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Published on: September 12, 2019
Endometrial cancer: Preoperative versus intraoperative staging
Mariana Rei1, Inês Rodrigues2, Pedro Condeço2
1Department of Obstetrics and Gynaecology, Hospital Beatriz Ângelo, Loures, Portugal; Department of Obstetrics and Gynaecology, Centro Hospitalar Universitário de São João, EPE Porto, Portugal; Porto Medical School, University of Porto, Portugal.
Transvaginal ultrasonography (TVS) and pelvic magnetic resonance imaging (MRI) accurately stage endometrial cancer myometrial invasion. Intraoperative frozen section (FS) offers high specificity, while MRI shows the best sensitivity for assessing myometrial invasion.
Area of Science:
- Gynecologic Oncology
- Diagnostic Imaging
- Pathology
Background:
- Accurate preoperative staging of endometrial cancer is crucial for treatment planning.
- Assessing myometrial invasion is a key factor in determining the extent of disease.
- Transvaginal ultrasonography (TVS), pelvic magnetic resonance imaging (MRI), and intraoperative frozen section (FS) are used for this assessment.
Purpose of the Study:
- To compare the accuracy of TVS and pelvic MRI with intraoperative FS for preoperative staging of endometrial cancer.
- To evaluate the performance of these methods in assessing myometrial invasion, using permanent section histology as the gold standard.
Main Methods:
- Retrospective longitudinal study of 156 endometrial carcinoma cases diagnosed between March 2012 and October 2018.
- Eligibility criteria included histologically confirmed malignancy, planned surgery, and undergoing TVS, MRI, and/or intraoperative FS.
- Comparison of diagnostic accuracy metrics (sensitivity, specificity, overestimation, underestimation) and inter-method agreement.
Main Results:
- TVS, MRI, and FS showed varying sensitivities (56%, 71%, 67%) and specificities (90%, 78%, 94%) for myometrial invasion.
- FS had the lowest overestimation rate (6.5%), while MRI had the lowest underestimation rate (29.2%).
- Agreement was highest between MRI and FS (K=0.56), followed by MRI and TVS (K=0.47).
Conclusions:
- Intraoperative FS demonstrates high specificity and low overestimation in evaluating myometrial invasion.
- Pelvic MRI appears to offer the highest sensitivity for detecting myometrial invasion.
- The choice of imaging modality should consider institutional availability and expertise, as agreement between methods is reasonable.
