Frozen Section as an Intraoperative Guide to Tailor Surgical Staging in Early-Stage Endometrial Cancer

• Published in: Indian journal of gynecologic oncology Vol. 20; no. 1
• Main Authors: Atallah, Khalid, Refky, Basel, Hamdy, Omar, Saleh, Gehad Ahmed, Zaki, M. M. A., Shahatto, Fayez, Elnahas, Waleed
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01-03-2022
• Subjects: Medicine; Medicine & Public Health; Oncology; Original Article; Surgical Oncology; Lymphadenectomy; Endometrial cancer; Frozen section; Surgical staging
• ISSN: 2363-8397; 2363-8400
• DOI: 10.1007/s40944-021-00601-0

Purpose
Endometrial cancer is a common gynecologic malignancy that usually presents at an early stage, and the need for lymphadenectomy in those patients is still debatable. In addition, it occurs in old comorbid patients. So performing unnecessary lymphadenectomy in patients with low risk of lymphatic metastases should be omitted to avoid related short- and long-term postoperative complications.
Methods
We used intraoperative frozen section for 62 patients with low- and intermediate-risk stage I endometrial cancer to evaluate the tumor histologic type, grade, depth of myometrial invasion, extension to the cervix, and ESMO risk group. According to the results of frozen section, lymphadenectomy and surgical staging were tailored.
Results
Intraoperative frozen section guided us to perform lymphadenectomy for 13 patients and omitting the procedure in 49 patients. Out of 62 patients, 55 were treated adequately, 5 patients were undertreated and needed surgical restaging procedure, and 2 patients were over-treated by unnecessary lymphadenectomy. The adequacy of frozen section in guiding lymphadenectomy was 88.7%.
Conclusion
Intraoperative frozen section is a useful strategy to guide and tailor surgical staging in early endometrial cancer.