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Leite S, Chen YS, Walker A, Riccio K, Taylor N, Zighelboim I, Graul A. Role of sentinel lymph node evaluation during hysterectomy for preoperative pathology diagnosis of endometrial intraepithelial neoplasia in a community hospital setting. Gynecol Oncol 2024; 184:83-88. [PMID: 38301310 DOI: 10.1016/j.ygyno.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To determine the utility of sentinel lymph node (SLN) evaluation during hysterectomy for endometrial intraepithelial neoplasia (EIN) in a community hospital setting and identify descriptive trends among pathology reports from those diagnosed with endometrial cancer (EC). METHODS We reviewed patients who underwent hysterectomy from January 2015 to July 2022 for a pathologically confirmed diagnosis of EIN obtained by endometrial biopsy (EMB) or dilation and curettage. Data was obtained via detailed chart review. Statistical testing was utilized for between-group comparisons and multivariate logistic regression modeling. RESULTS Of the 177 patients with EIN who underwent hysterectomy during the study period, 105 (59.3%) had a final diagnosis of EC. At least stage IB disease was found in 29 of these patients who then underwent adjuvant therapy. Pathology report descriptors suspicious for cancer and initial specimen type obtained by EMB were independently and significantly associated with increased odds of EC diagnosis (aOR 8.192, p < 0.001;3.746, p < 0.001, respectively). Operative times were not increased by performance of SLN sampling while frozen specimen evaluation added an average of 28 min to procedure length. Short-term surgical outcomes were also similar between groups. CONCLUSION Patients treated for EIN at community-based institutions might be more likely to upstage preoperative EIN diagnoses and have an increased risk of later stage disease than previous research suggests. Given no surgical time or short-term outcome differences, SLN evaluation should be more strongly considered in this practice setting, especially for patients diagnosed by EMB or with pathology reports indicating suspicion for EC.
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Affiliation(s)
- Samantha Leite
- Department of Obstetrics and Gynecology, St. Luke's University Health Network, 801 Ostrum St., Bethlehem, PA 18015, United States of America.
| | - Yiting Stefanie Chen
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
| | - Allison Walker
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
| | - Kelly Riccio
- Lewis Katz School of Medicine at Temple University, St. Luke's University Health Network, 3500 N Broad St., Philadelphia, PA 19140, United States of America
| | - Nicholas Taylor
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
| | - Israel Zighelboim
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
| | - Ashley Graul
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
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Ozdemir CY, Telli EU, Oge T, Yalcin OT. Ultrasonography, macroscopy, and frozen section: whıch is better for predicting deep myometrial invasıon in endometrial cancer? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230333. [PMID: 37729223 PMCID: PMC10511276 DOI: 10.1590/1806-9282.20230333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/07/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The aim of this study was to compare the power of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section for predicting deep myometrial invasion in endometrial cancer. METHODS This is a retrospective review involving 68 patients who underwent surgical staging for endometrial cancer from 2014 to 2017. Patients with grade 3 endometrial cancer and non-endometrioid tumors were excluded. The findings related to preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were compared with definitive histopathological diagnosis. RESULTS The mean age, gravidity, and body mass index of the patients were 58.1±8.9 years (range: 30-80 years), 3.2±2.1 (range: 0-9), and 33.5±6.6 kg/m2 (range: 20-52 kg/m2), respectively. Only 11 (16.2%) patients were in the premenopausal period, while 57 (83.8%) were in the postmenopausal period. Grade 1 endometrial cancer was found in 29 patients (42.6%) and grade 2 tumors were specified in 39 patients (57.4%). Stage IA disease was found in 45 (66.2%) patients, while stage IB disease was observed in 23 (33.8%) patients. The 5-year survival rate was 91.2%. The sensitivity of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were 56, 34, and 52%, respectively, for predicting deep myometrial invasion. In contrast, the specificity of preoperative ultrasonography, intraoperative macroscopic examination, and frozen section were 86, 100, and 100%, respectively. CONCLUSION Transvaginal ultrasonography and intraoperative frozen section were found to have similar sensitivity and specificity for predicting deep myometrial invasion. Preoperative transvaginal ultrasonography appears as an efficient approach for predicting endometrial cancers with deep myometrial invasion.
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Affiliation(s)
- Cem Yagmur Ozdemir
- Afyonkarahisar Health Sciences University Hospital, Facutly of Medicine, Department of Obstetrics and Gynecology – Afyonkarahisar, Turkey
| | - Elcin Uzmez Telli
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Obstetrics and Gynecology – Eskisehir, Turkey
| | - Tufan Oge
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Obstetrics and Gynecology – Eskisehir, Turkey
| | - Omer Tarik Yalcin
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Obstetrics and Gynecology – Eskisehir, Turkey
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3
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Tameish S, Florez N, Vidal JRP, Chen H, Vara J, Alcázar JL. Transvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial infiltration in patients with low-grade endometrioid endometrial cancer: A systematic review and head-to-head meta-analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1188-1197. [PMID: 37318272 DOI: 10.1002/jcu.23508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/18/2023] [Accepted: 06/03/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE We aimed to compare the diagnostic performance of magnetic resonance imaging (MRI) and transvaginal ultrasound (TVS) for detecting myometrial invasion (MI) in patients with low-grade endometrioid endometrial carcinoma. METHODS A comprehensive search of MEDLINE (Pubmed), Web of Science, Embase and Scopus (from January 1990 to December 2022) was performed for articles comparing TVS and MRI in the evaluation of myometrial infiltration in low-grade (grade 1 or 2) endometrioid endometrial carcinoma in the same group of patients. We used QUADAS-2 tool for assessing the risk of bias of studies. RESULTS We found 104 citations in our extensive research. Four articles were ultimately included in the meta-analysis, after excluding 100 reports. All articles were considered low risk of bias in most of the domains assessed in QUADAS-2. We observed that pooled sensitivity and specificity for detecting deep MI were 65% (95% confidence interval [CI] = 54%-75%) and 85% (95% CI = 79%-89%) for MRI, and 71% (95% CI = 63%-78%) and 76% (95% CI = 67%-83%) for TVS, respectively. No statistical differences were found between both imaging techniques (p > 0.05). We observed low heterogeneity for sensitivity and high for specificity regarding TVS; and moderate for both sensitivity and specificity in case of MRI. CONCLUSIONS The diagnostic performance of TVS and MRI for the evaluation of deep MI in women with low-grade endometrioid endometrial cancer is similar. However, further research is needed as the number of studies is scanty.
