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It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large‐scale, multi‐center, and retrospective study

INTRODUCTION: Stage IB (deep myometrial invasion) high‐grade endometrioid adenocarcinoma (EA), regardless of LVSI status, is classified into high‐intermediate risk groups, requiring surgical lymph node staging. Intraoperative frozen section (IFS) is commonly used, but its adequacy and reliability va...

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Autores principales: Yang, Xiaohang, Yin, Jingjing, Fu, Yu, Shen, Yuanming, Zhang, Chuyao, Yao, Shuzhong, Xu, Congjian, Xia, Min, Lou, Ge, Liu, Jihong, Lin, Bei, Wang, Jianliu, Zhao, Weidong, Zhang, Jieqing, Cheng, Wenjun, Guo, Hongyan, Guo, Ruixia, Xue, Fengxia, Wang, Xipeng, Han, Lili, Li, Xiaomao, Zhang, Ping, Zhao, Jianguo, Li, Wenting, Dou, Yingyu, Wang, Zizhuo, Liu, Jingbo, Li, Kezhen, Chen, Gang, Sun, Chaoyang, Wang, Beibei, Yang, Xingsheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10134352/
https://www.ncbi.nlm.nih.gov/pubmed/36718983
http://dx.doi.org/10.1002/cam4.5643
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author Yang, Xiaohang
Yin, Jingjing
Fu, Yu
Shen, Yuanming
Zhang, Chuyao
Yao, Shuzhong
Xu, Congjian
Xia, Min
Lou, Ge
Liu, Jihong
Lin, Bei
Wang, Jianliu
Zhao, Weidong
Zhang, Jieqing
Cheng, Wenjun
Guo, Hongyan
Guo, Ruixia
Xue, Fengxia
Wang, Xipeng
Han, Lili
Li, Xiaomao
Zhang, Ping
Zhao, Jianguo
Li, Wenting
Dou, Yingyu
Wang, Zizhuo
Liu, Jingbo
Li, Kezhen
Chen, Gang
Sun, Chaoyang
Wang, Beibei
Yang, Xingsheng
author_facet Yang, Xiaohang
Yin, Jingjing
Fu, Yu
Shen, Yuanming
Zhang, Chuyao
Yao, Shuzhong
Xu, Congjian
Xia, Min
Lou, Ge
Liu, Jihong
Lin, Bei
Wang, Jianliu
Zhao, Weidong
Zhang, Jieqing
Cheng, Wenjun
Guo, Hongyan
Guo, Ruixia
Xue, Fengxia
Wang, Xipeng
Han, Lili
Li, Xiaomao
Zhang, Ping
Zhao, Jianguo
Li, Wenting
Dou, Yingyu
Wang, Zizhuo
Liu, Jingbo
Li, Kezhen
Chen, Gang
Sun, Chaoyang
Wang, Beibei
Yang, Xingsheng
author_sort Yang, Xiaohang
collection PubMed
description INTRODUCTION: Stage IB (deep myometrial invasion) high‐grade endometrioid adenocarcinoma (EA), regardless of LVSI status, is classified into high‐intermediate risk groups, requiring surgical lymph node staging. Intraoperative frozen section (IFS) is commonly used, but its adequacy and reliability vary between reports. Hence, we determined the utility of IFS in identification of high‐risk factors, including deep myometrial invasion and high‐grade. METHOD: We retrospectively analyzed 9,985 cases operated with hysterectomy and diagnosed with FIGO stage I/II EA in postoperative paraffin section (PS) results at 30 Chinese hospitals from 2000 to 2019. We determined diagnostic performance of IFS and investigated whether the addition of IFS to preoperative biopsy and imaging could improve identification of high‐risk factors. RESULTS: IFS and postoperative PS presented the highest concordance in assessing deep myometrial invasion (Kappa: 0.834), followed by intraoperative gross examination (IGE Kappa: 0.643), MRI (Kappa: 0.395), and CT (Kappa: 0.207). IFS and postoperative PS presented the highest concordance for high‐grade EA (Kappa: 0.585) compared to diagnostic curettage (D&C 0.226) and hysteroscope (Hys 0.180). Sensitivity and specificity for detecting deep myometrial invasion were 86.21 and 97.20% for IFS versus 51.72 and 88.81% for MRI, 68.97 and 94.41% for IGE. These figures for detecting high‐grade EA were 58.21 and 96.50% for IFS versus 16.42 and 98.83% for D&C, 13.43 and 98.64% for Hys. Parallel strategies, including MRI‐IFS (Kappa: 0.626), D&C‐IFS (Kappa: 0.595), and Hys‐IFS (Kappa: 0.578) improved the diagnostic efficiencies of individual preoperative examinations. Based on the high sensitivity of IFS, parallel strategies improved the sensitivities of preoperative examinations to 89.66% (MRI), 64.18% (D&C), 62.69% (Hys), respectively, and these differences were statistically significant (p = 0.000). CONCLUSION: IFS presented reasonable agreement rates predicting postoperative PS results, including deep myometrial invasion and high‐grade. IFS helps identify high‐intermediate risk patients in preoperative biopsy and MRI and guides intraoperative lymphadenectomy decisions in EA.
