Accuracy of Intraoperative Consultation in Endometrial Cancers: Emphasis on Low Grade Low Stage Tumors
B Muezzinoglu, A Corakci. Kocaeli University Medical School, Kocaeli, Turkey
Background: In gynecologic pathology, hysterectomy specimens are most commonly submitted for intraoperative consultation (IC) to confirm tumor type, grade and to determine depth of myometrial invasion and presence of cervical involvement. Cases with low grade and superficially invasive cancer may not require further surgical staging.
Design: To evaluate the diagnostic accuracy of IC of endometrial cancers, we retrospectively rewieved all radical hysterectomies that had IC at our instution from January 2005 to August 2008.
Results: Our study included one hundred twenty-eight radical hysteretomy cases with IC operated between January 2005 and August 2008. Fifty five of the cases (42.9%) had low grade (Grade 1 FIGO) and low stage (non invasive or superficially invasive-less than one third-) endometrioid type adenocarcinoma on IC.Thirty five of these early disease cases had surgical staging (63.6%). On final pathologic diagnosis, 13 cases (23.6%) were upgraded and upstaged; two of which didnot have surgical impact since IC was Ta and final diagnosis was superficially invasive tumor in both low grade cancers. There were no incidence of serous, clear cell carcinoma or carcinosarcoma in discrepant early disease cases. Nine of upstaged and upgraded tumors had surgical staging. In cases without surgical staging, 4 were either upgraded or upstaged. Seventy three cases had IC diagnosis of high grade and/or high stage tumors and all of them were surgically staged. In final diagnosis of these cases, 33 (45.2%) had either higher grade (including different tumor types like serous carcinoma) or increased stage.
Conclusions: Our findings indicate, at least a quarter of cases had discrepancy between IC and final diagnosis. However, significantly better correlation was detected between IC of early disease and final diagnosis than the IC of higher stage tumors (p= 0.006) Keeping in mind the limited correlation, IC is still useful in deciding the surgical treatment of endometrial cancers.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 157, Wednesday Afternoon