Are preoperative features effective in the incompatibility of intraoperative frozen section and final pathology in operated patients diagnosed with atypia endometrial hyperplasia?
Abstract
ABSTRACT
Objective: We aim to investigate the relationship between demographic characteristics and preoperative laboratory findings with the discordance between intraoperative frozen section diagnoses and final diagnoses in patients undergoing surgery with endometrial hyperplasia with atypia.
Methods: The study included 154 patients who underwent surgery for endometrial hyperplasia with atypia and who received intraoperative frozen section (IFS) diagnosis between January 2015 and January 2021. Frozen section diagnoses and the final diagnoses of the patients were compared. Patient groups were split into two: patients with an IFS diagnosis concordant and patients with an IFS diagnosis discordant with the final diagnosis. These two groups were compared regarding body mass index (BMI), age, systemic diseases, laboratory parameters and ultrasonography findings.
Results: When final diagnoses and IFS diagnoses were contrasted, the results were concordant in 126 patients and discordant in 28 patients. The agreement rate was 81.8% (Kappa = 0.635; p < 0.001; significant agreement). When the concordant and discordant groups were compared regarding demographic characteristics and preoperative laboratory findings, it was found that the BMI was higher, and the rate of complex atypia in the preoperative pathological examination was higher in the discordant group (p < 0.05). Other inflammatory markers and demographic variables were not significantly different between groups (p > 0.05).
Conclusion: Among patients operated for endometrial hyperplasia with atypia, IFS diagnoses were mostly concordant with the final diagnoses. It should be kept in mind that the discordance rate may be higher in atypical hyperplasias with complex structure and in patients with high BMI.
References
- 1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58(2):71-96.
- 2. Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of "untreated" hyperplasia in 170 patients. Cancer. 1985;56(2):403-12.
- 3. Trimble CL, Kauderer J, Zaino R, Silverberg S, Lim PC, Burke JJ 2nd, et al. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study. Cancer. 2006;106(4):812-9.
- 4. American College of Obstetricians and Gynecologists. ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer. Obstet Gynecol. 2005;106(2):413-25.
- 5. 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. Surg Oncol. 2020;35:229-35.
- 6. Erdem B, Aşıcıoğlu O, Seyhan NA, Peker N, Ülker V, Akbayır Ö. Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia? Int J Surg. 2018;53:350-3.
- 7. Morotti M, Menada MV, Moioli M, Sala P, Maffeo I, Abete L, et al. Frozen section pathology at time of hysterectomy accurately predicts endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia. Gynecol Oncol. 2012;125(3):536-40.
- 8. Salman MC, Usubutun A, Dogan NU, Yuce K. The accuracy of frozen section analysis at hysterectomy in patients with atypical endometrial hyperplasia. Clin Exp Obstet Gynecol. 2009;36(1):31-4.
- 9. Turan T, Karadag B, Karabuk E, Tulunay G, Ozgul N, Gultekin M, et al. Accuracy of frozen sections for intraoperative diagnosis of complex atypical endometrial hyperplasia. Asian Pac J Cancer Prev. 2012;13(5):1953-6.
- 10. Indermaur MD, Shoup B, Tebes S, Lancaster JM. The accuracy of frozen pathology at time of hysterectomy in patients with complex atypical hyperplasia on preoperative biopsy. Am J Obstet Gynecol. 2007;196(5):e40-2.
- 11. Ureyen I, Karalok A, Tasci T, Turkmen O, Koc S, Ozgul A, et al. The importance of age and menopausal status in endometrial complex hyperplasia with atypia. J Obstet Gynaecol. 2016;36(1):102-5.
- 12. Gungorduk K, Ozdemir A, Ertas IE, Sahbaz A, Asicioglu O, Gokcu M, et al. A novel preoperative scoring system for predicting endometrial cancer in patients with complex atypical endometrial hyperplasia and accuracy of frozen section pathological examination in this context: a multicenter study. Gynecol Obstet Invest. 2015;79(1):50-6.
- 13. Moodley M, Bramdev A. Frozen section: Its role in gynaecological oncology. J Obstet Gynaecol. 2005;25(7):629-34.
- 14. Scurry JP, Sumithran E. An assessment of the value of frozen sections in gynecological surgery. Pathology. 1989;21(3):159-63.
