Preoperative MRI and Intraoperative Frozen Section Diagnosis of Myometrial Invasion in Patients With Endometrial Cancer

Tanaka, Tomohito; Terai, Yoshito; Fujiwara, Satoe; Tanaka, Yoshimichi; Sasaki, Hiroshi; Tsunetoh, Satoshi; Kanemura, Masanori; Yamamoto, Kazuhide; Yamada, Takashi; Ohmichi, Masahide

doi:10.1097/igc.0000000000000470

Cited by 35 publications

(31 citation statements)

References 26 publications

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“…For the evaluation of myometrial invasion, even if a magnetic resonance imaging has good specificity, its sensitivity is poor. 21,22 The only certitude for myometrial invasion is made on the hysterectomy specimen. When evaluating the safety of fertility preservation in patients with presumed grade 1 EC confined to the endometrium, the risk of subestimation of the tumor stage was not associated with increased mortality.…”

Section: Discussionmentioning

confidence: 99%

Impact of Conservative Managements in Young Women With Grade 2 or 3 Endometrial Adenocarcinoma Confined to the Endometrium

Gonthier

Trefoux-Bourdet

Koskas³

2017

International Journal of Gynecological Cancer

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Section: Discussionmentioning

confidence: 99%

Impact of Conservative Managements in Young Women With Grade 2 or 3 Endometrial Adenocarcinoma Confined to the Endometrium

Gonthier

Trefoux-Bourdet

Koskas³

2017

International Journal of Gynecological Cancer

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“…Tanaka et al [26] and Kisu et al [27] reported that frozen sectioning has a higher correlation rate than does MRI. They mentioned that diffusion-weighted MRI can have the same diagnostic precision as frozen sectioning [11].…”

Section: Roc Curvementioning

confidence: 99%

Can preoperative magnetic resonance imaging replace intraoperative frozen sectioning in the evaluation of myometrial invasion for early-stage endometrial carcinoma?

et al. 2019

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Objectives:To examine the performance of preoperative magnetic resonance imaging (MRI) and intraoperative frozen sectioning in the assessment of myometrial invasion during the early stages of endometrial cancer. Material and methods:This retrospective study employed data from patients with endometrial cancer who were operated on between January 2013 and November 2018. Patients who underwent preoperative MRI and were of FIGO 2009 stage I were included in the study. Radiological staging and intraoperative staging by frozen sectioning were carried out. The data were analyzed to assess agreement of the overall results concerning myometrial invasion. Results:In total, 222 patients were enrolled. Their mean age was 58.3 ± 8.5 years. The accuracy of MRI for the detection of myometrial invasion was 88.7% and its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 91.6%, 82.1%, 92.2%, and 80.9%, respectively, with a kappa coefficient of 0.734 (95% confidence interval [CI], 0.684-0.784; p < 0.001). The accuracy of intraoperative frozen sectioning was 94.4%, and its sensitivity, specificity, PPV, and NPV were 97.7%, 85.7%, 94.7%, and 93.4%, respectively, with a kappa coefficient of 0.856 (95% CI, 0.812-0.900; p < 0.001). No significant difference in accuracy was observed between MRI and frozen sectioning (p = 0.057). MRI and frozen sectioning were sensitive for the detection of myometrial invasion, according to receiver operating curve analyses (areas under the curve, 0.869 and 0.917, respectively; p < 0.001). Conclusions:The assessment of myometrial invasion by preoperative MRI and intraoperative frozen sectioning during the early stages of endometrial carcinoma was highly accurate.

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“…Accordingly, pre-surgical evaluation of the current risk factors for recurrence including deep myometrial invasion, histologically high-grade tumors, and lymph node metastasis is important. Although the pre-operative diagnosis by histological pathology of a biopsied specimen and MRI is accurate in most cases, frozen section evaluation of the removed uterus or lymph node may overturn the diagnosis in certain cases [5], where additional regional lymphadenectomy is recommended. Considering the advantages of our new method, it is reasonable to apply LDF to the above cases.…”

Section: Discussionmentioning

confidence: 99%

A direct endoscopic approach for left-sided infrarenal para-aortic lymphadenectomy immediately after hysterectomy for endometrial cancer treatment: left dome formation (LDF)

et al. 2019

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Background Endoscopic surgery for infrarenal para-aortic lymphadenectomy has been widely accepted. Two major approaches, "transperitoneal" and "extraperitoneal", are generally used; however, they have several disadvantages. A "transperitoneal" approach to the left para-aortic region is usually indirect, often performed after wide extension of the right para-aortic region. An "extraperitoneal" approach is unsuitable when a peritoneal tear exists after a prior surgical procedure such as hysterectomy. Here, we propose a modified transperitoneal technique, "Left dome formation (LDF)," which directly provides a surgical field for left infrarenal para-aortic lymphadenectomy even after hysterectomy. Methods The LDF procedure comprised three processes: (1) setting, (2) dissection of inframesenteric lymph nodes (step 1), and (3) dissection of infrarenal lymph nodes (step 2). Setting: two trocars were added 4 cm bilateral to the low-mid abdominal trocar that was used in prior hysterectomy. Step 1: The posterior layer of the renal fascia along with the left ureter and left ovarian vessel were separated from the left common iliac artery and iliopsoas. Left inframesentric nodes were removed from the surgical field. Step 2: The left ureter was isolated from the posterior renal fascia, and the dome was expanded cranially to the left renal vein, with the ovarian vein always visualizable at the dome ceiling. Left infrarenal nodes were removed. Results We applied LDF to ten endometrial cancer patients, recommended for additional dissection of para-aortic nodes based on intraoperative evaluation using the laparoscopically removed uterus. The operative time and number of removed lymph nodes in Step 1 and Step 2 were 28.8 (20-49) min and 5.3 (2-10) and 54.6 (52-70) min and 6.5 (1-11), respectively. Blood loss was below 50 ml. No serious organ injury occurred during procedures. Conclusion Since the left ureter is always observable, LDF procedure facilitates effective surgery to overcome the anatomical complexity of the left para-aortic region and is potentially useful for sentinel node sampling.

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Preoperative MRI and Intraoperative Frozen Section Diagnosis of Myometrial Invasion in Patients With Endometrial Cancer

Abstract: Frozen sections had a higher agreement rate for MI than MRI; however, MRI is still considered an acceptable modality to guide preoperative decisions regarding lymphadenectomy especially in grade 1 or 2 endometrioid adenocarcinoma.

Cited by 35 publications

References 26 publications

Impact of Conservative Managements in Young Women With Grade 2 or 3 Endometrial Adenocarcinoma Confined to the Endometrium

Impact of Conservative Managements in Young Women With Grade 2 or 3 Endometrial Adenocarcinoma Confined to the Endometrium

Can preoperative magnetic resonance imaging replace intraoperative frozen sectioning in the evaluation of myometrial invasion for early-stage endometrial carcinoma?

A direct endoscopic approach for left-sided infrarenal para-aortic lymphadenectomy immediately after hysterectomy for endometrial cancer treatment: left dome formation (LDF)

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