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It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large-scale, multi-center, and retrospective study

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作者：
Yang Xiaohang[1,2] * ; Yin Jingjing[1,2] ; Fu Yu[1,2] ; Shen Yuanming[3] ; Zhang Chuyao[4] ; Yao Shuzhong[5] ; Xu Congjian[6] ; Xia Min[7] ; Lou Ge[8] ; Liu Jihong[4] ; Lin Bei[9] ; Wang Jianliu[10] ; Zhao Weidong[11] ; Zhang Jieqing[12] ; Cheng Wenjun[13] ; Guo Hongyan[14] ; Guo Ruixia[15] ; Xue Fengxia[16] ; Wang Xipeng[17] ; Han Lili[18] ; Li Xiaomao[19] ; Zhang Ping[20] ; Zhao Jianguo[21] ; Li Wenting[1,2] ; Dou Yingyu[1,2] ; Wang Zizhuo[1,2] ; Liu Jingbo[1,2] ; Li Kezhen[1,2] ; Chen Gang[1,2] ; Sun Chaoyang[1,2] ; Wang Beibei[1,2,*2] ; Yang Xingsheng[22,*1] ;
单位： [1]Cancer Biology Research Center (Key Laboratory of the Ministry of Education),Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,China [2]Department of Gynecology and Obstetrics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,China [3]Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China [4]Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China [5]Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China [6]Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China [7]Department of Gynecology and Obstetrics, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China [8]Department of Gynecology Oncology, Harbin Medical University Cancer Hospital, Harbin, China [9]Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang, Liaoning, China [10]Peking University People's Hospital, Beijing, China [11]Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China [12]Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China [13]The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China [14]The Third Hospital of Peking University, Beijing, China [15]Department of Gynecology and Obstetrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China [16]Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China [17]Department of Gynecology and Obstetrics, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China [18]Department of Gynecology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China [19]Department of Gynecology and Obstetrics, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China [20]Department of Gynecology, The Second Hospital of Shandong University, Jinan, Shandong, China [21]Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Affiliated Hospital of Nankai University ,Tianjin Clinical Research Center For Gynecology and Obstetrics ,Branch of National Clinical Research Center For Gynecology and Obstetrics, Tianjin, China [22]Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
出处：
DOI： 10.1002/cam4.5643
ISSN：

关键词： endometrioid adenocarcinoma high-grade invasion retrospective studies

摘要：
Stage IB (deep myometrial invasion) high-grade endometrioid adenocarcinoma (EA), regardless of LVSI status, is classified into high-intermediate risk groups, requiring surgical lymph node staging. Intraoperative frozen section (IFS) is commonly used, but its adequacy and reliability vary between reports. Hence, we determined the utility of IFS in identification of high-risk factors, including deep myometrial invasion and high-grade.We retrospectively analyzed 9,985 cases operated with hysterectomy and diagnosed with FIGO stage I/II EA in postoperative paraffin section (PS) results at 30 Chinese hospitals from 2000 to 2019. We determined diagnostic performance of IFS and investigated whether the addition of IFS to preoperative biopsy and imaging could improve identification of high-risk factors.IFS and postoperative PS presented the highest concordance in assessing deep myometrial invasion (Kappa: 0.834), followed by intraoperative gross examination (IGE Kappa: 0.643), MRI (Kappa: 0.395), and CT (Kappa: 0.207). IFS and postoperative PS presented the highest concordance for high-grade EA (Kappa: 0.585) compared to diagnostic curettage (D&C 0.226) and hysteroscope (Hys 0.180). Sensitivity and specificity for detecting deep myometrial invasion were 86.21 and 97.20% for IFS versus 51.72 and 88.81% for MRI, 68.97 and 94.41% for IGE. These figures for detecting high-grade EA were 58.21 and 96.50% for IFS versus 16.42 and 98.83% for D&C, 13.43 and 98.64% for Hys. Parallel strategies, including MRI-IFS (Kappa: 0.626), D&C-IFS (Kappa: 0.595), and Hys-IFS (Kappa: 0.578) improved the diagnostic efficiencies of individual preoperative examinations. Based on the high sensitivity of IFS, parallel strategies improved the sensitivities of preoperative examinations to 89.66% (MRI), 64.18% (D&C), 62.69% (Hys), respectively, and these differences were statistically significant (p = 0.000).IFS presented reasonable agreement rates predicting postoperative PS results, including deep myometrial invasion and high-grade. IFS helps identify high-intermediate risk patients in preoperative biopsy and MRI and guides intraoperative lymphadenectomy decisions in EA.© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

基金：
The Nature and Science Foundation of China, Grant/Award Number: 82073259
语种：
外文
WOS：
PubmedID：
中科院(CAS)分区：
出版当年[2022]版：
大类 | 3 区 医学
小类 | 3 区 肿瘤学
最新[2025]版：
大类 | 3 区 医学
小类 | 3 区 肿瘤学
JCR分区：
出版当年[2021]版：
Q2 ONCOLOGY
最新[2023]版：
Q2 ONCOLOGY

影响因子： 最新[2023版] 最新五年平均 出版当年[2021版] 出版当年五年平均 出版前一年[2020版] 出版后一年[2022版]

第一作者：
第一作者单位： [1]Cancer Biology Research Center (Key Laboratory of the Ministry of Education),Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,China [2]Department of Gynecology and Obstetrics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,China
通讯作者：
通讯机构： [1]Cancer Biology Research Center (Key Laboratory of the Ministry of Education),Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,China [2]Department of Gynecology and Obstetrics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,China [22]Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China [*1]Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhua West Road, Jinan, Shandong 250012, China [*2]Department of Gynecology and Obstetrics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430000,China.
推荐引用方式(GB/T 7714)：
Yang Xiaohang,Yin Jingjing,Fu Yu,et al.It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large-scale, multi-center, and retrospective study[J].CANCER MEDICINE.2023,12(7):8897-8910.doi:10.1002/cam4.5643.
APA：
Yang Xiaohang,Yin Jingjing,Fu Yu,Shen Yuanming,Zhang Chuyao...&Yang Xingsheng.(2023).It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large-scale, multi-center, and retrospective study.CANCER MEDICINE,12,(7)
MLA：
Yang Xiaohang,et al."It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large-scale, multi-center, and retrospective study".CANCER MEDICINE 12..7(2023):8897-8910

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