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Affiliation(s)
- Sara Tameish
- Department of Obstetrics and Gynecology, University Hospital Sant Joan, Reus, Spain
| | - Natalia Florez
- Department of Obstetrics and Gynecology, University Hospital Virgen de Valme, Seville, Spain
| | - Juan Ramón Pérez Vidal
- Department Obstetrics and Gynecology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Hui Chen
- Department of Obstetrics and Gynecology, University Hospital Castelló, Castelló de la Plana, Spain
| | - Julio Vara
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
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4
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Misuraca L, Lugnani F, Brassetti A, Cacciatore L, Tedesco F, Anceschi U, Bove AM, D'Annunzio S, Ferriero M, Guaglianone S, Mastroianni R, Tuderti G, Panebianco V, Sentinelli S, Simone G. Single-Setting 3D MRI/US-Guided Frozen Sectioning and Cryoablation of the Index Lesion: Mid-Term Oncologic and Functional Outcomes from a Pilot Study. J Pers Med 2023; 13:978. [PMID: 37373967 DOI: 10.3390/jpm13060978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Our study explored frozen section reliability in prostate cancer (PCa) diagnoses and described surgical steps of a 3D magnetic resonance imaging (MRI)-ultrasound (US)-guided prostate biopsy (PB) and focal cryoablation of the index lesion (IL) in a single-setting procedure. Patients with a suspicious prostatic specific antigen (PSA) value, with a PIRADS 4 or 5 single lesion, were enrolled for trans perineal 3D MRI-US-guided PB and TRUS-guided focal cryoablation. Three cores were taken from the IL, three cores from the surrounding area, while systematic sampling was performed for the rest of the gland. After confirmation of PCa in frozen sections, focal cryoablation was performed. The 1st-year follow-up schedule included a PSA test at a 3-month interval, MRI 3 months and 1 year postoperatively and PB of the treated area at 1 year. Following the follow-up schedule, an involved PSA test at a 3-month interval and yearly MRI were performed. The PCa diagnosis was histologically confirmed in all three patients with frozen sections. At final histology, a single Gleason score upgrade from 6 (3 + 3) to 7 (3 + 4) was observed. All patients were discharged on postoperative day 1. At the 3-month evaluation, mean PSA values decreased from 12.54 (baseline) to 1.73 ng/mL and MRI images showed complete ablation of the IL in all patients. Urinary continence and potency were preserved in all patients. At the 1-year follow-up, one patient had suspicious ipsilateral recurrence on MRI and underwent a new analogous procedure. Post follow-up was uneventful and PSA remained stable in all patients. Three-dimensional MRI-US-guided frozen sectioning and focal cryoablation of the IL is a step forward towards a "patient-tailored" minimally invasive approach to the diagnosis and cure of PCa.
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Affiliation(s)
- Leonardo Misuraca
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | - Franco Lugnani
- Department of Urology, Hippocrates D.O.O, 6215 Divaca, Slovenia
| | - Aldo Brassetti
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | - Simone D'Annunzio
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | | | - Salvatore Guaglianone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | | | - Steno Sentinelli
- Department of Pathology, IRCCS "Regina Elena" National Cancer Institute, 00128 Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
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5
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Yang X, Yin J, Fu Y, Shen Y, Zhang C, Yao S, Xu C, Xia M, Lou G, Liu J, Lin B, Wang J, Zhao W, Zhang J, Cheng W, Guo H, Guo R, Xue F, Wang X, Han L, Li X, Zhang P, Zhao J, Li W, Dou Y, Wang Z, Liu J, Li K, Chen G, Sun C, Sun P, Lu W, Yao Q. Preoperative and intraoperative assessment of myometrial invasion in patients with FIGO stage I non-endometrioid endometrial carcinoma-a large-scale, multi-center, and retrospective study. Diagn Pathol 2023; 18:8. [PMID: 36698195 PMCID: PMC9878924 DOI: 10.1186/s13000-023-01294-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Myometrial invasion is a prognostic factor for lymph node metastases and decreased survival in non-endometrioid endometrial carcinoma patients. Herein, we explored the mode of myometrial invasion diagnosis in FIGO stage I non-endometrioid carcinoma and evaluated the differences in diagnostic efficiency among intraoperative frozen section (IFS), intraoperative gross examination (IGE), magnetic resonance imaging (MRI), and computed tomography (CT) in clinical practice. Finally, we suggested which test should be routinely performed. METHOD This was a historical cohort study nationwide with 30 centers in China between January 2000 and December 2019. Clinical data, including age, histology, method of myometrial invasion evaluation (MRI, CT, IGE, and IFS), and final diagnosis of postoperative paraffin sections, were collected from 490 non-endometrioid endometrial carcinoma (serous, clear cell, undifferentiated, mixed carcinoma, and carcinosarcoma) women in FIGO stage I. RESULTS Among the 490 patients, 89.59% presented myometrial invasion. The methods reported for myometrial invasion assessment were IFS in 23.47%, IGE in 69.59%, MRI in 37.96%, and CT in 10.20% of cases. The highest concordance was detected between IFS and postoperative paraffin sections (Kappa = 0.631, accuracy = 93.04%), followed by IGE (Kappa = 0.303, accuracy = 82.40%), MRI (Kappa = 0.131, accuracy = 69.35%), and CT (Kappa = 0.118, accuracy = 50.00%). A stable diagnostic agreement between IFS and the final results was also found through the years (2000-2012: Kappa = 0.776; 2013-2014: Kappa = 0.625; 2015-2016: Kappa = 0.545; 2017-2019: Kappa = 0.652). CONCLUSION In China, the assessment of myometrial invasion in non-endometrioid endometrial carcinoma is often performed via IGE, but the reliability is relatively low in contrast to IFS. In clinical practice, IFS is a reliable method that can help accurately assess myometrial invasion and intraoperative decision-making (lymph node dissection or not). Hence, it should be routinely performed in non-endometrioid endometrial carcinoma patients.
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Affiliation(s)
- Xiaohang Yang
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Jingjing Yin
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Yu Fu
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Yuanming Shen
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000 China
| | - Chuyao Zhang
- grid.488530.20000 0004 1803 6191Department of Gynecologic Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng E Rd, Guangzhou, 510060 China
| | - Shuzhong Yao
- grid.412615.50000 0004 1803 6239Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, No 58. Zhong Shan ER Lu, Guangzhou, 510080 China
| | - Congjian Xu
- grid.412312.70000 0004 1755 1415Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Min Xia
- grid.440323.20000 0004 1757 3171Department of Gynecology and Obstetrics, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, NO 20 Yuhuangding East Road, Yantai, Shandong 264000 China
| | - Ge Lou
- grid.412651.50000 0004 1808 3502Department of Gynecology Oncology, Harbin Medical University Cancer Hospital, Harbin, 150086 China
| | - Jihong Liu
- grid.488530.20000 0004 1803 6191Department of Gynecologic Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng E Rd, Guangzhou, 510060 China
| | - Bei Lin
- grid.412467.20000 0004 1806 3501Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, Liaoning 110004 China
| | - Jianliu Wang
- grid.411634.50000 0004 0632 4559Peking University People’s Hospital, Beijing, 100044 China
| | - Weidong Zhao
- grid.59053.3a0000000121679639The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001 China
| | - Jieqing Zhang
- grid.256607.00000 0004 1798 2653Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, Guangxi 530021 China
| | - Wenjun Cheng
- grid.412676.00000 0004 1799 0784The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, Jiangsu 210029 China
| | - Hongyan Guo
- grid.411642.40000 0004 0605 3760The Third Hospital of Peking University, 49 North Garden Rd., Haidian District, Beijing, China
| | - Ruixia Guo
- grid.412633.10000 0004 1799 0733Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe East Road, Zhengzhou, 450052 China
| | - Fengxia Xue
- grid.412645.00000 0004 1757 9434Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154 Anshan Dao, Heping District, Tianjin, 300052 China
| | - Xipeng Wang
- grid.412987.10000 0004 0630 1330Department of Gynecology and Obstetrics, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200092 China
| | - Lili Han
- grid.410644.3Department of Gynecology, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Street, Tianshan District, Urumqi, 830001 China
| | - Xiaomao Li
- grid.412558.f0000 0004 1762 1794Department of Gynecology and Obstetrics, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, 510630 China
| | - Ping Zhang
- grid.452704.00000 0004 7475 0672Department of Gynecology, The Second Hospital of Shandong University, 247 Bei Yuan Street, Jinan, Shandong 250033 China
| | - Jianguo Zhao
- grid.410626.70000 0004 1798 9265Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Affiliated Hospital of Nankai University, No. 156, Sanma Road, Nankai District, Tianjin, 300100 China ,grid.216938.70000 0000 9878 7032Tianjin Clinical Research Center for Gynecology and Obstetrics, Affiliated Hospital of Nankai University, No. 156, Sanma Road, Nankai District, Tianjin, 300100 China ,grid.216938.70000 0000 9878 7032Branch of National Clinical Research Center for Gynecology and Obstetrics, Affiliated Hospital of Nankai University, No. 156, Sanma Road, Nankai District, Tianjin, 300100 China
| | - Wenting Li
