Department of Gynaecology and Obstetrics, University Hospital Schleswig Holstein, Campus Luebeck, Luebeck, Germany.
Department of Gynaecology and Obstetrics, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany.
Arch Gynecol Obstet. 2019 Jul;300(1):169-174. doi: 10.1007/s00404-019-05158-0. Epub 2019 Apr 21.
The aim of this study was to estimate the accuracy of intra-operative frozen section (FS) diagnosis during hysterectomy for early-stage endometrial cancer (EC).
At the Department of Obstetrics and Gynecology, University of Luebeck, between 2009 and 2014, the intra-operative FS pathology of 164 patients with pre-operative endometrial curettage, showing G1 or G2 endometrioid EC at an early clinical stage (FIGO I-II), was compared retrospectively with the final paraffin section reports. The accuracy of myometrial invasion (MI) in all patients and separately in stage FIGO I patients was calculated and the under- or overtreatment of the patients was analyzed. A subgroup analysis was performed focusing on the percentage of inadequate staging by FS with clinical consequences.
Concordance of FS and final pathology results in terms of FIGO stage was 85.2%, with an under-diagnosis rate of 14% and an over-diagnosis rate of 0.8%. The subgroup analysis rate of patients who were inappropriately operated using FS was 6.6%, while 3.3% underwent a secondary operation. The overall accuracy of FS in predicting MI was 93.3% and in patients with stage FIGO I, 92.7%. Sensitivity, specificity, PPV and NPV were 98.25%, 89.06%, 88.89% and 98.28%, respectively, and in stage FIGO I, 98.25%, 84.62%, 90.32% and 97.06%, respectively.
The authors consider that intra-operative FS is a reliable diagnostic method to identify the clinical stage of EC and especially MI, to determine the necessity of lymphadenectomy. Further development of diagnostic techniques is essential to maximize diagnostic accuracy.
本研究旨在评估子宫内膜癌（EC）早期行子宫切除术时术中冷冻切片（FS）诊断的准确性。
在吕贝克大学妇产科，2009 年至 2014 年期间，对 164 例术前子宫内膜刮宫术显示 G1 或 G2 子宫内膜样 EC 的早期临床分期（FIGO I-II）患者的术中 FS 病理进行回顾性比较，与最终石蜡切片报告。计算所有患者和单独在 FIGO I 期患者中的肌层浸润（MI）准确性，并分析患者的治疗不足或过度治疗情况。进行了亚组分析，重点关注 FS 对临床后果的分期不足百分比。
FS 与最终病理结果在 FIGO 分期方面的一致性为 85.2%，漏诊率为 14%，误诊率为 0.8%。使用 FS 进行不适当手术的患者亚组分析率为 6.6%，而 3.3%的患者接受了二次手术。FS 预测 MI 的总体准确性为 93.3%，FIGO I 期患者为 92.7%。灵敏度、特异性、PPV 和 NPV 分别为 98.25%、89.06%、88.89%和 98.28%，FIGO I 期患者分别为 98.25%、84.62%、90.32%和 97.06%。
作者认为术中 FS 是一种可靠的诊断方法，可识别 EC 的临床分期，尤其是 MI，以确定是否需要淋巴结切除术。进一步开发诊断技术对于最大限度地提高诊断准确性至关重要。
