| Objective:This study aims to retrospectively analyze the results of intraoperative fast frozen section pathology(FS)of 64 patients with typeⅠ endometrial carcinoma(EC),and evaluate the identification of intraoperative FS in combination with the clinical data of the patients.The coincidence rate of tumor cell grades,the depth of tumor invading the myometrium,and tumor invading the stromal conective tissue of the cervix in patients with type IEC and its clinical value.And preliminarily discuss the factors affecting the coincidence rate of intraoperative FS examination.Provide reference value for surgical treatment of type IEC patients.Methods:Among 103 cases of endometrial carcinoma patients who pay a visited the Obstetrics and Gynecology Department of the Affiliated Hospital of Southwest Medical University from November 2018 to November 2019,64 patients who were confirmed to be type Ⅰendometrial carcinoma after the operation were selected as the research objects.To compare the intraoperative FS results with the postoperative Paraffin section(PS)results(gold standard),Thus,the intraoperative FS concordancy rate in determining the grade of tumor cells,the depth of uterine myometrium of tumor lesions,and whether the lesions invaded the cervical interstitium in type IEC patients was obtained.The Fisher exact probability method or Chi-square test was used for single factor analysis in that have been classified and counted the factors related to the incidence of type IEC patients to determine the influence of a single risk factor on the intraoperative FS determination of tumor cell grade,the depth of uterine musculus of cancer focal infiltration,and the coincidence rate of whether the focal invasion of cervical intercervix.Results:1.According to the intraoperative FS,the overall coincidence rate of tumor cell grade is 71.88%(46/64),κ=0.56,of which the G1 coincidence rate is 60.87%(14/23),and the G2 and G3 coincidence rates are 50%(7/14)respectively,92.59%(25/27).2.The intraoperative FS showed an overall diagnostic coincidence rate of92.18%(59/64),κ=0.72,In the depth of uterine musculus of cancer focal infiltration,among which the coincidence rate of FS was 96.23%(51/53)when the depth of the infiltrated myometrium was <1/2,and 72.73%(8/11)when the depth of the infiltrated myometrium was ≥1/2.3.The intraoperative FS showed an overall diagnostic coincidence rate of89.06%(57/64),κ=0.65,in the tumor invading the stromal conective tissue of the cervix,without invading the stromal conective tissue of the cervix was 94.12%(48/51),and invading the stromal conective tissue of the cervix was 69.23%(9/13).4.The coincidence rate of intraoperative FS judgment of tumor cell grade in postmenopausal patients with type IEC is as high as 92.50%(37/40),while the coincidence rates of non-menopausal and transitional menopause are 35.71%(5/14)and 40%(4/10);the coincidence rates with or without irregular vaginal bleeding or fluid were 80.00%(40/50)and 42.86%(6/14),respectively;the coincidences with or without birth history The rates were 80.00%(4/5)and 71.19%(42/59);the coincidence rates of BMI≥25kg/m2 and BMI<25kg/m2 were 88.23%(30/34)and 53.33%(16/30)respectively;The coincidence rates of combined hypertension and(or diabetes)were71.43%(20/28)and 72.22%(26/36)respectively.5.Intraoperative FS in patients with type IEC in postmenopausal,non-menopausal and transitional menopausal patients judged the depth of cancer infiltration into the myometrium.The coincidence rates were 95.00%(38/40),92.86%(13/14),80.00,respectively %(8/10);with or without irregular vaginal bleeding or fluid,the code rate was 100%(50/50),64.29%(9/14)respectively;the coincidence rate for no birth history and birth history100% and 91.53%(54/59);the coincidence rates of BMI≥25kg/m2 and BMI<25kg/m2 are 97.06%(33/34)and 86.67%(26/30);combined with hypertension and(or diabetes)The coincidence rate of 85.71%(24/28)and 97.22%(35/36).6.Intraoperative FS in patients with type IEC in postmenopausal,non-menopausal and transitional menopausal patients judged cervical mesenchymal involvement with 95%(38/40),78.57%(11/14),and 80.00% respectively;With or without irregular vaginal bleeding or fluid,the coincidence rate was 96.00%(48/50)and 64.29%(9/14);the coincidence rate of no birth history and birth history was 80.00%(4/5)and 89.83%(53/59);the coincidence rate of BMI≥25kg/m2 and BMI<25kg/m2 is 88.24%(30/34)and 90.00%(27/30);the coincidence rate of combined hypertension and(or diabetes)They were 82.14%(23/28)and 94.44%(34/36).Conclusion:1.The intraoperative FS to determine the type Ⅰendometrial carcinoma have moderate consistency,and G3 diagnostic coincidence rate was higher than G1 and G2.2.Intraoperative FS to determine the depth of myometrial invasion has a high coincidence rate and high degree of consistency,especially in the tumor limited to the endometrium or invading less than half the myometrium.3.Judging the overall diagnostic coincidence rate of invading the stromal conective tissue of the cervix was ideal.In wich the FS have high degree of consistency.4.The intraoperative FS has guiding significance for the operation of type Ⅰ endometrial carcinoma.But the intraoperative FS needs to be enhanced in the judgment of tumor cell grade.5.For patients with type IEC,menopausal status,BMI,with or without irregular vaginal bleeding or discharge symptoms can be factors influencing the coincidence rate of intraoperative FS to judge tumor cell grade.However,fertility history,high blood pressure and(or diabetes)may not affect the judgment of tumor cell grade by intraoperative FS.6.With or without regular vaginal bleeding or fluid,It may be one of the influencing factors for intraoperative FS to determine the depth of myometrial invasion and cervical interstitial involvement in patients with type IEC.However,menopausal status,birth history,BMI,Whether it is combined with hypertension or(and)diabetes has not significantly affected the judgment of intraoperative FS for the depth of the uterine musculus of cancer focal infiltration,and the coincidence rate of whether the focal invasion of cervical intercervix. |
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