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Yingyu Dou
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Zizhuo Wang
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Jingbo Liu
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Kezhen Li
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Gang Chen
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Chaoyang Sun
- grid.412793.a0000 0004 1799 5032Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China ,grid.412793.a0000 0004 1799 5032Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000 China
| | - Pengming Sun
- grid.256112.30000 0004 1797 9307Fujian Provincial Women & Children’s Hospital, Fujian Provincial Maternity & Children Health Hospital, Fujian Medical University, Fuzhou, Fujian 350000 China
| | - Weiguo Lu
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000 China
| | - Qin Yao
- grid.412521.10000 0004 1769 1119Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong 266003 China
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6
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Current Approaches to the Management of Patients with Endometrial Cancer. Cancers (Basel) 2022; 14:cancers14184500. [PMID: 36139659 PMCID: PMC9497194 DOI: 10.3390/cancers14184500] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 02/07/2023] Open
Abstract
Simple Summary New data, the development of new methods of treatment and management and the rising incidence of endometrial cancer require constant reviewing, in order to inform healthcare professionals about the current approaches to endometrial cancer. This review aims to present old, new and emerging perspectives in the management of endometrial cancer and evaluate the existing therapeutic strategies, by assessing the different surgical routes, the position of adjuvant therapies in the treatment of endometrial cancer and the implementation of SLNB. Upon reviewing literature data, it became clear that minimally invasive surgery is becoming gradually the preferred route of surgery, whereas SLNB is gaining more ground and could yield important information about the management needed in low-risk and high-risk endometrial cancer. Abstract The incidence of endometrial cancer (EC) is rising and healthcare professionals need to be informed about the latest data on the constant developments in the field of its management. With particular interest in the classification and management of EC, we surveyed current literature, national and international data, and guidelines, as well as the latest studies to present the most recent data regarding the management of EC. It became evident that despite the consensus on low-risk EC, there are still controversies surrounding the management of high-risk EC, especially regarding the role of sentinel lymph node biopsy (SLNB). Our aim is to present the old and new perspectives in the management of EC, the different available surgical routes, the possible desire for fertility preservation, the role of adjuvant therapies and the focus on the advantages and the limitations of the implementation of SLNB in therapeutic strategies. It became evident throughout our search and based on literature data that minimally invasive surgery (MIS) leads to satisfying outcomes, thus becoming gradually the preferred route of surgery, while SLNB could provide essential information and guidance about the overall management needed in cases of both low-risk and high-risk EC.
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7
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Elshanbary AA, Awad AA, Abdelsalam A, Ibrahim IH, Abdel-Aziz W, Darwish YB, Isa AS, Drid B, Mustafa MG, Allam RH, Abo Ali AA, Nourelden AZ, Ragab KM, AlGwaiz HIM, Awaji AA, Germoush MO, Albrakati A, Piscopo M, Ghaboura N, Zaazouee MS. The diagnostic accuracy of intraoperative frozen section biopsy for diagnosis of sentinel lymph node metastasis in breast cancer patients: a meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:47931-47941. [PMID: 35543788 PMCID: PMC9252966 DOI: 10.1007/s11356-022-20569-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
Sentinel lymph node (SLN) sampling is important for evaluating the nodal stage of breast cancer when the axillary nodes are clinically free of metastasis. The intraoperative frozen section (IFS) of SLN is used for lymph node assessment. This meta-analysis aims to provide evidence about the diagnostic accuracy and the applicability of IFS of SLN in breast cancer patients. Data were collected by searching PubMed, Cochrane, Scopus, and Web of Science electronic databases for trials matching our eligibility criteria. The statistical analysis included the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and pooled studies' diagnostic odds ratio outcomes. The analyses were conducted using the Open Meta-analyst software. This meta-analysis pooled the results of 110 studies. The overall sensitivity of IFS for SLN metastasis was 74.7%; 95% CI [72.0, 77.2], P < 0.001. It was 31.4% 95% CI [25.2, 38.3], P < 0.001 for the micro-metastasis, and 90.2%; 95% CI [86.5, 93.0], P < 0.001 for the macro-metastasis. The overall specificity was 99.4%; 95% CI [99.2, 99.6], P < 0.001. The overall positive likelihood ratio was 121.4; 95% CI [87.9, 167.6], P < 0.001, and the overall negative likelihood ratio was 0.226; 95% CI [0.186, 0.274], P < 0.001. The overall diagnostic odds ratio of IFS for diagnosing SLN metastasis was 569.5; 95% CI [404.2, 802.4], P < 0.001. The intraoperative frozen section of SLN has good sensitivity for diagnosing breast cancer macro-metastasis. However, the sensitivity is low for micro-metastasis. The specificity is very satisfactory.
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Affiliation(s)
- Alaa Ahmed Elshanbary
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Alaa Abdelsameia Awad
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Alaa Abdelsalam
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Islam H Ibrahim
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Walid Abdel-Aziz
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Youssef Bahaaeldin Darwish
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - Alaa Saad Isa
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Boutheyna Drid
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Batna 2 University, Batna, Algeria
| | - Marwa Gamal Mustafa
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Pharmacy, Fayoum University, Fayoum, Egypt
| | - Radwa Hamdy Allam
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Amira A Abo Ali
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Anas Zakarya Nourelden
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Khaled Mohamed Ragab
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Minia University, Minia, Egypt
| | - Hussah I M AlGwaiz
- Department of Biology, College of Science, Princess Nourah Bint Abdulrahman University, Riyadh, 11474, Saudi Arabia
| | - Aeshah A Awaji
- Department of Biology, Faculty of Science, University College of Taymaa, University of Tabuk, Tabuk, 71491, Saudi Arabia
| | - Mousa O Germoush
- Biology Department, College of Science, Jouf University, P.O. Box: 2014, Sakaka, Saudi Arabia
| | - Ashraf Albrakati
- Department of Human Anatomy, College of Medicine, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
| | - Marina Piscopo
- Department of Biology, University of Naples Federico II, Via Cinthia, 80126, Naples, Italy
| | - Nehmat Ghaboura
- Department of Pharmacy Practice, Batterjee Medical College, Pharmacy Program, P.O. Box 6231, Jeddah, 21442, Saudi Arabia
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8
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Gastón B, Muruzábal JC, Lapeña S, Modroño A, Guarch R, García de Eulate I, Alcázar JL. Transvaginal Ultrasound Versus Magnetic Resonance Imaging for Assessing Myometrial Infiltration in Endometrioid Low Grade Endometrial Cancer: A Prospective Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:335-342. [PMID: 33780025 DOI: 10.1002/jum.15708] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To compare the diagnostic accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) for assessing myometrial infiltration (MI) in patients with low grade endometrioid endometrial cancer. METHODS Observational prospective study performed at a single tertiary care center from 2016 to 2020, comprising 156 consecutive patients diagnosed by endometrial sampling as having an endometrioid grade 1/grade 2 endometrial cancer. TVS and MRI were performed prior to surgical staging for assessing MI, which was estimated using subjective examiner's impression and Karlsson's method for both TVS and MRI. During surgery, intraoperative assessment of MI was also performed. Definitive pathological study considered as reference standard. Diagnostic accuracy for ultrasound, MRI, and intraoperative biopsy was estimated and compared. RESULTS Sensitivity and specificity of TVS for detecting deep MI were 75 and 73.5% for subjective impression and 65 and 70% for Karlsson method, respectively (P = .54). Sensitivity and specificity of MRI for detecting deep MI were 80 and 87% for subjective impression and 70 and 71.3% for Karlsson method. MRI subjective impression showed a significant better specificity than MRI Karlsson method (P = .03). MRI showed better specificity than TVS when subjective impression was considered (P <.05), but not for Karlsson method. Sensitivity and specificity of intraoperative were 75 and 97%, respectively. Intraoperative biopsy showed better specificity than ultrasound and MRI either using examiner's impression or Karlsson method (P <.05). CONCLUSIONS MRI revealed a significant higher specificity than TVS when assessing deep myometrial infiltration. However, the intraoperative biopsy offers a significant better diagnostic accuracy than preoperative imaging techniques.
