Frozen Section Results Do Not Influence the Decision To Perform Lymphadenectomy in Low Grade Endometrial Endometrioid Adenocarcinoma
Bojana Djordjevic, Elizabeth D Euscher, Andres A Roma, Elizabeth J Moschiano, Rouba Ali-Fehmi, Elizabeth E Frauenhoffer, Delia P Montiel, Insun Kim, Sung R Hong, Denise A Barbuto, Anais Malpica, Elvio G Silva. Multi-Institutional Study, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
Background: The role of lymphadenectomy in the surgical treatment of low grade endometrial endometrioid adenocarcinoma (EEC) is not well defined. In a related study, we have shown that intraoperative frozen section (FS) does not reliably predict the likelihood of lymph node metastases in these tumors. The objective of this study was to assess whether FS results influenced the decision to perform lymphadenectomy.
Design: In a collaborative international study, 9 cancer centers collected 528 cases of FIGO grade 1 and 2 EEC with no evidence of extrauterine disease at the time of surgery. Among these, 17 cases which recurred in follow-up and which were assessed by intraoperative FS were identified. Lymphadenectomy was not performed in 6 cases, while in the other 11 cases, lymphadenectomy was carried out and subsequently yielded negative lymph nodes. Tumor grade, depth of myometrial invasion (MI) and presence of lymphovascular invasion (LVI) reported at FS were recorded for the two groups.
Results: FS was performed in 32%-84% of cases (median 50%) at 6 participating institutions (5 from the United States and 1 from Korea), and in no cases at 3 participating institutions (from Canada, Korea and Mexico).
Among the 17 tumors that recurred, cases that underwent lymphadenectomy versus those that did not, showed no significant difference in the rate of grade 2 tumors, outer MI or presence of LVI on FS, suggesting that FS results did not influence the decision to perform lymphadenectomy. Interestingly, although grade 2 EEC was more common in both groups, both groups also showed a tendency towards inner MI and absence of LVI, features that would normally persuade against lymphadenectomy.
|Grade: 1-2||MI: Inner Half-Outer Half||LVI: Absent-Present-Not Reported|
|LNs Not Resected, n=6||17%-83%||100%-0%||67%-0%-33%|
|LNs Resected, n=11||0%-100%||91%-9%||36%-18%-46%|