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spelling pubmed-101343522023-04-28 It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large‐scale, multi‐center, and retrospective study Yang, Xiaohang Yin, Jingjing Fu, Yu Shen, Yuanming Zhang, Chuyao Yao, Shuzhong Xu, Congjian Xia, Min Lou, Ge Liu, Jihong Lin, Bei Wang, Jianliu Zhao, Weidong Zhang, Jieqing Cheng, Wenjun Guo, Hongyan Guo, Ruixia Xue, Fengxia Wang, Xipeng Han, Lili Li, Xiaomao Zhang, Ping Zhao, Jianguo Li, Wenting Dou, Yingyu Wang, Zizhuo Liu, Jingbo Li, Kezhen Chen, Gang Sun, Chaoyang Wang, Beibei Yang, Xingsheng Cancer Med RESEARCH ARTICLES INTRODUCTION: Stage IB (deep myometrial invasion) high‐grade endometrioid adenocarcinoma (EA), regardless of LVSI status, is classified into high‐intermediate risk groups, requiring surgical lymph node staging. Intraoperative frozen section (IFS) is commonly used, but its adequacy and reliability vary between reports. Hence, we determined the utility of IFS in identification of high‐risk factors, including deep myometrial invasion and high‐grade. METHOD: We retrospectively analyzed 9,985 cases operated with hysterectomy and diagnosed with FIGO stage I/II EA in postoperative paraffin section (PS) results at 30 Chinese hospitals from 2000 to 2019. We determined diagnostic performance of IFS and investigated whether the addition of IFS to preoperative biopsy and imaging could improve identification of high‐risk factors. RESULTS: IFS and postoperative PS presented the highest concordance in assessing deep myometrial invasion (Kappa: 0.834), followed by intraoperative gross examination (IGE Kappa: 0.643), MRI (Kappa: 0.395), and CT (Kappa: 0.207). IFS and postoperative PS presented the highest concordance for high‐grade EA (Kappa: 0.585) compared to diagnostic curettage (D&C 0.226) and hysteroscope (Hys 0.180). Sensitivity and specificity for detecting deep myometrial invasion were 86.21 and 97.20% for IFS versus 51.72 and 88.81% for MRI, 68.97 and 94.41% for IGE. These figures for detecting high‐grade EA were 58.21 and 96.50% for IFS versus 16.42 and 98.83% for D&C, 13.43 and 98.64% for Hys. Parallel strategies, including MRI‐IFS (Kappa: 0.626), D&C‐IFS (Kappa: 0.595), and Hys‐IFS (Kappa: 0.578) improved the diagnostic efficiencies of individual preoperative examinations. Based on the high sensitivity of IFS, parallel strategies improved the sensitivities of preoperative examinations to 89.66% (MRI), 64.18% (D&C), 62.69% (Hys), respectively, and these differences were statistically significant (p = 0.000). CONCLUSION: IFS presented reasonable agreement rates predicting postoperative PS results, including deep myometrial invasion and high‐grade. IFS helps identify high‐intermediate risk patients in preoperative biopsy and MRI and guides intraoperative lymphadenectomy decisions in EA. John Wiley and Sons Inc. 2023-01-31 /pmc/articles/PMC10134352/ /pubmed/36718983 http://dx.doi.org/10.1002/cam4.5643 Text en © 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle RESEARCH ARTICLES
Yang, Xiaohang
Yin, Jingjing
Fu, Yu
Shen, Yuanming
Zhang, Chuyao
Yao, Shuzhong
Xu, Congjian
Xia, Min
Lou, Ge
Liu, Jihong
Lin, Bei
Wang, Jianliu
Zhao, Weidong
Zhang, Jieqing
Cheng, Wenjun
Guo, Hongyan
Guo, Ruixia
Xue, Fengxia
Wang, Xipeng
Han, Lili
Li, Xiaomao
Zhang, Ping
Zhao, Jianguo
Li, Wenting
Dou, Yingyu
Wang, Zizhuo
Liu, Jingbo
Li, Kezhen
Chen, Gang
Sun, Chaoyang
Wang, Beibei
Yang, Xingsheng
It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large‐scale, multi‐center, and retrospective study
title It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large‐scale, multi‐center, and retrospective study
title_full It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large‐scale, multi‐center, and retrospective study
title_fullStr It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large‐scale, multi‐center, and retrospective study
title_full_unstemmed It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large‐scale, multi‐center, and retrospective study
title_short It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large‐scale, multi‐center, and retrospective study
title_sort it is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: a large‐scale, multi‐center, and retrospective study
topic RESEARCH ARTICLES
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10134352/
https://www.ncbi.nlm.nih.gov/pubmed/36718983
http://dx.doi.org/10.1002/cam4.5643
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