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Affiliation(s)
- Begoña Gastón
- Division of Benign Gynecologic Pathology, Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Juan C Muruzábal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Sonia Lapeña
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Ana Modroño
- Division of Ultrasound, Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Rosa Guarch
- Department of Pathological Anatomy, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | | | - Juan L Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Abdallah R, Khalil A, Ghunaim S, El Housheimi A, Khalife D, Sassine D, Khoury K, Mailhac A, Nassour F, Saliba M, Seoud M. The accuracy and clinical impact of intraoperative frozen section in determining the extent of surgical intervention in patients with early stage endometrial cancer. J OBSTET GYNAECOL 2022; 42:1474-1481. [PMID: 35020562 DOI: 10.1080/01443615.2021.2004583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The aim of this study was to compare intraoperative frozen section (FS) with the final pathology (FP), and determine its clinical impact in clinically apparent early stage endometrial cancer (EC) at the American University of Beirut Medical Center (AUBMC). Data for patients 18 years or older, with clinically apparent early stage, grade 1 or 2, endometrioid EC, who underwent hysterectomy ± lymph node dissection (LND) at AUBMC between January 1st 1996 and June 30th 2016 were retrospectively reviewed. 70 patients were included. The overall concordance between FS and FP was 92.3% for histological subtype, 77% for tumour grade, 82% for Myometrial invasion (MI) and 100% for tumour size. At a median follow up of 30 months, 8 recurrences (11.4%) were noted, with a 5-year PFS and OS of 76 and 84% respectively, with a trend towards lower recurrence and improved survival in patients who underwent FS or LND.Impact statementWhat is already known on this subject? Hysterectomy and bilateral salpingo-oophorectomy is the standard surgery for stage I endometrial cancer (EC). Intraoperative frozen section (FS) facilitates the decision on performing lymph node dissection (LND). However, its accuracy and clinical impact have been questioned.What do the results of this study add? Our objective is to compare FS with the final pathology (FP), and determine its clinical impact in clinically apparent early stage EC at the American University of Beirut Medical Center (AUBMC). There is a lack of standardisation regarding FS use and reporting at AUBMC.What are the implications of these findings for clinical practice and/or further research? The strong correlation between FS and FP can serve as a tool to guide decision to perform LND in patients with apparent early stage disease, where use of sentinel LN biopsy technique is not available.
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Affiliation(s)
- Reem Abdallah
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Khalil
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Suleiman Ghunaim
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alaa El Housheimi
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dalia Khalife
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dib Sassine
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karinia Khoury
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aurelie Mailhac
- Clinical Research Institute, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Farah Nassour
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maelle Saliba
- Department of Pathology & Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhieddine Seoud
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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Iitsuka C, Asami Y, Hirose Y, Nagashima M, Mimura T, Miyamoto S, Onuki M, Ohgiya Y, Kushima M, Sekizawa A, Matsumoto K. Preoperative Magnetic Resonance Imaging versus Intraoperative Frozen Section Diagnosis for Predicting the Deep Myometrial Invasion in Endometrial Cancer: Our Experience and Literature Review. J Obstet Gynaecol Res 2021; 47:3331-3338. [PMID: 34155730 DOI: 10.1111/jog.14891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 12/24/2022]
Abstract
AIM The present study was designed to directly compare the diagnostic performance of preoperative magnetic resonance imaging (MRI) and intraoperative frozen section (FS) diagnoses in predicting deep myometrial invasion (MI) of endometrial cancer. METHODS Using MRI findings and FS diagnoses, 194 patients with surgically staged endometrial cancer were evaluated for deep MI between 2006 and 2018. Definitive histological diagnosis of paraffin sections of excised tissues was used as the gold standard approach. RESULTS Of 194 cases, 53 (27.3%) cases were finally diagnosed as having deep MI (≥50%). There was 82% total agreement between MRI and FS diagnoses in predicting deep MI, with a kappa value of 0.54 (95% confidence interval [CI] = 0.40-0.67, moderate agreement). The sensitivity of FS diagnosis (0.66, 95% CI = 0.52-0.78) for predicting deep MI was lower than that of MRI (0.77, 95% CI = 0.63-0.87; p = 0.21), while the specificity of FS (0.98, 95% CI = 0.93-0.99) was significantly higher than that of MRI (0.88, 95% CI = 0.81-0.93; p = 0.001). Overall, the accuracy of FS (0.89, 95% CI = 0.84-0.93) was higher than that of MRI (0.85, 95% CI = 0.79-0.90), although the difference did not reach statistical significance (p = 0.23). The accuracy (0.95, 95% CI = 0.90-0.97) was very high in cases with concordant MRI and FS results. CONCLUSIONS MRI and FS showed different diagnostic characteristics for predicting deep MI, with a higher specificity observed for FS and the greatest accuracy obtained in concordant cases. Thus, our findings recommend the addition of FS diagnosis, either alone or in conjunction with MRI, to MI evaluation.
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Affiliation(s)
- Chiaki Iitsuka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Yuka Asami
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Yusuke Hirose
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Minoru Nagashima
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Takashi Mimura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Shingo Miyamoto
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Mamiko Onuki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Yoshimitsu Ohgiya
- Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Miki Kushima
- Department of Pathology, Showa University School of Medicine, Koto Toyosu Hospital, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Koji Matsumoto
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
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Jónsdóttir B, Marcickiewicz J, Borgfeldt C, Bjurberg M, Dahm-Kähler P, Flöter-Rådestad A, Hellman K, Holmberg E, Kjølhede P, Rosenberg P, Tholander B, Åvall-Lundqvist E, Stålberg K, Högberg T. Preoperative and intraoperative assessment of myometrial invasion in endometrial cancer-A Swedish Gynecologic Cancer Group (SweGCG) study. Acta Obstet Gynecol Scand 2021; 100:1526-1533. [PMID: 33721324 DOI: 10.1111/aogs.14146] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Deep myometrial invasion (≥50%) is a prognostic factor for lymph node metastases and decreased survival in endometrial cancer. There is no consensus regarding which pre/intraoperative diagnostic method should be preferred. Our aim was to explore the pattern of diagnostic methods for myometrial invasion assessment in Sweden and to evaluate differences among magnetic resonance imaging (MRI), transvaginal sonography, frozen section, and gross examination in clinical practice. MATERIAL AND METHODS This is a nationwide historical cohort study; women with endometrial cancer with data on assessment of myometrial invasion and FIGO stage I-III registered in the Swedish Quality Registry for Gynecologic Cancer (SQRGC) between 2017 and 2019 were eligible. Data on age, histology, FIGO stage, method, and results of myometrial invasion assessment, pathology results, and hospital level were collected from the SQRGC. The final assessment by the pathologist was considered the reference standard. RESULTS In the study population of 1401 women, 32% (n = 448) had myometrial invasion of 50% of more. The methods reported for myometrial invasion assessment were transvaginal sonography in 59%, MRI in 28%, gross examination in 8% and frozen section in 5% of cases. Only minor differences were found for age and FIGO stage when comparing methods applied for myometrial invasion assessment. The sensitivity, specificity, and accuracy to find myometrial invasion of 50% or more with transvaginal sonography were 65.6%, 80.3%, and 75.8%, for MRI they were 76.9%, 71.9%, and 73.8%, for gross examination they were 71.9%, 93.6%, and 87.3%, and for frozen section they were 90.0%, 92.7%, and 92.0%, respectively. CONCLUSIONS In Sweden, the assessment of deep myometrial invasion is most often performed with transvaginal sonography, but the sensitivity is lower than for the other diagnostic methods. In clinical practice, the accuracy is moderate for transvaginal sonography and MRI.
