Endometrial cancer: Preoperative versus intraoperative staging - 14/11/20
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Highlights |
• | The role of preoperative staging in endometrial cancer has been recently recognized. |
• | Intraoperative frozen section remains the method with the best performance. |
• | Preoperative tools provide adequate diagnostic yields assessing myometrial invasion. |
• | The optimal alternative will highly depend on the availability and expertise. |
Abstract |
Purpose |
To determine the accuracy of transvaginal ultrasonography (TVS) and pelvic magnetic resonance imaging (MRI) in preoperative staging of endometrial cancer in comparison to frozen section (FS) for the assessment of myometrial invasion, considering permanent section as the gold standard.
Methods |
A retrospective longitudinal study of all endometrial carcinomas diagnosed in our institution between March 2012 and October 2018 was conducted. Women with histologically confirmed endometrial malignancy, planned for surgery as primary treatment and submitted either to TVS, MRI and/or intraoperative FS followed by comprehensive surgical staging were eligible.
Results |
From a total of 187 endometrial carcinomas, 156 were eligible for the study. The most frequent histology was endometrioid carcinoma (n=115), followed by serous carcinoma (n=25); the majority presented a FIGO stage IA (n=85) or IB (n=21). TVS, MRI and FS presented a sensitivity 56 %, 71 % and 67 % [95 %CI 0.35-0.75; 0.49-0.87; 0.45-0.84] and a specificity of 90 %, 78 % and 94 % [95 %CI 0.79-0.97; 0.58-0.91; 0.84-0.98], respectively. FS was the method with the lowest overestimation rate (6.5 %, 95 %CI 0.02-0.16), whereas MRI showed the lowest underestimation rate (29.2 %, 95 %CI 0.13-0.51). Agreement was superior between MRI and FS (Pa=0.79, K=0.56) and secondly between MRI and TVS (Pa=0.78, K=0.47).
Conclusions |
Intraoperative FS presents the higher specificity and the lowest overestimation rate, while MRI seems to be the exam with the highest sensitivity in the evaluation of myometrial invasion. Agreement between the different methods is reasonable, suggesting that the best alternative will be highly dependent on the availability and experience of each institution.
Le texte complet de cet article est disponible en PDF.Keywords : Endometrial cancer, Staging, Frozen section, Ultrasonography, Magnetic resonance
Plan
☆ | Address of the institution at which the study was carried out: Hospital Beatriz Ângelo, Av. Carlos Teixeira 514, Loures, Portugal. |
Vol 49 - N° 10
Article 101647- décembre 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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