Diagnostic performance of intraoperative assessment in grade 2 endometrioid endometrial carcinoma
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(2020) 18:284
RESEARCH
Open Access
Diagnostic performance of intraoperative assessment in grade 2 endometrioid endometrial carcinoma Antonio Bandala-Jacques1,2, David Cantú-de-León3, Delia Pérez-Montiel4, Rosa A. Salcedo-Hernández5, Diddier Prada1,6,7, Aarón González-Enciso8, Arely Gonzalez-Valdés5 and Salim Abraham Barquet-Muñoz5*
Abstract: Background: Endometrial carcinoma is the most common gynecologic malignancy in developed countries. Grade 2 carcinoma is associated with pelvic lymph-node metastasis, depending on selected risk factors. Intraoperative assessment (IOA) can identify patients at risk for lymph node metastasis who should undergo staging surgery. Our objective was to establish the diagnostic precision of IOA in determining the need for surgical staging in grade 2 endometrioid endometrial carcinoma. Methods: Two hundred twenty-two patients underwent IOA. Results were compared to the final pathology report. The accuracy of the IOA parameters was calculated. Variables were evaluated in patients with positive versus negative IOA. Overall and disease-free survivals were calculated according to IOA, lymphadenectomy, and nodal metastasis. Results: IOA was positive in 80 patients. It showed an accuracy of 76.13% when compared with the postoperative assessment. The best individual parameter was myometrial invasion. Nodal metastasis was observed in 16 patients in the positive IOA group and 7 patients in the negative group. Patients with lymph node metastasis had a 5-year overall survival rate of 80.9%, whereas patients without metastasis had a 5-year overall survival rate of 97.9%. Conclusions: IOA is an adequate tool to identify high-risk patients in grade 2 endometrial carcinoma. Myometrial invasion is the individual parameter that yields the highest diagnostic precision. Keywords: Endometrial cancer, Endometrioid adenocarcinoma, Surgical diagnostic technique, Frozen sections, Lymphadenectomy, Myometrial invasion
Background Endometrial carcinoma is the most common gynecologic malignancy in high- and middle-income countries [1]. It is the fourth most common cancer in women and has had a rising incidence trend in the last decade [2]. The most common histology is endometrioid, and its treatment consists of hysterectomy with bilateral salpingooophorectomy [3]. Patients may undergo pelvic and paraaortic lymphadenectomy depending on their risk for * Correspondence: [email protected] 5 Department of Gynecology, Instituto Nacional de Cancerología, Mexico City, Mexico Full list of author information is available at the end of the article
lymph node metastasis. Lymph node metastasis is one of the most important prognostic factors for endometrial cancer, as it renders a tumor with a high risk for recurrence that calls for adjuvant therapy [4]. Lymph node metastasis cannot be determined without node dissection, especially if metastasis is microscopic, but it strongly associates with a high tumor grade and deep myometrial invasion, which can be determined intraoperatively, through intraoperative gross examination
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