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Affiliation(s)
- Björg Jónsdóttir
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Janusz Marcickiewicz
- Department of Obstetrics and Gynecology, Varbergs Hospital, Region Halland, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital, and Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Maria Bjurberg
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Angelique Flöter-Rådestad
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet. Stockholm, Sweden
| | - Kristina Hellman
- Department of Gynecologic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Holmberg
- Regional Cancer Center Western Sweden, Gothenburg, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Rosenberg
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Bengt Tholander
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Elisabeth Åvall-Lundqvist
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Karin Stålberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Thomas Högberg
- Department of Medical Oncology, Institute of Clinical Sciences, Lund University, Lund, Sweden
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12
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Guo Q, Yi H, Chen X, Song J, Chen L, Zheng X. Is routine frozen section analysis necessary in patients with non-endometrioid cancer or grade 3 endometrioid cancer? Int J Gynaecol Obstet 2021; 156:256-261. [PMID: 33864253 PMCID: PMC9290841 DOI: 10.1002/ijgo.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 12/24/2022]
Abstract
Objective To explore the accuracy related to type and subtype between frozen section (FS) results and final pathology results in patients with endometrial cancer and to suggest whether it should be routinely performed. Methods Retrospective data were collected from 184 patients with endometrial cancer who underwent surgery at a single center (January 2014–December 2018). FS results were compared with the final pathology results with respect to histotype, tumor grade, and depth of invasion to define the accuracy of FS analysis. Results Frozen section analysis was performed in 141 (76.6%) patients. The accuracy rates and κ values between the FS and final pathology results with respect to histotype, tumor grade, and depth of invasion were 87.23%, 81.15%, and 98.2% and 0.41, 0.7, and 0.9, respectively (P < 0.001). Among the 18 patients with preoperative non‐endometrioid cancer (non‐EC), six underwent FS analysis, and final pathology confirmed EC in three, of whom 75% were detected by FS analysis. Eight of 19 patients with preoperative grade 3 EC underwent FS analysis and the accuracy rate was 87.5%. Conclusion Intraoperative FS analysis is a reliable method that can help intraoperative decision making. It should be performed routinely in patients with non‐EC and grade 3 EC.
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Affiliation(s)
- Qingyong Guo
- Department of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Huan Yi
- Department of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaodan Chen
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jianrong Song
- Department of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Lingsi Chen
- Department of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiangqin Zheng
- Department of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
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13
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Reijnen C, Visser NC, Kasius JC, Boll D, Geomini PM, Ngo H, Van Hamont D, Pijlman BM, Vos MC, Bulten J, Snijders MP, Massuger LF, Pijnenborg JM. Improved preoperative risk stratification with CA-125 in low-grade endometrial cancer: a multicenter prospective cohort study. J Gynecol Oncol 2020; 30:e70. [PMID: 31328454 PMCID: PMC6658593 DOI: 10.3802/jgo.2019.30.e70] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/30/2019] [Accepted: 02/24/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The global obesity epidemic has great impact on the prevalence of low-grade endometrial carcinoma. The preoperative tumor serum marker cancer antigen 125 (CA-125) might contribute to improved identification of high-risk patients within this group. The study aimed to investigate the prognostic value of CA-125 in relation to established preoperative prognosticators, with a focus on identifying patients with poor outcome in low-grade endometrial carcinoma (EC) patients. METHODS Prospective multicenter cohort study including all consecutive patients surgically treated for endometrial carcinoma in nine collaborating hospitals from September 2011 until December 2013. All preoperative histopathological diagnoses were reviewed in a blinded manner. Associations between CA-125 and clinicopathological features were determined. Univariable and multivariable analysis by Cox regression were used. Separate analyses were performed for preoperatively designated low-grade and high-grade endometrial carcinoma patients. RESULTS A total of 333 patients were analyzed. CA-125 was associated with poor prognostic features including advanced International Federation of Gynecology and Obstetrics (FIGO) stage. In multivariable analysis, age, preoperative tumor and CA-125 were significantly associated with disease-free survival (DFS); preoperative grade, tumor type, FIGO and CA-125 were significantly associated with disease-specific survival (DSS). Low-grade EC patients with elevated CA-125 revealed a DFS of 80.6% and DSS of 87.1%, compared to 92.1% and 97.2% in low-grade EC patients with normal CA-125. CONCLUSION Preoperative elevated CA-125 was associated with poor prognostic features and independently associated with DFS and DSS. Particularly patients with low-grade EC and elevated CA-125 represent a group with poor outcome and should be considered as high-risk endometrial carcinoma.
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Affiliation(s)
- Casper Reijnen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
| | - Nicole Cm Visser
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jenneke C Kasius
- Centre of Gynaecologic Oncology Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Dorry Boll
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Peggy M Geomini
- Department of Obstetrics and Gynaecology, Màxima Medical Centre, Veldhoven, The Netherlands
| | - Huy Ngo
- Department of Obstetrics and Gynaecology, Elkerliek Hospital, Helmond, The Netherlands
| | - Dennis Van Hamont
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - Brenda M Pijlman
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Maria Caroline Vos
- Department of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc Plm Snijders
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Leon Fag Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johanna Ma Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
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14
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Coussoou C, Laigle-Quérat V, Loussouarn D, Vaucel E, Frampas E. [Magnetic Resonance Imaging for local preoperative staging in endometrial cancer: Nantes local experience]. ACTA ACUST UNITED AC 2020; 48:374-383. [PMID: 32058046 DOI: 10.1016/j.gofs.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine the diagnostic accuracy of magnetic resonance imaging (MRI) for local preoperative staging in endometrial cancer in our center (Centre Hospitalier Universitaire de Nantes: CHU), since the French National Cancer Institute's surgery recommendations publication in 2010, especially for the prediction of myometrial and cervical stromal invasion. METHODS Retrospective monocentric study of consecutive women operated of endometrial cancer in gynecology department of CHU de Nantes, who underwent preoperative pelvic MRI in our Radiology department from November 2010 to November 2016. MRI data collected from initial report and compared to surgical histological findings as gold standard. RESULTS Sixty-four patients were included. Deep myometrial invasion was present in 35 patients in MRI versus 34 patients on postoperative histology (5 false positives, 4 false negatives). Cervical stromal invasion was present in 9 patients in MRI versus 19 patients on postoperative histology (2 false positives, 12 false negatives). The sensitivity and the specificity were respectively 88.23% (95% confidence intervals (CI) [0.71-0.96]) and 83.33% (CI [0.64-0.93]) for the deep myometrial invasion; 36.84% (CI [0.17-0.61]) and 95.55% (CI [0.83-0.99]) for the cervical stromal invasion. CONCLUSION Our results were comparable to the literature data, with a low sensitivity for the cervical stromal invasion detection, driving us to change our MRI protocol with optional high-resolution T2 sequences perpendicular to the cervical canal if necessary.
