Validation of intraoperative risk assessment on frozen section for surgical management of endometrial carcinoma

ObjectiveThis study aimed to evaluate the accuracy of risk assessment in intraoperative frozen section (IFS) in order to direct surgical management and also attempted to validate the clinical significance of using five variables for classification as low- or intermediate high-risk endometrial carcinoma in routine practice.Patients and methodsCharts of 410 patients who underwent surgery for endometrial cancer between January 1992 and December 2003 were retrospectively reviewed, and risk assignment on the basis of IFS was compared with final pathological reports. Clinical relevance of risk assessment and its surgical consequences were studied on the basis of patient survival data.ResultsIn 303 (95%) of 318 cases, IFS-assessed risk corresponded with that estimated from final paraffin sections, giving a positive predictive value of 99% and a negative predictive value of 92%. Unrecognized lymphovascular invasion in IFS was the main factor responsible for the discrepancies between the two examinations. Survival analysis showed a highly significantly better outcome for patients with low-risk as compared to intermediate high-risk carcinomas for recurrence-free (RFS) and overall survival (OS). However, survival in patients with intermediate high-risk carcinomas who underwent lymphadenectomy (LNE) was not significantly improved as compared to those who did not. Moreover, in multivariate analysis lymph node involvement did not emerge as a variable with significant impact on survival. Age, tumor stage and intraoperatively assessed risk were seen to be independent prognosticators in this study (p < 0.0001).ConclusionOur data show that IFS, when performed by experienced gynecopathologists, is a reliable and applicable tool in estimating risk in endometrial cancer and that systematic LNE seems to not be superior to radiotherapy with regard to patient survival.