Sánchez M F, Causa Andrieu P I, Latapie C, Saez Perrotta M C, Napoli N, Perrotta M, Chacón C R B, Wernicke A
Servicio de Anatomía Patológica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Radiologia (Engl Ed). 2019 Jul-Aug;61(4):315-323. doi: 10.1016/j.rx.2019.01.007. Epub 2019 Mar 21.
The standard treatment for endometrial cancer is simple hysterectomy with bilateral salpingo-oophorectomy. Patients with high risk also benefit from lumbo-aortic lymphadenectomy. High risk patients include those with grades and histologic subtypes associated with poor prognosis and depth of myometrial invasion greater than 50% (M2). To determine which patients would benefit from lumbo-aortic lymphadenectomy, the depth of myometrial invasion can be assessed by intraoperative frozen section or by magnetic resonance imaging (MRI). We aimed to determine the diagnostic yield of intraoperative frozen section and MRI for detecting the presence of M2 in patients with endometrial cancer.
This cross-sectional study included women with a histologically confirmed diagnosis of endometrial cancer who underwent baseline MRI and surgical intervention in our institution between 1 January 2010 and 31 December 2017. We reviewed the MRI studies and the intraoperative frozen section reports and compared them with the information in the histopathology report. We compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the two tests. We also calculated the diagnostic accuracy of each method and the percentages of underestimation and overestimation. Finally, we calculated the predictive value of MRI for the presence of M2, adjusting it for the histologic variables known to be associated with poor prognosis.
To detect M2, MRI had 63% sensitivity, 87% specificity, 73% PPV, and 81% NPV; the diagnostic accuracy was 78.8%, with 13.12% underestimation and 8.13% overestimation of M2. Intraoperative frozen section had 69% sensitivity, 86.7% specificity, 69% PPV, and 86% NPV; the diagnostic accuracy was 81.5%, with 9.24% underestimation and 9.24% overestimation of M2. The degree of concordance between the two methods was moderate (k=0.54, p < 0.00001).
In our experience, MRI and intraoperative frozen section have adequate diagnostic yields for determining M2, though intraoperative frozen section is slightly better. The contribution of MRI in determining the presence and the site of deep myometrial invasion, as well as the factors that can confound the diagnosis, when added to the contribution of intraoperative frozen section, means that both methods help reduce the number of unnecessary lymph node dissections and the morbidity, mortality, and health costs associated with this practice.
子宫内膜癌的标准治疗方法是单纯子宫切除术加双侧输卵管卵巢切除术。高危患者也可从腰主动脉淋巴结清扫术中获益。高危患者包括那些具有预后不良相关分级和组织学亚型以及肌层浸润深度大于50%（M2）的患者。为了确定哪些患者将从腰主动脉淋巴结清扫术中获益，可通过术中冰冻切片或磁共振成像（MRI）评估肌层浸润深度。我们旨在确定术中冰冻切片和MRI在检测子宫内膜癌患者中M2存在情况的诊断效能。
这项横断面研究纳入了2010年1月1日至2017年12月31日期间在我们机构接受组织学确诊为子宫内膜癌并接受基线MRI和手术干预的女性。我们回顾了MRI研究和术中冰冻切片报告，并将它们与组织病理学报告中的信息进行比较。我们比较了两种检查的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。我们还计算了每种方法的诊断准确性以及低估和高估的百分比。最后，我们计算了MRI对M2存在情况的预测值，并针对已知与预后不良相关的组织学变量进行了调整。
为检测M2，MRI的敏感性为63%，特异性为87%，PPV为73%，NPV为81%；诊断准确性为78.8%，对M2的低估为13.12%，高估为8.13%。术中冰冻切片的敏感性为69%，特异性为86.7%，PPV为69%，NPV为86%；诊断准确性为81.5%，对M2的低估为9.24%，高估为9.24%。两种方法之间的一致性程度为中等（k = 0.54，p < 0.00001）。
根据我们的经验，MRI和术中冰冻切片在确定M2方面具有足够的诊断效能，尽管术中冰冻切片略好一些。MRI在确定肌层深部浸润的存在和部位以及可能混淆诊断的因素方面的贡献，加上术中冰冻切片的贡献，意味着这两种方法都有助于减少不必要的淋巴结清扫数量以及与此相关的发病率、死亡率和医疗成本。