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Affiliation(s)
- C Coussoou
- Service de radiologie et imagerie médicale, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France.
| | - V Laigle-Quérat
- Service de radiologie et imagerie médicale, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - D Loussouarn
- Service d'anatomie cytologie pathologique, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - E Vaucel
- Service de gynécologie-obstétrique, hôpital Femme-Enfant-Adolescent, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - E Frampas
- Service de radiologie et imagerie médicale, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
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15
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Ribeiro R, Fontes Cintra G, Barrozo A, Tieko Tsunoda A, Pupo Nogueira A, Andreazza Laporte G, de Araújo RLC, Jara Reis R, Patury P, Reis RD, Affonso RJ, Moretti Marques R, Leal RMLV, Oliveira AF, Henrique Zanvettor P, de Oliveira Lopes FC, Arenhart Pessini S, Lopes A, de Azevedo RN, de Assis Gobetti G, Silva KFPE, Andrade CEMDC, Carneiro VCG, Fin FR, de Castilho TJC, Kwiatkowski FV, Simões JC, Foiato T, de Oliveira VR, Augusto Casteleins W, Filippi LT, Zanini LAG, de Maria Maués Sacramento R, de Souza RS, Castro Lanaze G, Barreto E, Fonteles Ritt G, Ziggiatti Güth G, de Sousa TA, Cruz RP, Schwengber A, Bocanegra RED, da Silva JPA, Tayeh MRA, Filho JDN, Gatelli CN, Adriano MG, Toniazzi Lissa F, de Oliveira Cucolicchio G, Loureiro CMB, Cunha JRD, Lourenço Lira D, de Araújo EO, de Resende FAM, Venâncio Pinto C, Mendes Medeiros G, Baiocchi G. Brazilian Society of Surgical Oncology guidelines for surgical treatment of endometrial cancer in regions with limited resources. J Surg Oncol 2019; 121:730-742. [PMID: 31845348 DOI: 10.1002/jso.25797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Approximately 70% of cancer-related deaths occur in low- and middle-income countries. In addition to social and racial inequalities, treatment options in these countries are usually limited because of the lack of trained staff and equipment, limited patient access to health services, and a small number of clinical guidelines. OBJECTIVES The Brazilian Society of Surgical Oncology developed this guideline to address these barriers and guide physicians treating patients with endometrial cancer (EC) in regions with limited resources and few specialized centers. METHODS The guideline was prepared from 10 January to 25 October 20192019 by a multidisciplinary team of 56 experts to discuss the main obstacles faced by EC patients in Brazil. Thirteen questions considered critical to the surgical treatment of these patients were defined. The questions were assigned to groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments for presentations in meetings, classified the level of evidence, and voted on the recommendations. RESULTS For all questions including staging, fertility spearing treatment, genetic testing, sentinel lymph node use, surgical treatment, and other clinical relevant questions, major agreement was achieved by the participants, always using accessible alternatives. CONCLUSIONS It is possible to provide adequate treatment for most EC patients in resource-limited areas, but the first option should be referral to specialized centers with more resources.
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Affiliation(s)
- Reitan Ribeiro
- Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba, Brazil
| | | | - Abner Barrozo
- Department of Surgical Oncology, Instituto Brasileiro de Controle de Câncer, São Paulo, Brazil
| | | | | | - Gustavo Andreazza Laporte
- Departament of Surgical Oncology, Santa casa de Porto Alegre/Santa Rita Hospital/Universidade Federal de ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | | | - Rosilene Jara Reis
- Departament of Surgical Oncology, Santa casa de Porto Alegre/Santa Rita Hospital/Universidade Federal de ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Patricia Patury
- Gynecologic Oncology Department, National Cancer Institute, Rio de Janeiro, Brazil
| | - Ricardo Dos Reis
- Gynecologic Oncology Department, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Renato Moretti Marques
- Gynecologic Oncology Division, Oncologic Center, Albert Einstein Hospital, São Paulo, Brazil
| | | | | | | | | | - Suzana Arenhart Pessini
- Department of Gynecologic Oncology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Gynecologic Oncology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - André Lopes
- Department of Gynecology, Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil
| | | | | | | | | | | | - Fabio Roberto Fin
- Gynecologic Oncology Department, São Vicente Hospital, Curitiba, Brazil
| | | | | | - João Carlos Simões
- Department of Surgical Oncology, Mackenzie University Hospital, Curitiba, Brazil
| | - Tariane Foiato
- Department of Surgical Oncology, Cascavel Cancer Hospital, Castavel, Brazil
| | | | | | - Lucas Torelly Filippi
- Department of Surgical Oncology, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil
| | | | | | | | | | - Elio Barreto
- Department of Oncology, Onofre Lopes University Hospital, Natal, Brazil
| | | | | | | | - Ricardo Pedrini Cruz
- Department of Surgical Oncology, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil
| | - Alex Schwengber
- Department of Surgical Oncology, Ana Nery Hospital, Jacarezinho, Brazil
| | | | | | - Muhamed Read Ali Tayeh
- Department of Surgical Oncology, Materninade Marieta Konder Bornhausen Hospital, Itajaí, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Cláudio Venâncio Pinto
- Department of Surgical Oncology, Centro de Câncer de Brasília (CETTRO), Brasilia, Brazil
| | | | - Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil
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16
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Brooks RA, Fleming GF, Lastra RR, Lee NK, Moroney JW, Son CH, Tatebe K, Veneris JL. Current recommendations and recent progress in endometrial cancer. CA Cancer J Clin 2019; 69:258-279. [PMID: 31074865 DOI: 10.3322/caac.21561] [Citation(s) in RCA: 245] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Endometrial cancer is the most common gynecologic cancer in the United States, and its incidence is rising. Although there have been significant recent advances in our understanding of endometrial cancer biology, many aspects of treatment remain mired in controversy, including the role of surgical lymph node assessment and the selection of patients for adjuvant radiation or chemotherapy. For the subset of women with microsatellite-instable, metastatic disease, anti- programmed cell death protein 1 immunotherapy (pembrolizumab) is now approved by the US Food and Drug Administration, and numerous trials are attempting to build on this early success.
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Affiliation(s)
- Rebecca A Brooks
- Associate Professor, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
- Dr. Brooks is now the Associate Professor and Chief of the Division of Gynecologic Oncology, University of California Davis School of Medicine, Davis, CA
| | - Gini F Fleming
- Professor of Medicine and Director, Medical Oncology Breast Program, Department of Medical Oncology, The University of Chicago, Chicago, IL
| | - Ricardo R Lastra
- Assistant Professor, Department of Pathology, The University of Chicago, Chicago, IL
| | - Nita K Lee
- Assistant Professor of Obstetrics and Gynecology, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
| | - John W Moroney
- Associate Professor of Obstetrics and Gynecology, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
| | - Christina H Son
- Assistant Professor, Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Ken Tatebe
- Resident, Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Jennifer L Veneris
- Instructor of Medicine, Division of Gynecologic Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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17
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Gitas G, Proppe L, Alkatout I, Rody A, Kotanidis C, Tsolakidis D, Baum S. Accuracy of frozen section at early clinical stage of endometrioid endometrial cancer: a retrospective analysis in Germany. Arch Gynecol Obstet 2019; 300:169-174. [DOI: 10.1007/s00404-019-05158-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/06/2019] [Indexed: 11/24/2022]
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18
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Evaluation of Intraoperative Assessments in the Management of Endometrial Carcinoma: A Retrospective Quality Assurance Review. Int J Gynecol Pathol 2018; 37:414-420. [PMID: 30102260 DOI: 10.1097/pgp.0000000000000445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intraoperative assessment (IA) of uteri is often used to help determine whether to perform lymphadenectomy in patients with endometrial carcinoma. We sought to perform a quality assurance review of the practice of IA at our institution. In a 1-yr period, 107 hysterectomies had an IA performed. Grade of neoplasm in preoperative endometrial biopsy, neoplasm size, depth of myometrial invasion at IA, operative management, and final histologic features were recorded. Operative reports were reviewed to assess the surgeon's interpretation of the IA and the effect on surgical management. The sensitivity and specificity for IA of deep myometrial invasion (>50% myometrial thickness) compared with final histology was 76.9% and 91.1%. The positive predictive value was 71.4%, negative predictive value 93.2% and accuracy 88%. Neoplasm size was provided in 47% of cases. In 10% of patients lymphadenectomy was performed despite low-risk features. IA results were included in the operative report in 87% of cases. There were differences in 8.4% of cases between the IA diagnosis and the surgeon's operative report. IA of deep myometrial invasion is reliable at our institution. Several metrics for quality improvement have been identified as a result of this retrospective review. These include but are not limited to more reliable reporting of neoplasm size, documentation, and communication with gynecologic oncologists.
