The role of frozen-section in the surgical management of patients with endometrial intraepithelial neoplasia

Abstract

Objective: Patients with endometrial intraepithelial neoplasia may have concurrent endometrial cancer if managed surgically or develop cancer in time if managed conservatively. Therefore, intraoperative assessment of the uterus may be helpful if a surgical approach is decided on. Our study aimed to investigate the role of frozen-section examination in patients with endometrial intraepithelial neoplasia. Material and Method:Patients with endometrial intraepithelial neoplasia who were subjected to hysterectomy with intraoperative frozen-section assessment were included. Main outcome measures were the rates of concurrent endometrial cancer and concurrent high-risk endometrial cancer as well as the efficacy of frozen-section in the detection of concurrent invasive disease and in the designation of low-risk and high-risk features. Results:The study group consisted of seventy-three patients. Permanent pathology revealed endometrial adenocarcinoma in 19.2% whereas only one patient (1.4%) had high-risk disease necessitating surgical staging. Frozen-section diagnoses were consistent with final pathology in 93.2% of patients in terms of the presence or absence of co-existent carcinoma. When frozen-section reports were further evaluated in terms of the presence or absence of high-risk endometrial carcinoma, consistency with the final pathology was seen in 98.6% of patients. Conclusion:Co-existent endometrial cancer is not uncommon in endometrial intraepithelial neoplasia. Intraoperative frozen-section evaluation should therefore be considered whenever possible. Frozen-section is effective in the detection of coexistent invasive disease and in the designation of low-risk features. Although coexistent high-risk cancer is extremely rare, frozen-section assessment is not successful in determining high-risk features. Therefore, a re-staging surgery may be required on rare occasions.Key Words: Endometrial hyperplasia, Intraepithelial neoplasm, Endometrial cancer, Frozen-section ÖZ Amaç: Endometrial intraepitelyal neoplazi tanısı olan hastalarda cerrahi sonrasında eşzamanlı endometrial kanser saptanabilir veya konservatif tedavi yaklaşımında zaman içinde kanser gelişebilir. Bu nedenle cerrahi yaklaşım kararı verilmiş ise uterusun intraoperatif değerlendirilmesi yararlı olabilir. Çalışmamızda endometrial intraepitelyal neoplazi olan hastalarda frozen kesit incelemesinin rolünün araştırılması amaçlanmıştır. Gereç ve Yöntem:Çalışmaya histerektomi sırasında intraoperatif frozen kesit değerlendirmesi yapılan endometrial intraepitelyal neoplazi tanılı hastalar dahil edildi. Değerlendirilen sonuçlar içinde esas olarak eşzamanlı endometrium kanseri ve eşzamanlı yüksek riskli endometrial kanser oranları yanı sıra eşzamanlı invaziv hastalığın saptanmasında ve düşük-yüksek riskli özelliklerin belirlenmesinde frozen kesit incelemenin etkinliği yer aldı. Bulgular: Çalışma grubu 73 hastadan oluştu. Kalıcı kesitlerin incelenmesi sonucunda %19,2 oranında endometrial adenokarsinom saptanırken bu hastaların sadece bir tanesinde (%1,4) cerr...

Preoperative detection of occult endometrial malignancies in endometrial hyperplasia to improve primary surgical therapy: A scoping review of the literature

“…The results of the scoping review were reported according to the Preferred Reporting Items for Systematic reviews and Meta-criteria and were included in our review. We included 24 primary studies, [9][10][11][13][14][15][16][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] three meta-analyses, [17][18][19] and one poster presentation. 12 The characteristics of the 28 included studies are shown in Table 2.…”

“…12 The characteristics of the 28 included studies are shown in Table 2. Five studies were multicentric, 17-19, 27,35 five studies were from Turkey, 11,15,20,23,25 four studies were from the USA, 12,13,21,22 two studies were from the UK, 14,16 two studies were from Canada 10,34 and there was one study from each of Australia, 9 South Korea, 24 France, 26 Belgium, 28 Italy, 29 Denmark, 30 Greece, 31 Norway, 32 Taiwan, 33 and China. 36 These studies included the data of 7409 patients and recorded 2377 concurrent EC cases (32.1%).…”

“…We identified 591 potential articles via our search up until July 3, 2021. Twenty‐eight studies fit our inclusion criteria and were included in our review 9–36 . We included 24 primary studies, 9–11,13–16,20–36 three meta‐analyses, 17–19 and one poster presentation 12 .…”

“…Twenty‐eight studies fit our inclusion criteria and were included in our review 9–36 . We included 24 primary studies, 9–11,13–16,20–36 three meta‐analyses, 17–19 and one poster presentation 12 . The characteristics of the 28 included studies are shown in Table 2.…”

“…Age and body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) were the most studied clinical predictors across the studies. Eleven studies 15,16,20,[22][23][24][25][26][27]30,32 found a statistically significant correlation between age and concurrent EC. Antonsen et al 30 showed an incremental dose-response relationship between age and concurrent EC.…”