Altintas A, Cosar E, Vardar M A, Demir C, Tuncer I
Department of Obstetrics and Gynecology, Cukurova University Medical Faculty, Adana, Turkey.
Eur J Gynaecol Oncol. 1999;20(4):329-31.
To evaluate the adequacy of intraoperative assessment of depth of myometrial invasion in patients with endometrial adenocarcinoma.
Of the 58 evaluable cases, depth of myometrial invasion was estimated by gross examination of fresh tissue by an experienced surgeon and a pathologist and on the frozen section by the same pathologist. This was compared with the depth of invasion on the final microscopic examination performed by another pathologist.
The depth of invasion was accurately predicted by the surgeon in 89.7% of the patients, while the pathologist's accurate prediction rates on fresh tissue and frozen section were 86.2% and 91.4%, respectively. The accurate prediction rate gradually diminished for both the surgeon and the pathologist as the histologic grade increased. Frozen section examination was reliable in grade I cancer (100%), while gross examination of the surgeon and the pathologist had a significant error rate in predicting accurate depth of invasion (7.6%-33%).
If frozen section shows that myometrial invasion in patients with grade 1 endometrial carcinoma is less than 1/3, lymphadenectomy may be omitted. In all other cases radical surgery and surgical staging is mandatory to avoid undertreatment.
评估子宫内膜腺癌患者术中子宫肌层浸润深度评估的充分性。
在58例可评估病例中，由经验丰富的外科医生和病理学家通过对新鲜组织进行大体检查以及由同一位病理学家在冰冻切片上估计子宫肌层浸润深度。将其与另一位病理学家进行的最终显微镜检查中的浸润深度进行比较。
外科医生对89.7%的患者的浸润深度预测准确，而病理学家在新鲜组织和冰冻切片上的准确预测率分别为86.2%和91.4%。随着组织学分级增加，外科医生和病理学家的准确预测率均逐渐降低。冰冻切片检查在I级癌症中可靠（100%），而外科医生和病理学家的大体检查在预测准确浸润深度方面有显著错误率（7.6%-33%）。
如果冰冻切片显示1级子宫内膜癌患者的子宫肌层浸润小于1/3，则可省略淋巴结切除术。在所有其他情况下，为避免治疗不足，根治性手术和手术分期是必需的。