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19
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Tanner E, Puechl A, Levinson K, Havrilesky LJ, Sinno A, Secord AA, Fader AN, Lee PS. Use of a novel sentinel lymph node mapping algorithm reduces the need for pelvic lymphadenectomy in low-grade endometrial cancer. Gynecol Oncol 2017; 147:535-540. [DOI: 10.1016/j.ygyno.2017.10.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/14/2017] [Accepted: 10/15/2017] [Indexed: 11/17/2022]
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20
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Tas EE, Yavuz AF. The prognostic significance of preoperative serum cancer antigen 15-3 levels in endometrial carcinomas. Saudi Med J 2017; 38:1096-1100. [PMID: 29114696 PMCID: PMC5767611 DOI: 10.15537/smj.2017.11.20479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the associations between serum cancer antigen 15-3 levels and prognostic factors in patients with endometrial carcinomas. Additionally, we investigated the clinical utility of serum cancer antigen 15-3 levels in the selection of low-risk patients with endometrioid type, tumor size less than 2 cm, myometrial invasion ≤50%, and histological grade 1-2. Methods: Ninety-six patients, who were surgically staged at Ankara Yildirim Beyazit University, Ankara, Turkey, between 2007 and 2016, were retrospectively analyzed. Demographic, clinical, and surgical characteristics were retrieved from the patients' hospital records. A p less than 0.05 was considered significant. Results: Fifteen patients had advanced (≥Stage II) disease, 14 patients had Type 2 histology, 20 patients had Grade 3 tumors, 23 patients had lymphovascular space invasion, and 10 patients had positive lymph node involvement. Serum cancer antigen 15-3 levels were significantly higher in patients with advanced (≥Stage II) disease, Type 2 histology, Grade 3 tumors, lymphovascular space invasion, and positive lymph node involvement (p less than 0.05). Serum cancer antigen 15-3 levels were also significantly correlated with tumor size (p=0.006). Serum cancer antigen 15-3 levels were significantly lower (95% confidence interval: 0.57-0.79; p=0.03) in low-risk patients compared to other endometrial carcinoma patients. A cutoff of 25.0 IU/mL was used to identify high-risk patients with a specificity of 100%. Conclusion: Serum cancer antigen 15-3 levels significantly correlated with prognostic factors and were a useful diagnostic tool for endometrial carcinomas.
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Affiliation(s)
- Emre E Tas
- Department of Obstetrics and Gynecology, Ankara Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital, Ankara, Turkey. E-mail.
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21
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Bartosch C, Pires M, Jerónimo C, Lopes JM. The role of pathology in the management of patients with endometrial carcinoma. Future Oncol 2017; 13:1003-1020. [PMID: 28481146 DOI: 10.2217/fon-2016-0570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Pathology plays a critical role in every step in the management of endometrial carcinoma patients. In this review, we describe the state of the art of pathological examination, including examination of endometrium biopsy; intra-operative evaluation with gross examination and frozen section; and grossing of hysterectomy specimen and its histological and immunohistochemistry study. The main pathologic findings in each step are described, as well as limitations and difficulties that may ensue. We highlight the important pathologic parameters that determine treatment options and prognosis of endometrial cancer patients.
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Affiliation(s)
- Carla Bartosch
- Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal.,Department of Pathology and Oncology, Medical Faculty, University of Porto, Porto, Portugal.,Cancer Biology & Epigenetics Group, Research Center, Portuguese Oncology Institute of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (PCCC), Porto, Portugal
| | - Mónica Pires
- Porto Comprehensive Cancer Center (PCCC), Porto, Portugal.,Department of Gynecology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Carmen Jerónimo
- Cancer Biology & Epigenetics Group, Research Center, Portuguese Oncology Institute of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (PCCC), Porto, Portugal.,Department of Pathology & Molecular Immunology, Institute of Biomedical Sciences Abel Salazar-ICBAS, University of Porto, Porto, Portugal
| | - José Manuel Lopes
- Department of Pathology and Oncology, Medical Faculty, University of Porto, Porto, Portugal.,Department of Pathology, Centro Hospitalar de São João, Porto, Portugal.,IPATIMUP (Institute of Molecular Pathology & Immunology, University of Porto) & I3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Portugal
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22
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Desouki MM, Li Z, Hameed O, Fadare O. Intraoperative Pathologic Consultation on Hysterectomy Specimens for Endometrial Cancer: An Assessment of the Accuracy of Frozen Sections, "Gross-Only" Evaluations, and Obtaining Random Sections of a Grossly "Normal" Endometrium. Am J Clin Pathol 2017; 148:345-353. [PMID: 28967955 DOI: 10.1093/ajcp/aqx076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pathologic intraoperative consultation (IOC) is a common approach for segregating the subset of patients with endometrial cancer who likely require a lymphadenectomy. METHODS We evaluate factors related to the performance and value of IOC, including the accuracy of frozen sections, "gross-only examinations," and obtaining random sections when a gross lesion is not apparent. RESULTS IOC was performed by gross examination only in 17 (8%) of 250 cases, the specificity and negative predictive value of which in diagnosing cancer were 100% and 85%, respectively. Among the 64 cases wherein a gross lesion was not apparent and random sections were examined, a final diagnosis of carcinoma was rendered in 20, of which only three (15%) had a diagnosable malignancy on the random section. The frozen-section/final diagnosis concordance was 80% for tumor grade. Determining the depth of myometrial invasion was problematic, with 36% underestimation and 2.6% overestimation. CONCLUSIONS Obtaining random sections in the absence of a gross lesion has no significant benefit, and a negative result is likely to provide inaccurate data to the surgeon. Frozen-section analyses are a generally reliable tool to determine "low-risk" pathologic parameters that were evaluated herein when a gross lesion is present.
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Affiliation(s)
- Mohamed Mokhtar Desouki
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Zaibo Li
- Department of Pathology,Ohio State University, Cincinnati
| | - Omar Hameed
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Oluwole Fadare
- Department of Pathology,University of California, San Diego
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23
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Pasanen A, Loukovaara M, Tuomi T, Bützow R. Preoperative Risk Stratification of Endometrial Carcinoma: L1CAM as a Biomarker. Int J Gynecol Cancer 2017; 27:1318-1324. [DOI: 10.1097/igc.0000000000001043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectivePreoperative or intraoperative risk assessment models are used to stratify patients with endometrial carcinoma to lymphadenectomy. Our aim was to determine whether preoperative analysis of L1 cell adhesion molecule (L1CAM) can improve risk assessment.MethodsImmunohistochemical L1CAM staining was performed on endometrial biopsies of 241 patients and paired hysterectomy samples of 75 patients. Risk assessment models based on preoperative histologic type and grade, myometrial invasion, and/or tumor diameter and alternative models incorporating preoperative L1CAM were compared with regard to their capability of predicting lymph nodal or distant metastasis. Soluble L1 levels were measured by enzyme-linked immunosorbent assay in serum samples of 40 patients with endometrial carcinoma.ResultsThe concordance rate between L1CAM staining results of preoperative and hysterectomy samples was moderate (κ = 0.586, P < 0.0001). Preoperative L1CAM expression was associated with nonendometrioid histology, lymph node involvement, advanced stage, and positive peritoneal cytology. Receiver operating characteristic curve analyses showed that L1CAM did not significantly improve risk stratification algorithms based on traditional risk factors. Intraoperative tumor diameter was an effective surrogate for myometrial invasion. There was no statistical difference between L1 serum levels of patients with an L1CAM-positive or L1CAM-negative endometrial carcinoma (P = 0.786).ConclusionsL1 cell adhesion molecule expression in endometrial biopsy correlates with high-risk features of endometrial carcinoma but does not significantly improve risk stratification algorithms based on traditional factors. Soluble L1 detected in the serum of patients with endometrial carcinoma does not correlate with tumoral L1CAM expression.
