The Value Of Intraoperative Frozen Section In Endometrial Carcinoma Surgery

[Objective] Endometrial carcinoma is one kind of most common gynecologic malignant tumors, it is always controversial to use the intraoperative frozen section(IFS) for directing the surgical staging in endometrial carcinoma. The aim of this retrospective study is to evaluate the accuracy of the IFS in directing the surgery management and its value in Clinical diagnosis. The study is based on the10-year statistics of the findings on endometrial cancer patients who were surgically treated in a short term after diagnosed by preoperative pathological diagnosis, including all of the patients’general information, the IFS results in surgery, the methods of surgery, and the comparison of the IFS pathology findings both preoperative and intraoperative, and the findings in postoperative paraffin pathological examination.[Method] Under the help of the management system of the hospital medical record, the retrospective analysis was carried out on women who were diagnosed as endometrial cancer by Preoperative histopathological and surgically treated in Qilu Hospital of Shandong University from Jan.2003to Dec.2012. The study covered all the range of ages, menstruation, reproductive history, complications, family history of cancer, TCT, ultrasonic, MRI, CT, PET-CT, histopathological diagnosis in preoperative, intraoperative frozen section, surgical approach, postoperative pathology, postoperative surgical pathological stage, grade, etc. The data was drawn out through the comparison and analysis of the complexity and differences of the diagnosis, which was related to the tumor cellular grades and myometrial invasion which were done respectively by IFS and postoperative paraffin pathological. All statistical data was input into Excel table and double-checked by double transmission method. For further analyzing and processing the data, the method of Kappa test and software SPSS13.0were introduced.[Results] Setting the postoperative paraffin pathological examination results as the basis,①Regarding the cell level between IFS and postoperative paraffin pathological, the overall compliance rate is50.8%(61/120)(Kappa=0.796, P=0.005). Of which, the endometrial cancer coincidence rate is86%(46/53) for G1,58%(7/12) for G2and88%(8/9) for G3.②Regarding myometrial invasion between IFS and postoperative paraffin pathological lesions organizations, the overall compliance rate is62.5%(75/120)(Kappa-0.832, P=0.000). And of which,61.5%(8/13) for MI=0(intimal layer),94%(55/58) for MI<1/2(superficial myometrial) and85.8%(12/14) MI≥1/2(deep myometrial).[Conclusion]①There is poor correlation in histological grade and myometrial infiltration between the intraoperative frozen section(IFS) and postoperative paraffin pathology. Findings by IFS can not accurately predict the tumor histological grade and myometrial infiltration.②It is not necessary to execute an routine IFS examination during the surgery of endometrial carcinoma, and the extent of surgery can not be directed only by the finding of intraoperative frozen pathological examination.