What is the correlation between the results of the intraoperative histopathological consultation and the final pathological examinations in uterine cancer patients? Results and retrospective analysis of 218 cases

Background: Endometrial carcinoma (EC) is the most common gynecological malignancy in developed countries. For optimal treatment, the clinicopathological characteristics of EC need to be revealed. This study aimed to evaluate the compatibility of intraoperative frozen section (IFS) and final diagnostic results. Methods: In this study, two hundred and eighteen EC patients, who were operated on for EC between 2008 and 2018, were evaluated retrospectively. The IFS and final diagnosis results of the patients were compared in terms of myometrial invasion (MI), cervical invasion, tumor size, histological subtype and grade, and the concordance rate between IFS and final diagnosis was calculated. Results: One hundred thirty-nine patients were included in the study. The average age of the patients was 57.60 ± 10.41 years, the average body mass index (BMI) was 37.82 ± 8.75 kg/m2, and the average surgery duration was 258.24 ± 151.30 minutes. The concordance between IFS and final diagnosis was 81.3%, 88.5%, 89.2%, 71.9% and 95.9% for tumor histology, tumor grade, MI, tumor diameter and cervical involvement, respectively. None of the 139 patients received unnecessary treatment, three patients received inadequate treatment due to MI, and seven patients received inadequate treatment due to grade incompatibility. Conclusions: The compliance results of our study suggest that IFS is a good indicator for decisions about the appropriate surgical procedure.

Cervical invasion; Endometrial carcinoma; Histological subtype; Myometrial invasion; Tumor size

[1] Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA: A Cancer Journal for Clinicians. 2022; 72: 7–33.

[2] Saini A, Suh L, Gao J, Leung K, Wilkie G, Matteson K, et al. Intra-operative tumor spillage in minimally invasive surgery for endometrial cancer and its impact on recurrence risk. Gynecologic Oncology. 2023; 175: 128–132.

[3] Dyba T, Randi G, Bray F, Martos C, Giusti F, Nicholson N, et al. The European cancer burden in 2020: incidence and mortality estimates for 40 countries and 25 major cancers. European Journal of Cancer. 2021; 157: 308–347.

[4] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021; 71: 209–249.

[5] Çakır İ, Gülseren V, Özdemir İA, Abacı H, Talu ECK, Çakır ZE, et al. Characteristics of patients with late recurrence endometrial cancer. Journal of Cancer Research and Therapeutics. 2024; 20: 232–237.

[6] Crosbie EJ, Kitson SJ, McAlpine JN, Mukhopadhyay A, Powell ME, Singh N. Endometrial cancer. The Lancet. 2022; 399: 1412–1428.

[7] Njoku K, Barr CE, Crosbie EJ. Current and emerging prognostic biomarkers in endometrial cancer. Frontiers in Oncology. 2022; 12: 890908.

[8] Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, et al. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. International Journal of Gynecological Cancer. 2016; 26: 2–30.

[9] Yang X, Yin J, Fu Y, Shen Y, Zhang C, Yao S, et al. Preoperative and intraoperative assessment of myometrial invasion in patients with FIGO stage I non-endometrioid endometrial carcinoma—a large-scale, multi-center, and retrospective study. Diagnostic Pathology. 2023; 18: 8.

[10] American College of Obstetricians and Gynecologists. ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer. Obstetrics & Gynecology. 2005; 106: 413–425.

[11] Gallego JC, Porta A, Pardo MC, Fernández C. Evaluation of myometrial invasion in endometrial cancer: comparison of diffusion-weighted magnetic resonance and intraoperative frozen sections. Abdominal Imaging. 2014; 39: 1021–1026.

[12] Kumar S, Bandyopadhyay S, Semaan A, Shah JP, Mahdi H, Morris R, et al. The role of frozen section in surgical staging of low risk endometrial cancer. PLOS ONE. 2011; 6: e21912.

[13] Mandato VD, Torricelli F, Mastrofilippo V, Palicelli A, Ciarlini G, Pirillo D, et al. Accuracy of preoperative endometrial biopsy and intraoperative frozen section in predicting the final pathological diagnosis of endometrial cancer. Surgical Oncology. 2020; 35: 229–235.

[14] Concin N, Creutzberg CL, Vergote I, Cibula D, Mirza MR, Marnitz S, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Virchows Archiv. 2021; 478: 153–190.

[15] Gitas G, Proppe L, Alkatout I, Rody A, Kotanidis C, Tsolakidis D, et al. Accuracy of frozen section at early clinical stage of endometrioid endometrial cancer: a retrospective analysis in Germany. Archives of Gynecology and Obstetrics. 2019; 300: 169–174.

[16] Yang X, Yin J, Fu Y, Shen Y, Zhang C, Yao S, et al. It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large-scale, multi-center, and retrospective study. Cancer Medicine. 2023; 12: 8897–8910.

