The department of diagnostic radiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan.
The department of diagnostic radiology, Tesseikai Neurosurgical Hospital, Shijonawate City, Osaka, Japan.
BMC Cancer. 2021 Nov 4;21(1):1178. doi: 10.1186/s12885-021-08910-5.
Surgeons sometimes have difficulty determining which result to favor when preoperative results (MRI + preoperative endometrial biopsy [pre-op EB]) differ from intraoperative frozen section histology (FS) results. Investigation of how FS can complement ordinary preoperative examinations like MRI and pre-op EB in identification of patients at high risk of lymph node metastasis (high-risk patients) could provide clarity on this issue. Therefore, the aim of this study is to assess the utility of pre-op EB, MRI and FS results and determine how to combine these results in identification of high-risk patients.
The subjects were 172 patients with endometrial cancer. Patients with a histological high-grade tumor (HGT), namely, grade 3 endometrioid cancer, clear cell carcinoma or serous cell carcinoma, or with any type of cancer invading at least half of the uterine myometrium were considered high-risk. Tumors invading at least half of the uterine myometrium were classified as high-stage tumors (HST). We compared (a) detection of HGT using pre-op EB versus FS, (b) detection of HST using MRI versus FS, and (c) identification of high-risk patients using MRI + pre-op EB versus FS. Lastly, we determined to what degree addition of FS results improves identification of high-risk patients by routine MRI + pre-op EB.
(a) Sensitivity, specificity, and accuracy for detecting HGT were 59.6, 98.4 and 87.8% for pre-op EB versus 55.3, 99.2 and 87.2% for FS (P = 0.44). (b) These figures for detecting HST were 74.4, 83.0 and 80.8% for MRI versus 46.5, 99.2 and 86.0% for FS (P < 0.001). (c) These figures for identifying high-risk patients were 78.3, 85.4 and 82.6% for MRI + pre-op EB versus 55.1, 99.0 and 81.2% for FS (P < 0.001). The high specificity of FS improved the sensitivity of MRI + pre-op EB from 78.3 to 81.2%, but this difference was not statistically significant (P < 0.16).
Frozen section enables identification of high-risk patients with nearly 100% specificity. This advantage can be used to improve sensitivity for identification of high-risk patients by routine MRI + pre-op EB, although this improvement is not statistically significant.
当术前结果（MRI+术前子宫内膜活检[pre-op EB]）与术中冷冻切片组织学（FS）结果不同时，外科医生有时难以确定应该选择哪种结果。研究 FS 如何补充 MRI 和 pre-op EB 等普通术前检查，以识别高淋巴结转移风险（高危）患者，可能有助于解决这个问题。因此，本研究旨在评估 pre-op EB、MRI 和 FS 结果的效用，并确定如何结合这些结果识别高危患者。
研究对象为 172 名子宫内膜癌患者。具有组织学高级别肿瘤（HGT），即 3 级子宫内膜样癌、透明细胞癌或浆液性癌，或任何类型的肿瘤侵犯子宫肌层至少一半的患者被认为是高危患者。侵犯子宫肌层至少一半的肿瘤被归类为高分期肿瘤（HST）。我们比较了（a）pre-op EB 与 FS 检测 HGT 的情况，（b）MRI 与 FS 检测 HST 的情况，以及（c）MRI+pre-op EB 与 FS 识别高危患者的情况。最后，我们确定了 FS 结果的添加在多大程度上提高了常规 MRI+pre-op EB 对高危患者的识别能力。
（a）pre-op EB 检测 HGT 的敏感性、特异性和准确性分别为 59.6%、98.4%和 87.8%，FS 分别为 55.3%、99.2%和 87.2%（P=0.44）。（b）MRI 检测 HST 的这些数字分别为 74.4%、83.0%和 80.8%，FS 分别为 46.5%、99.2%和 86.0%（P<0.001）。（c）MRI+pre-op EB 识别高危患者的这些数字分别为 78.3%、85.4%和 82.6%，FS 分别为 55.1%、99.0%和 81.2%（P<0.001）。FS 的高特异性将 MRI+pre-op EB 的敏感性从 78.3%提高到 81.2%，但差异无统计学意义（P<0.16）。
FS 可实现几乎 100%的特异性来识别高危患者。这种优势可用于提高常规 MRI+pre-op EB 识别高危患者的敏感性，尽管这种提高无统计学意义（P<0.16）。