- 15. Lok J, Tse KY, Lee EYP, Wong RWC, Cheng ISY, Chan ANH, et al. Intraoperative Frozen Section Biopsy of Uterine Smooth Muscle Tumors: A Clinicopathologic Analysis of 112 Cases With Emphasis on Potential Diagnostic Pitfalls. Am J Surg Pathol. 2021;45(9):1179-89.
- 16. Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. Lancet. 2005;366(9484):491-505.
- 17. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454(7203):436-44.
- 18. Ural ÜM, Şehitoğlu İ, Tekin YB, Şahin FK. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in patients with endometrial hyperplasia and endometrial cancer. J Obstet Gynaecol Res. 2015;41(3):445-8.
- 19. Leng J, Wu F, Zhang L. Prognostic Significance of Pretreatment Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, or Monocyte-to-Lymphocyte Ratio in Endometrial Neoplasms: A Systematic Review and Meta-analysis. Front Oncol. 2022;12:734948.
- 20. Vetter MH, Smith B, Benedict J, Hade EM, Bixel K, Copeland LJ, et al. Preoperative predictors of endometrial cancer at time of hysterectomy for endometrial intraepithelial neoplasia or complex atypical hyperplasia. Am J Obstet Gynecol. 2020;222(1):60.e1-60.e7.
- 21. Hahn HS, Chun YK, Kwon YI, Kim TJ, Lee KH, Shim JU, et al. Concurrent endometrial carcinoma following hysterectomy for atypical endometrial hyperplasia. Eur J Obstet Gynecol Reprod Biol. 2010;150(1):80-3.
- 22. Kurt S, Demirtaş O, Kopuz A, Beyan E, Demirtaş G, Besler A, et al. Evaluation of the histopathological diagnosis of patients preoperatively diagnosed with atypical endometrial hyperplasia after hysterectomy. Eur J Gynaecol Oncol. 2012;33(5):459-62.
Atipili endometrial hiperplazi tanısı ile opere edilen hastalarda intraoperatif frozen patoloji ile nihai patoloji uyumsuzluğunda preoperatif özellikler etkili midir?
Abstract
ÖZET:
Amaç: Atipili endometrial hiperplazi tanısı ile opere edilen hastalarda intraoperatif frozen section patoloji ile postoperatif final patoloji sonuçları arasındaki farklılıkların demografik özellikler ve preoperatif laboratuar bulguları ile ilişkisinin araştırılmasıdır.
Yöntem: Kliniğimizde Ocak 2015-Ocak 2021 tarihleri arasında atipili endometrial hiperplazi nedeniyle opere olan ve intraoperatif frozen section patoloji (FSP) çalışılan 154 hasta çalışmaya alındı. Hastaların FSP ve postoperatif final patoloji sonuçları karşılaştırıldı. Hastalar FSP ve final patoloji uyumlu olanlar ve uyumlu olmayanlar olmak üzere iki gruba ayrıldı. Bu iki grup; yaş, vücut kitle indeksi (VKİ), sistemik hastalıklar, laboratuar parametreleri ve ultrasonografi bulguları açısından karşılaştırıldı.
Bulgular: FSB ve final patoloji sonuçları karşılaştırıldığında 126 hastada sonuçlar uyumluyken 28 hastada sonuçlar uyumsuz olarak değerlendirildi. Uyumluluk oranı %81.8 olarak saptandı (Kappa=0.635; p<0.001; önemli derecede uyumlu). Uyumlu olan ve uyumlu olmayan gruplar demografik ve preoperatif laboratuar bulguları açısından karşılaştırıldığında uyumsuz grupta VKI’nin daha yüksek ve preoperatif patolojide kompleks atipi oranının daha fazla olduğu saptandı (p<0.05). Diğer demografik özellikler ve inflamatuar göstergeler açısından iki grup arasında fark saptanmadı (p>0.05).
Sonuç: Atipili endometrial hiperplazi nedeniyle opere olan hastalarda FSP sonuçları büyük oranda final patoloji sonuçları ile uyum içerisindedir. Uyumsuzluk oranının kompleks yapılı atipili hiperplazilerde ve yüksek VKI sahip hastalarda daha fazla olabileceği akılda tutulmalıdır.
References
- 1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58(2):71-96.
- 2. Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of "untreated" hyperplasia in 170 patients. Cancer. 1985;56(2):403-12.
- 3. Trimble CL, Kauderer J, Zaino R, Silverberg S, Lim PC, Burke JJ 2nd, et al. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study. Cancer. 2006;106(4):812-9.