[17] Case AS, Rocconi RP, Straughn JM III, Conner M, Novak L, Wang W, et al. A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer. Obstetrics & Gynecology. 2006; 108: 1375–1379.

[18] Turan T, Oguz E, Unlubilgin E, Tulunay G, Boran N, Demir OF, et al. Accuracy of frozen-section examination for myometrial invasion and grade in endometrial cancer. uropean Journal of Obstetrics & Gynecology and Reproductive Biology. 2013; 167: 90–95.

[19] Quinlivan JA, Petersen RW, Nicklin JL. Accuracy of frozen section for the operative management of endometrial cancer. BJOG: An International Journal of Obstetrics & Gynaecology. 2001; 108: 798–803.

[20] Jonsdottir B, Marcickiewicz J, Borgfeldt C, Bjurberg M, Dahm-Kähler P, Flöter-Rådestad A, et al. Preoperative and intraoperative assessment of myometrial invasion in endometrial cancer—a Swedish Gynecologic Cancer Group (SweGCG) study. Acta Obstetricia et Gynecologica Scandinavica. 2021; 100: 1526–1533.

[21] Ooka R, Nanki Y, Yamagami W, Kawaida M, Nagai S, Hirano T, et al. Evaluation of the role of intraoperative frozen section and magnetic resonance imaging in endometrial cancer. International Journal of Gynecology & Obstetrics. 2023; 160: 554–562.

[22] Lago V, Martin B, Ballesteros E, Cárdenas-Rebollo JM, Minig L. Tumor grade correlation between preoperative biopsy and final surgical specimen in endometrial cancer: the use of different diagnostic methods and analysis of associated factors. International Journal of Gynecological Cancer. 2018; 28: 1258–1263.

[23] Dogan Durdag G, Alemdaroglu S, Aka Bolat F, Yılmaz Baran Ş, Yüksel Şimşek S, Çelik H. Accuracy of intra-operative frozen section in guiding surgical staging of endometrial cancer. Archives of Gynecology and Obstetrics. 2021; 304: 725–732.

[24] Acikalin A, Gumurdulu D, Bagir EK, Torun G, Guzel AB, Zeren H, et al. The guidance of intraoperative frozen section for staging surgery in endometrial carcinoma: frozen section in endometrial carcinoma. Pathology and Oncology Research. 2015; 21: 119–122.

[25] Stephan JM, Hansen J, Samuelson M, McDonald M, Chin Y, Bender D, et al. Intra-operative frozen section results reliably predict final pathology in endometrial cancer. Gynecologic Oncology. 2014; 133: 499–505.

[26] Santoro A, Piermattei A, Inzani F, Angelico G, Valente M, Arciuolo D, et al. Frozen section accurately allows pathological characterization of endometrial cancer in patients with a preoperative ambiguous or inconclusive diagnoses: our experience. BMC Cancer. 2019; 19: 1096.

[27] Kumar S, Medeiros F, Dowdy SC, Keeney GL, Bakkum-Gamez JN, Podratz KC, et al. A prospective assessment of the reliability of frozen section to direct intraoperative decision making in endometrial cancer. Gynecologic Oncology. 2012; 127: 525–531.

[28] Bandala-Jacques A, Cantu-de-Leon D, Perez-Montiel D, Salcedo-Hernández RA, Prada D, González-Enciso A, et al. Diagnostic performance of intraoperative assessment in grade 2 endometrioid endometrial carcinoma. World Journal of Surgical Oncology. 2020; 18: 284.

[29] Giglio A, Miller B, Curcio E, Kuo YH, Erler B, Bosscher J, et al. Challenges to intraoperative evaluation of endometrial cancer. Journal of the Society of Laparoscopic & Robotic Surgeons. 2020; 24: e2020.00011.

[30] Karabagli P, Ugras S, Yilmaz BS, Celik C. The evaluation of reliability and contribution of frozen section pathology to staging endometrioid adenocarcinomas. Archives of Gynecology and Obstetrics. 2015; 292: 391–397.

[31] Guo Q, Yi H, Chen X, Song J, Chen L, Zheng X. Is routine frozen section analysis necessary in patients with non-endometrioid cancer or grade 3 endometrioid cancer? International Journal of Gynecology & Obstetrics. 2022; 156: 256–261.

[32] Wang X, Li L, Cragun JM, Chambers SK, Hatch KD, Zheng W. Assessment of the role of intraoperative frozen section in guiding surgical staging for endometrial cancer. International Journal of Gynecological Cancer. 2016; 26: 918–923.

[33] Abdallah R, Khalil A, Ghunaim S, El Housheimi A, Khalife D, Sassine D, et al. The accuracy and clinical impact of intraoperative frozen section in determining the extent of surgical intervention in patients with early stage endometrial cancer. Journal of Obstetrics and Gynaecology. 2022; 42: 1474–1481.