Cargando…

The Role of Frozen Section in Surgical Staging of Low Risk Endometrial Cancer

BACKGROUND: The role of frozen section (FS) in intraoperative decision making for surgical staging of endometrial cancer is controversial. Objective of this study is to assess the agreement rate between the FS and paraffin section (PS); and the potential impact of the role of FS in the intra-operati...

Descripción completa

Detalles Bibliográficos
Autores principales: Kumar, Sanjeev, Bandyopadhyay, Sudeshna, Semaan, Assaad, Shah, Jay P., Mahdi, Haider, Morris, Robert, Munkarah, Adnan, Ali-Fehmi, Rouba
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164668/
https://www.ncbi.nlm.nih.gov/pubmed/21912633
http://dx.doi.org/10.1371/journal.pone.0021912
_version_ 1782211066885832704
author Kumar, Sanjeev
Bandyopadhyay, Sudeshna
Semaan, Assaad
Shah, Jay P.
Mahdi, Haider
Morris, Robert
Munkarah, Adnan
Ali-Fehmi, Rouba
author_facet Kumar, Sanjeev
Bandyopadhyay, Sudeshna
Semaan, Assaad
Shah, Jay P.
Mahdi, Haider
Morris, Robert
Munkarah, Adnan
Ali-Fehmi, Rouba
author_sort Kumar, Sanjeev
collection PubMed
description BACKGROUND: The role of frozen section (FS) in intraoperative decision making for surgical staging of endometrial cancer is controversial. Objective of this study is to assess the agreement rate between the FS and paraffin section (PS); and the potential impact of the role of FS in the intra-operative decision making for the complete surgical staging in low risk endometrial cancer. METHODS: This is a retrospective analysis of patients diagnosed with intra-operative FS stage I, grade I or II endometrial cancer from 1995–2004. FS results were compared with final pathology results with regard to tumor grade, depth of myometrial invasion, cervical involvement, lymphovascular invasion, and lymph node involvement. Agreement statistic with kappa was calculated using SPSS statistical software. Categorical variables were tested using chi-square test with p value of ≤0.05 being statistically significant. RESULTS: Of the 457 patients with endometrial cancer, 146 were evaluated by intra-operative FS and met inclusion criteria. FS results were in disagreement with permanent section in 35% for the grade (kappa 0.58, p = 0.003), 28% for depth of myometrial invasion (kappa 0.61, p<0.0001), 13% for cervical involvement (kappa 0.78, p = 0.002), and 32% for lymphovascular invasion (kappa 0.6, p = 0.01). Permanent pathology upstaged 31.9% & 23.2% of FS stage IA, & IB specimen respectively. Lymph node dissection was done in 56.8%. Lymph node metastasis was identified in 8.4%. Use of intraoperative FS would have resulted in suboptimal surgical treatment in 13% stage IA and 6.6% of stage IB patients respectively by foregoing lymphadenectomy. CONCLUSION: A significant number of patients with low risk endometrial cancer by FS were upstaged and upgraded on final pathology. Before placing absolute reliance on intraoperative FS to undertake complete surgical staging, the inherent limitation of the same in predicting final stage and grade highlighted by our data need to be carefully considered.
format Online
Article
Text
id pubmed-3164668
institution National Center for Biotechnology Information
language English
publishDate 2011
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-31646682011-09-12 The Role of Frozen Section in Surgical Staging of Low Risk Endometrial Cancer Kumar, Sanjeev Bandyopadhyay, Sudeshna Semaan, Assaad Shah, Jay P. Mahdi, Haider Morris, Robert Munkarah, Adnan Ali-Fehmi, Rouba PLoS One Research Article BACKGROUND: The role of frozen section (FS) in intraoperative decision making for surgical staging of endometrial cancer is controversial. Objective of this study is to assess the agreement rate between the FS and paraffin section (PS); and the potential impact of the role of FS in the intra-operative decision making for the complete surgical staging in low risk endometrial cancer. METHODS: This is a retrospective analysis of patients diagnosed with intra-operative FS stage I, grade I or II endometrial cancer from 1995–2004. FS results were compared with final pathology results with regard to tumor grade, depth of myometrial invasion, cervical involvement, lymphovascular invasion, and lymph node involvement. Agreement statistic with kappa was calculated using SPSS statistical software. Categorical variables were tested using chi-square test with p value of ≤0.05 being statistically significant. RESULTS: Of the 457 patients with endometrial cancer, 146 were evaluated by intra-operative FS and met inclusion criteria. FS results were in disagreement with permanent section in 35% for the grade (kappa 0.58, p = 0.003), 28% for depth of myometrial invasion (kappa 0.61, p<0.0001), 13% for cervical involvement (kappa 0.78, p = 0.002), and 32% for lymphovascular invasion (kappa 0.6, p = 0.01). Permanent pathology upstaged 31.9% & 23.2% of FS stage IA, & IB specimen respectively. Lymph node dissection was done in 56.8%. Lymph node metastasis was identified in 8.4%. Use of intraoperative FS would have resulted in suboptimal surgical treatment in 13% stage IA and 6.6% of stage IB patients respectively by foregoing lymphadenectomy. CONCLUSION: A significant number of patients with low risk endometrial cancer by FS were upstaged and upgraded on final pathology. Before placing absolute reliance on intraoperative FS to undertake complete surgical staging, the inherent limitation of the same in predicting final stage and grade highlighted by our data need to be carefully considered. Public Library of Science 2011-09-01 /pmc/articles/PMC3164668/ /pubmed/21912633 http://dx.doi.org/10.1371/journal.pone.0021912 Text en Kumar et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Kumar, Sanjeev
Bandyopadhyay, Sudeshna
Semaan, Assaad
Shah, Jay P.
Mahdi, Haider
Morris, Robert
Munkarah, Adnan
Ali-Fehmi, Rouba
The Role of Frozen Section in Surgical Staging of Low Risk Endometrial Cancer
title The Role of Frozen Section in Surgical Staging of Low Risk Endometrial Cancer
title_full The Role of Frozen Section in Surgical Staging of Low Risk Endometrial Cancer
title_fullStr The Role of Frozen Section in Surgical Staging of Low Risk Endometrial Cancer
title_full_unstemmed The Role of Frozen Section in Surgical Staging of Low Risk Endometrial Cancer
title_short The Role of Frozen Section in Surgical Staging of Low Risk Endometrial Cancer
title_sort role of frozen section in surgical staging of low risk endometrial cancer
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164668/
https://www.ncbi.nlm.nih.gov/pubmed/21912633
http://dx.doi.org/10.1371/journal.pone.0021912
work_keys_str_mv AT kumarsanjeev theroleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT bandyopadhyaysudeshna theroleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT semaanassaad theroleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT shahjayp theroleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT mahdihaider theroleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT morrisrobert theroleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT munkarahadnan theroleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT alifehmirouba theroleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT kumarsanjeev roleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT bandyopadhyaysudeshna roleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT semaanassaad roleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT shahjayp roleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT mahdihaider roleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT morrisrobert roleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT munkarahadnan roleoffrozensectioninsurgicalstagingoflowriskendometrialcancer
AT alifehmirouba roleoffrozensectioninsurgicalstagingoflowriskendometrialcancer