- 4. American College of Obstetricians and Gynecologists. ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer. Obstet Gynecol. 2005;106(2):413-25.
- 5. 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. Surg Oncol. 2020;35:229-35.
- 6. Erdem B, Aşıcıoğlu O, Seyhan NA, Peker N, Ülker V, Akbayır Ö. Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia? Int J Surg. 2018;53:350-3.
- 7. Morotti M, Menada MV, Moioli M, Sala P, Maffeo I, Abete L, et al. Frozen section pathology at time of hysterectomy accurately predicts endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia. Gynecol Oncol. 2012;125(3):536-40.
- 8. Salman MC, Usubutun A, Dogan NU, Yuce K. The accuracy of frozen section analysis at hysterectomy in patients with atypical endometrial hyperplasia. Clin Exp Obstet Gynecol. 2009;36(1):31-4.
- 9. Turan T, Karadag B, Karabuk E, Tulunay G, Ozgul N, Gultekin M, et al. Accuracy of frozen sections for intraoperative diagnosis of complex atypical endometrial hyperplasia. Asian Pac J Cancer Prev. 2012;13(5):1953-6.
- 10. Indermaur MD, Shoup B, Tebes S, Lancaster JM. The accuracy of frozen pathology at time of hysterectomy in patients with complex atypical hyperplasia on preoperative biopsy. Am J Obstet Gynecol. 2007;196(5):e40-2.
- 11. Ureyen I, Karalok A, Tasci T, Turkmen O, Koc S, Ozgul A, et al. The importance of age and menopausal status in endometrial complex hyperplasia with atypia. J Obstet Gynaecol. 2016;36(1):102-5.
- 12. Gungorduk K, Ozdemir A, Ertas IE, Sahbaz A, Asicioglu O, Gokcu M, et al. A novel preoperative scoring system for predicting endometrial cancer in patients with complex atypical endometrial hyperplasia and accuracy of frozen section pathological examination in this context: a multicenter study. Gynecol Obstet Invest. 2015;79(1):50-6.
- 13. Moodley M, Bramdev A. Frozen section: Its role in gynaecological oncology. J Obstet Gynaecol. 2005;25(7):629-34.
- 14. Scurry JP, Sumithran E. An assessment of the value of frozen sections in gynecological surgery. Pathology. 1989;21(3):159-63.
- 15. Lok J, Tse KY, Lee EYP, Wong RWC, Cheng ISY, Chan ANH, et al. Intraoperative Frozen Section Biopsy of Uterine Smooth Muscle Tumors: A Clinicopathologic Analysis of 112 Cases With Emphasis on Potential Diagnostic Pitfalls. Am J Surg Pathol. 2021;45(9):1179-89.
- 16. Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. Lancet. 2005;366(9484):491-505.
- 17. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454(7203):436-44.
- 18. Ural ÜM, Şehitoğlu İ, Tekin YB, Şahin FK. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in patients with endometrial hyperplasia and endometrial cancer. J Obstet Gynaecol Res. 2015;41(3):445-8.
- 19. Leng J, Wu F, Zhang L. Prognostic Significance of Pretreatment Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, or Monocyte-to-Lymphocyte Ratio in Endometrial Neoplasms: A Systematic Review and Meta-analysis. Front Oncol. 2022;12:734948.
- 20. Vetter MH, Smith B, Benedict J, Hade EM, Bixel K, Copeland LJ, et al. Preoperative predictors of endometrial cancer at time of hysterectomy for endometrial intraepithelial neoplasia or complex atypical hyperplasia. Am J Obstet Gynecol. 2020;222(1):60.e1-60.e7.
- 21. Hahn HS, Chun YK, Kwon YI, Kim TJ, Lee KH, Shim JU, et al. Concurrent endometrial carcinoma following hysterectomy for atypical endometrial hyperplasia. Eur J Obstet Gynecol Reprod Biol. 2010;150(1):80-3.
- 22. Kurt S, Demirtaş O, Kopuz A, Beyan E, Demirtaş G, Besler A, et al. Evaluation of the histopathological diagnosis of patients preoperatively diagnosed with atypical endometrial hyperplasia after hysterectomy. Eur J Gynaecol Oncol. 2012;33(5):459-62.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Research |
| Authors | |
| Publication Date | November 30, 2023 |
| Acceptance Date | August 23, 2023 |
| Published in Issue | Year 2023 Volume: 13 Issue: 6 |