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24
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Di Cello A, Di Sanzo M, Perrone FM, Santamaria G, Rania E, Angotti E, Venturella R, Mancuso S, Zullo F, Cuda G, Costanzo F. DJ-1 is a reliable serum biomarker for discriminating high-risk endometrial cancer. Tumour Biol 2017; 39:1010428317705746. [DOI: 10.1177/1010428317705746] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Annalisa Di Cello
- Unit of Obstetrics and Gynaecology, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Maddalena Di Sanzo
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Francesca Marta Perrone
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Gianluca Santamaria
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Erika Rania
- Unit of Obstetrics and Gynaecology, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Elvira Angotti
- Laboratory of Clinical Biochemistry, AOU Mater Domini, Catanzaro, Italy
| | - Roberta Venturella
- Unit of Obstetrics and Gynaecology, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Serafina Mancuso
- Laboratory of Clinical Biochemistry, AOU Mater Domini, Catanzaro, Italy
| | - Fulvio Zullo
- Unit of Obstetrics and Gynaecology, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giovanni Cuda
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Francesco Costanzo
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
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25
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Stålberg K, Kjølhede P, Bjurberg M, Borgfeldt C, Dahm-Kähler P, Falconer H, Holmberg E, Staf C, Tholander B, Åvall-Lundqvist E, Rosenberg P, Högberg T. Risk factors for lymph node metastases in women with endometrial cancer: A population-based, nation-wide register study-On behalf of the Swedish Gynecological Cancer Group. Int J Cancer 2017; 140:2693-2700. [PMID: 28340503 DOI: 10.1002/ijc.30707] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/09/2017] [Accepted: 02/17/2017] [Indexed: 11/10/2022]
Abstract
The role of lymphadenectomy in the management of early endometrial cancer remains controversial. In the recent ESMO-ESGO-ESTRO guidelines, lymphadenectomy is recommended for patients with endometrioid adenocarcinoma Grade 3 with deep myometrial invasion, but complete agreement was not achieved. In Sweden, DNA aneuploidy has been included as a high-risk factor. The aim of our study was to evaluate the impact of tumor histology, FIGO grade, DNA ploidy and myometrial invasion (MI) on occurrence of lymph node metastasis (LNM) in patients with endometrial cancer. The study design is a retrospective cohort study based on prospectively recorded register data. Endometrial cancer patients registered in the Swedish Quality Registry for Gynecologic Cancer 2010-2015 with FIGO Stages I-III and verified nodal status were included. Data on DNA ploidy, histology, FIGO grade and MI were included in multivariable log-binomial regression analyses with LNM as dependent variable. 1,165 cases fulfilled the inclusion criteria. The multivariable analyses revealed increased risk of LNM in patients with tumors with MI ≥ 50% (risk ratio [RR] = 4.1; 95% confidence interval [CI] 3.0-5.6), nonendometrioid compared to endometrioid histology (RR 1.8; CI 1.4-2.4) and FIGO Grade 3 compared to Grade 1-2 tumors (RR 1.5; CI 1.1-2.0). No statistically significant association between DNA ploidy status and LNM was detected. This population-based, nation-wide study in women with endometrial cancer confirms a strong association between MI ≥ 50%, nonendometrioid histology and FIGO Grade 3, respectively, and LNM. DNA ploidy should not be included in the preoperative decision making of removing nodes or not.
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Affiliation(s)
- K Stålberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - P Kjølhede
- Department of Obstetrics and Gynecology, Linköpings Universitet, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Linköpings Universitet, Linköping, Sweden
| | - M Bjurberg
- Department of Hematology, Oncology, and Radiation Physics, Skanes Universitetssjukhus, Lund, Sweden.,Division of Oncology and Pathology, Department of Clinical Sciences, Lunds Universitet, Lund, Sweden
| | - C Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Lund, Sweden
| | - P Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - H Falconer
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - E Holmberg
- Regional Cancer Center Western Sweden, Sahlgrenska Universitetssjukhuset, Gothenburg, Sweden.,Institute of Clinical Sciences, Goteborgs Universitet Sahlgrenska Akademin, Göteborg, Sweden
| | - C Staf
- Sahlgrenska Universitetssjukhuset, Regional Cancer Center Western Sweden, Göteborg, Sweden
| | - B Tholander
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - E Åvall-Lundqvist
- Department of Oncology, Linköpings University, Linköping, Sweden.,Department Clinical and Experimental Medicine, Linköpings University, Linköping, Sweden.,Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - P Rosenberg
- Department of Oncology Högberg, Universitetssjukhuset i Linköping, Linköping, Sweden
| | - T Högberg
- Department of Cancer Epidemiology, Skåne University Hospital, Lund University, Lund, Sweden
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26
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Hefler-Frischmuth K, Hirtl-Goergl E, Unterrichter V, Lafleur J, Brunnmayr-Petkin G, Moinfar F, Hefler L. One-stop clinical assessment of risk for endometrial hyperplasia (OSCAR-Endo): a fast-track protocol for evaluating endometrial pathologies. Arch Gynecol Obstet 2017; 295:959-964. [PMID: 28265757 DOI: 10.1007/s00404-017-4326-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/07/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate a one-stop clinical assessment of risk for assessing endometrial pathologies (OSCAR-Endo), consisting of a fast-track protocol with hysteroscopy, dilation and curettage (D&C) with intraoperative frozen section analysis of the removed tissue in cases of hysteroscopic suspicion of malignancy. METHODS In this prospective clinical trial, a total of 304 consecutive women with sonographically suspected endometrial hyperplasia and/or postmenopausal bleeding, underwent D&C with intraoperative frozen section analysis between May 2013 and September 2015. Based on the results of the hysteroscopy and/or frozen section, the OSCAR-Endo score was reported: negative, when no frozen section was regarded necessary or the frozen section yielded a negative result; equivocal, when the frozen section reported an equivocal result; positive, when frozen section reported either complex hyperplasia with atypia or cancer. RESULTS Frozen sections were required by the surgeons in 59 (19.4%) of cases. When compared with the final histology after D&C, frozen section showed a sensitivity, specificity, PPV, NPV, and overall test accuracy of 91.3, 100, 100, 94.1, and 96.3% for predicting malignant disease, respectively. The OSCAR-Endo score showed a sensitivity, specificity, PPV, NPV, and overall test accuracy of 84, 100, 100, 98.6, and 98.7% for predicting malignant disease, respectively. CONCLUSION The OSCAR-Endo protocol is easy to perform in daily clinical practice reaching an excellent test accuracy. It helps in immediate postoperative counseling of affected patients. Clinical Trial Registration http://www.clinicaltrials.gov ; NCT01961102.
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Affiliation(s)
- Katrin Hefler-Frischmuth
- Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria.
- Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria.
| | - Elisabeth Hirtl-Goergl
- Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria
- Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria
| | - Verena Unterrichter
- Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria
- Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria
| | - Judith Lafleur
- Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria
- Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria
| | - Gudrun Brunnmayr-Petkin
- Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria
- Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria
| | - Farid Moinfar
- Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria
- Department of Pathology, Ordensklinikum Linz, Linz, Austria
- Department of Pathology, Medical University of Graz, Graz, Austria
| | - Lukas Hefler
- Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria
- Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria
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Endometrioid Endometrial Cancer: Concordance Between Preoperative and Final Surgical Histopathology. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0090-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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