How accurate is frozen section histology of pelvic lymph nodes in patients with endometrial cancer?

OBJECTIVE

Recent prospective data support the trend towards systematic retroperitoneal lymphadenectomy in patients with high-risk endometrial cancer. Because para-aortic node involvement in the absence of pelvic node involvement is uncommon, a reliable finding of negative pelvic lymph nodes (PLN) at intraoperative frozen section examination might allow omitting para-aortic dissection. We analyzed the diagnostic accuracy of frozen section examination of PLN in patients with endometrial cancer.

METHODS

We reviewed 131 patients with endometrial cancer who underwent surgery including systematic pelvic lymphadenectomy (n=101) or pelvic and para-aortic lymphadenectomy (n=27). Intraoperative frozen section examination of PLN was performed in 72 (55%) patients. Results of frozen section examination were compared with those of final histopathology and the diagnostic accuracy of frozen section examination of PLN was calculated. One pathologist measured the diameters of PLN metastases retrospectively.

RESULTS

A total of 1063 and 2666 PLN were analyzed by frozen section examination and by final histopathology, respectively. PLN metastases were found in 7 cases (10%) at frozen section examination, and in 17 cases (24%) at final histopathology (false negative rate, 59%). No false positive cases were noted. The mean diameter of all PLN metastases at final histopathology was 4.3 mm, as compared to 9.0 mm for the metastases detected at frozen section analyses. The mean diameter of PLN metastases missed at frozen section examination was 2.0 mm.

CONCLUSION

In this review at a single institution, intraoperative frozen section histology missed nearly two of three endometrial cancer patients with positive nodes. These results do not support tailoring the extent of lymphadenectomy according to the results of frozen section examination.

Topotecan-induced long-term remission of an advanced endometrial cancer after treatment with cisplatinum, an anthracycline and paclitaxel

BACKGROUND

The optimal palliative chemotherapy in endometrial cancer is unknown.

CASE REPORT

A patient was diagnosed to have primary endometrioid endometrial cancer metastatic to the pelvic, paraaortic and right inguinal lymph nodes (FIGO IVb). After radical surgery, she received 6 adjuvant cycles of cisplatin and epirubicin. Twelve months later, she developed a pelvic recurrence and received second-line paclitaxel chemotherapy. Three months thereafter, computed tomography showed diffuse peritoneal carcinomatosis with lesions up to 2 cm in diameter. She received eighteen weekly cycles of topotecan which led to a complete clinical response confirmed by CT. Forty-three months after the start of third-line chemotherapy with topotecan, the patient is alive with no evidence of disease.

CONCLUSION

Long-term survival with NED may be achievable by topotecan in selected patients with an initial diagnosis of extensive endometrial cancer despite repeated relapses and previous exposure to cisplatinum, an anthracycline and a taxane.