Discussion The Coherence About Cervical Involvement Between Preoperative,Intraoperative Diagnostic Method And Paraffin Pathology For Early Stage Endometrial Cancer

Objective: The aim is to study the coherence about cervical involvement(CI)for early stage endometrial carcinoma between fractional curettage,hysteroscopic biopsy and imaging techniques: transvaginal sonography(TVS),computed tomography(CT),magnetic resonance imaging(MRI),frozen section and the paraffin pathology,then to discuss the clinical value.Materials and methods: Reviewing the early stage endometrial carcinoma patients' clinical information and the results of fractional curettage,hysteroscopic biopsy and imaging techniques: TVS,CT,MRI,frozen section and the paraffin pathology who received operation treatment between January 2010 and Decemember 2015 in the Maternity Affiliated Hospital of Dalian Medical University.The sensitivity,specificity,positive predictive values(PPV)and negative predictive values(NPV)as well as the accuracy of each preoperative,intraoperative diagnostic method for cervical involvement were calculated.Paraffin pathology was the standard of reference to calculated the coherence by Kappa test.Results:1.There are 487 cases of early stage endometrial carcinoma incorporated into this study,including 205 cases who received fractional curettage,163 cases received hysteroscopic biopsy.There was no significant difference noted in age,height,weight,body mass index(BMI),stage between the two groups.The kappa value are 0.328 and 0.654 for each group.The coherence of hysteroscopy group is better.However the PPV are 28.89% and 64.70% for each group only.2.All the patients underwent TVS,and 37 for CT,45 for MRI.The accuracy are 86.04%,83.78%,80.69%,kappa value are 0.610,0.524,0.339 compare to Paraffin pathology.MRI shows higher coherence than TVS and CT.3.Intraoperative frozen section was performed for 263 patients.The sensitivity,specificity,PPV,NPV,accuracy and the kappa value are 94.73%,100%,100%,99.12%,99.24%and 0.969 respectively.Frozen section shows great coherence with paraffin pathology.Conclusion:1.There are higher coherence about cervical involvement for early stage endometrial carcinoma with paraffin pathology in hysteroscopic biopsy than fractional curettage.Therefore hysteroscopic biopsy has higher clinical application value.2.MRI is the most reliable imaging technique in predicting cervical involvement for early stage endometrial carcinoma than TVS and CT,and could provide more precise and accurate staging plan in the preoperative risk plan.3.Frozen section shows great coherence with paraffin pathology in prediction CI in early stage endometrial carcinoma,which means this intraoperative assessment method can provide efficient information for options of surgery extent.