although the current standard surgical procedure is still staging comprehensively in endometrial cancer (EC), the therapeutic effect of lymph node dissection (LND) is debatable for early stages. Therefore, it is important to identify high risk patients. In this study, it is intended to see the accuracy rate of frozen section (FS) in our institution by determining high-risk patients for lymph node metastasis (LNM) in EC.
METHODS: Intraoperative FS were studied in 37 EC patients, histopathological typing, grade, tumor size (TS), myometrial invasion depth (MID) and lymphovascular emboli (LVE) parameters were measured. These parameters were monitored and compared with the final paraffin results (PR).
RESULTS: In FS examination, the histopathological diagnosis of a patient with type I was a type II in PR (2.7%). In MID assessment one patient was (2.7%) misdiagnosed. In TS measurement, FS and PR were consistent in all patients. Referring to LVE, 4 patients (10.8%) were false negative by FS examination. FS received a false negative diagnosis in 5 patients (13.5%) for nuclear high grade and in 3 patients (8.1%) for structural high grade. The accuracy of the test sequence were calculated for histopathological type determination, MID, LVE, nuclear and structural grade as 94%, 97%, 89%, 86% and 91%, respectively. When all parameters were evaluated together, in terms of capturing the high-risk EC patients for LNM by FS examination, the sensitivity, specificity, and accuracy were calculated as 96% 100% and 97%, respectively. FS examination was failed for diagnosing one high-risk (1/37) EC patient (2.7%).
DISCUSSION AND CONCLUSION: FS examination was successful for histopathological type determination, TS and evaluation of MID but low accuracy rate was observed for LVE, for the determination of nuclear and structural grades.

Endometrium Kanserinde Risk Triajý Ýçin Frozen Kesit Ýle Parafin Takip Sonuçlarý Ne Kadar Uyumludur?

GÝRÝÞ ve AMAÇ: Endometrium kanseri (EK)’nde halen standart cerrahi her ne kadar tam evreleme þeklinde olsa da, erken evrede lenf nodu diseksiyonu (LND)’nun yeri tartýþmalýdýr. O nedenle yüksek riskli hastalarýn tespiti önem taþýmaktadýr. Bu çalýþmada lenf nodu metastazý (LNM) için yüksek riskli hastalarýn operasyon sýrasýnda frozen kesit (FK) ile kurumumuzda hangi doðrulukta tespit edilebileceðini görmek amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: EK’li 37 hastada intraoperatif FK ile, histopatolojik tiplendirme, greyd, tümör çapý (TÇ), miyometrial invazyon derinliði (MÝD) ve lenfovasküler emboli (LVE) parametrelerine bakýldý. Bu parametreler parafin takip (PT)‘lerindeki nihai sonuçlarý ile karþýlaþtýrýldý.
BULGULAR: FK incelemede histopatolojik tip I taný alan bir hasta (%2,7), PT’te tip II olarak deðerlendirildi. MÝD deðerlendirmesinde FK incelemede bir hasta derin invazyon açýsýndan yanlýþ negatif (%2,7) taný aldý. TÇ ölçümü FK ve PT tüm hastalarda uyumlu idi. LVE bakýldýðýnda, FK incelemede 4 hastada (%10,8) LVE tespit edilemedi. Tümörler diferansiasyon açýsýndan derecelendiðinde nükleer yüksek greyd 5 hastada (%13,5), yapýsal yüksek greyd ise 3 hastada (%8,1) FK ile yanlýþ negatif taný aldý. Histopatolojik tip tayini, MÝD, LVE, nükleer ve yapýsal greyd için testlerin doðruluðu sýrasý ile %94, %97, %89, %86 ve %91 olarak hesaplandý. Tüm parametreler birlikte deðerlendirildiðinde EK hastalarda LNM için yüksek riskli olaný yakalama açýsýndan FK incelemenin duyarlýlýk, özgüllük ve doðruluðu sýrasý ile %96, %100 ve %97 olarak hesaplandý. FK inceleme yüksek riskli EK’ni yakalama açýsýndan (1/37) bir hastada (%2,7) baþarýlý olamadý.
TARTIÞMA ve SONUÇ: EK’li hastada FK incelemenin histopatolojik tip tayini, TÇ ve MÝD deðerlendirmesi açýsýndan baþarýlý fakat LVE, nükleer ve yapýsal greyd tayini için doðruluk oranýn düþük olduðu izlendi.