术前和术中评估在子宫内膜癌管理中的临床价值。

The clinical value of preoperative and intraoperative assessments in the management of endometrial cancer.

机构信息

Department of Obstetrics and Gynecology, Meram Medical Faculty, Selçuk University, Konya, Turkey.

出版信息

Int J Gynecol Cancer. 2010 Apr;20(3):358-62. doi: 10.1111/IGC.0b013e3181cff1f3.

DOI:10.1111/IGC.0b013e3181cff1f3

PMID:20375797

Abstract

OBJECTIVE

In this study, we aimed to investigate the diagnostic accuracy of preoperative assessment and frozen-section analysis (FSA) in endometrial cancer by comparing postoperative histopathology.

METHODS

A total of 72 consecutive patients with endometrial cancer were included in this study. Comprehensive surgical staging was performed in all patients. After abdominal hysterectomy, the uterus was investigated for FSA. For preoperative analysis, histological grade and histological subtypes were investigated. In FSA, all the specimens were reviewed for histological subtype, histological grade, depth of myometrial invasion, lymphovascular space invasion (LVI), and cervical involvement. These results were compared with final histopathology. Data were statistically analyzed.

RESULTS

The accuracy of preoperative examination was 95.8% (69/72) for histological type and 90% (65/72) for histological grade. In the frozen section, the accuracies of histological grade and subtype were found to be 92% and 98%, respectively. However, histological grade had 43% sensitivity in preoperative and intraoperative assessments. Myometrial invasion and LVI were correctly diagnosed in 93% and 94% of the cases, respectively. The risk assessment was correctly determined in 63 (87%) of 72 patients. Five patients were underclassified, and there was no lymph node invasion in these patients after final histopathology. Lymph node invasion was higher in patients with grade 3 classification, deep myometrial invasion, positive cervical involvement, and LVI.

CONCLUSIONS

Frozen-section analysis is a feasible method for the management of the patients with endometrial cancer. However, preoperative and intraoperative assessment of histological grade has lower sensitivity in endometrial cancer.

摘要

目的

本研究旨在通过与术后组织病理学比较，评估术前评估和冰冻切片分析（FSA）在子宫内膜癌中的诊断准确性。

方法

本研究共纳入 72 例连续的子宫内膜癌患者。所有患者均行全面的外科分期。腹式子宫切除术后，对子宫进行 FSA 检查。对于术前分析，检查组织学分级和组织学亚型。在 FSA 中，所有标本均复查组织学亚型、组织学分级、肌层浸润深度、淋巴血管间隙浸润（LVI）和宫颈受累情况。将这些结果与最终组织病理学进行比较。对数据进行统计学分析。

结果

术前检查对组织类型的准确率为 95.8%（69/72），对组织学分级的准确率为 90%（65/72）。在冰冻切片中，组织学分级和亚型的准确率分别为 92%和 98%。然而，术前和术中评估的组织学分级的敏感性为 43%。93%和 94%的病例正确诊断了肌层浸润和 LVI。72 例患者中有 63 例（87%）正确评估了风险。5 例患者被低估，这些患者在最终组织病理学检查中无淋巴结浸润。组织学分级 3 级、肌层浸润深、宫颈受累和 LVI 的患者中淋巴结侵犯更高。