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

Research

Jingjing Yin¹  Xiaohang Yang¹  Gang Chen¹  Zizhuo Wang¹  Jingbo Liu¹  Yu Fu¹  Kezhen Li¹  Yingyu Dou¹  Wenting Li¹  Chaoyang Sun¹  Jieqing Zhang²  Chuyao Zhang³  Jihong Liu³  Jianguo Zhao⁴  Ge Lou⁵  Min Xia⁶  Ruixia Guo⁷  Xiaomao Li⁸  Fengxia Xue⁹  Xipeng Wang^1,10  Congjian Xu^1,11  Lili Han^1,12  Ping Zhang^1,13  Bei Lin^1,14  Qin Yao^1,15  Shuzhong Yao^1,16  Pengming Sun^1,17  Jianliu Wang^1,18  Wenjun Cheng^1,19  Weidong Zhao^2,20  Hongyan Guo^2,21  Weiguo Lu^2,22  Yuanming Shen^2,22 

[1] Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430000, Wuhan, Hubei, China;Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430000, Wuhan, Hubei, China;Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, 71 Hedi Road, 530021, Nanning, Guangxi, China;Department of Gynecologic Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng E Rd, 510060, Guangzhou, China;Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Affiliated Hospital of Nankai University, No. 156, Sanma Road, Nankai District, 300100, Tianjin, China;Tianjin Clinical Research Center for Gynecology and Obstetrics, Affiliated Hospital of Nankai University, No. 156, Sanma Road, Nankai District, 300100, Tianjin, China;Branch of National Clinical Research Center for Gynecology and Obstetrics, Affiliated Hospital of Nankai University, No. 156, Sanma Road, Nankai District, 300100, Tianjin, China;Department of Gynecology Oncology, Harbin Medical University Cancer Hospital, 150086, Harbin, China;Department of Gynecology and Obstetrics, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, NO 20 Yuhuangding East Road, 264000, Yantai, Shandong, China;Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe East Road, 450052, Zhengzhou, China;Department of Gynecology and Obstetrics, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, 510630, Guangzhou, China;Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154 Anshan Dao, Heping District, 300052, Tianjin, China;Department of Gynecology and Obstetrics, XinHua Hospital, Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China;Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China;Department of Gynecology, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Street, Tianshan District, 830001, Urumqi, China;Department of Gynecology, The Second Hospital of Shandong University, 247 Bei Yuan Street, 250033, Jinan, Shandong, China;Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, No. 36, Sanhao Street, Heping District, 110004, Shenyang, Liaoning, China;Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, 266003, Qingdao, Shandong, China;Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, No 58. Zhong Shan ER Lu, 510080, Guangzhou, China;Fujian Provincial Women & Children’s Hospital, Fujian Provincial Maternity & Children Health Hospital, Fujian Medical University, 350000, Fuzhou, Fujian, China;Peking University People’s Hospital, 100044, Beijing, China;The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, 210029, Nanjing, Jiangsu, China;The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 230001, Hefei, Anhui, China;The Third Hospital of Peking University, 49 North Garden Rd., Haidian District, Beijing, China;Women’s Hospital, School of Medicine, Zhejiang University, 310000, Hangzhou, China;

关键词: Non-endometrioid endometrial carcinoma;    Frozen sections;    Myometrial invasion;    Lymph node dissection;    Retrospective studies;   

DOI  :  10.1186/s13000-023-01294-z

 received in 2022-10-22, accepted in 2023-01-16,  发布年份 2023

来源: Springer

【 摘 要 】

IntroductionMyometrial invasion is a prognostic factor for lymph node metastases and decreased survival in non-endometrioid endometrial carcinoma patients. Herein, we explored the mode of myometrial invasion diagnosis in FIGO stage I non-endometrioid carcinoma and evaluated the differences in diagnostic efficiency among intraoperative frozen section (IFS), intraoperative gross examination (IGE), magnetic resonance imaging (MRI), and computed tomography (CT) in clinical practice. Finally, we suggested which test should be routinely performed.MethodThis was a historical cohort study nationwide with 30 centers in China between January 2000 and December 2019. Clinical data, including age, histology, method of myometrial invasion evaluation (MRI, CT, IGE, and IFS), and final diagnosis of postoperative paraffin sections, were collected from 490 non-endometrioid endometrial carcinoma (serous, clear cell, undifferentiated, mixed carcinoma, and carcinosarcoma) women in FIGO stage I.ResultsAmong the 490 patients, 89.59% presented myometrial invasion. The methods reported for myometrial invasion assessment were IFS in 23.47%, IGE in 69.59%, MRI in 37.96%, and CT in 10.20% of cases. The highest concordance was detected between IFS and postoperative paraffin sections (Kappa = 0.631, accuracy = 93.04%), followed by IGE (Kappa = 0.303, accuracy = 82.40%), MRI (Kappa = 0.131, accuracy = 69.35%), and CT (Kappa = 0.118, accuracy = 50.00%). A stable diagnostic agreement between IFS and the final results was also found through the years (2000–2012: Kappa = 0.776; 2013–2014: Kappa = 0.625; 2015–2016: Kappa = 0.545; 2017–2019: Kappa = 0.652).ConclusionIn China, the assessment of myometrial invasion in non-endometrioid endometrial carcinoma is often performed via IGE, but the reliability is relatively low in contrast to IFS. In clinical practice, IFS is a reliable method that can help accurately assess myometrial invasion and intraoperative decision-making (lymph node dissection or not). Hence, it should be routinely performed innon-endometrioid endometrial carcinoma patients.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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