Faculty of Medicine, Department of Gynecology and Obsterics, Başkent University, Adana Application and Research Hospital, Adana, Turkey.
Faculty of Medicine, Department of Pathology, Başkent University, Adana Application and Research Hospital, Adana, Turkey.
Arch Gynecol Obstet. 2021 Sep;304(3):725-732. doi: 10.1007/s00404-021-05979-y. Epub 2021 Feb 20.
Surgery consists the main treatment of endometrial cancer; however, decision of lypmhadenectomy is controversial. Intra-operative frozen section (FS) is commonly used in guiding surgical staging; nevertheless, there are different reports regarding its adequacy and reliability. Aim of this study is to assess accuracy of FS in predicting paraffin section (PS) results in patients with endometrium cancer.
Data of 223 cases, who were operated for endometrial cancer at a tertiary hospital in 2012-2019, were analyzed retrospectively. Histological type, grade, tumor diameter, depth of myometrial invasion, and cervical and adnexal involvement in frozen and paraffin section were evaluated. Positive and negative predictive values and accuracy of frozen results in predicting paraffin results for each parameter was assessed. Statistical significance was taken as 0.05 in all tests.
Accuracy of FS in predicting PS results were 76.23% for histology, 75.45% for grade, 85.31% for depth of myometrial invasion, and 95.45% for tumor diameter. Surgery, based on FS results, caused undertreatment in 4 patients, while metastatic lymph node ratios were found in only 35.3-50.0% of cases who had high risk parameters at FS.
Our FS results have reasonable accuracy rates in predicting PS results, in comparison with the previous literature. However, even if the high risk parameters detected in FS predict PS accurately, absence of lymph node involvement in all cases with high risk parameters indicates that FS-based triage cannot prevent unnecessary lymphadenectomies.
手术是子宫内膜癌的主要治疗方法；然而，淋巴结切除术的决策存在争议。术中冷冻切片（FS）常用于指导手术分期；然而，关于其充分性和可靠性的报告却不尽相同。本研究旨在评估 FS 在预测子宫内膜癌患者石蜡切片（PS）结果的准确性。
回顾性分析 2012 年至 2019 年在一家三级医院接受子宫内膜癌手术的 223 例患者的数据。评估 FS 和 PS 中的组织学类型、分级、肿瘤直径、肌层浸润深度以及宫颈和附件累及情况。评估 FS 对每个参数的 PS 结果的预测的阳性和阴性预测值和准确性。所有检验的统计学意义均为 0.05。
FS 预测 PS 结果的准确性分别为：组织学 76.23%，分级 75.45%，肌层浸润深度 85.31%，肿瘤直径 95.45%。根据 FS 结果进行手术导致 4 例治疗不足，而在 FS 高风险参数的病例中仅发现 35.3-50.0%存在转移性淋巴结比率。
与先前的文献相比，我们的 FS 结果在预测 PS 结果方面具有合理的准确性。然而，即使 FS 检测到的高风险参数能够准确预测 PS，但所有高风险参数病例中均无淋巴结受累表明，基于 FS 的分类不能预防不必要的淋巴结切除术。
