Guiding Value Of Intraoperative Frozen Section In Low-risk Stage ⅠA Endometrial Carcinoma

Objective:The clinical data of 77 patients with low-risk stage IA endometrial carcinoma diagnosed by intraoperative frozen section were analyzed retrospectively.The factors affecting the postoperative prognosis were analyzed,and the accuracy of frozen section was evaluated.The purpose is to provide reference for clinical surgical treatment of this kind of patients,and provide guidance for the clinical application of frozen sections in this kind of patientsMethods:From January 2013 to December 2016,80 patients with low-risk stage IA endometrial carcinoma diagnosed by intraoperative frozen section in the first affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)were selected extrafascial hysterectomy and bilateral salpingo-oophorectomy,in which only 77 cases were followed up routinely.The clinical and pathological data of the patients were collected,followed up by telephone and the survival or recurrence was recorded.The deadline for follow-up was December 2019.The coincidence rate of staging diagnosis was evaluated by naked eye description in surgical records and the results of frozen section intraoperatively.The depth of myometrial invasion was judged by naked eye,and the histological grade,depth of myometrial invasion and pathological type were diagnosed by intraoperative frozen section.The accuracy of frozen section was judged by the results of routine pathological diagnosis postoperatively.The screening was included in all the clinical data of the patients for statistical description,and the factors affecting the prognosis and the accuracy of frozen section diagnosis were analyzed.SPSS 16.0 system software was used for data processing,and count data is checked by chi-square.Cox regression model was used to analyze the prognosis of univariate and multivariate factors and to draw survival curves.Kappa test and McNemar test were used to analyze the consistency and difference.The difference was statistically significant when the test level was a=0.05 and p<0.05Results:The average age of 77 patients was 48.8 years old,and the median age was 49 years old(30-71 years old).The follow-up period was 36 months.During the follow-up period,the 3-year recurrence-free survival rate of 77 patients with endometrial cancer was 90.9%,and the 3-year survival rate was 98.7%.Univariate analysis was conducted to analyze the six risk factors that might be related to the prognosis of endometrial carcinoma.Age(p=0.043),CA125(p=0.005),pathological type(p=0.001),myometrial invasion depth(p=0.001),histological grade(p=0.001),surgical-pathological stage(p<0.001)and second operation in underestimated group(p<0.028)were the related factors affecting the prognosis of this kind of endometrial carcinoma.By COX multivariate regression model,it was found that surgical-pathological stage,pathological type of tumor,grade of tissue differentiation and depth of myometrial invasion all had significant effects on the prognosisThe coincidence rate between frozen section and routine pathology was 77.9%(n=60),17 cases(22.1%)in underestimation group and 60 cases(77.9%)in accuracy group.Surgical-pathological stage(p<0.001),pathological type(p<0.001),depth of myometrial invasion(p<0.001)and histological grade(p<0.001)were the factors affecting the accuracy of intraoperative frozen pathology,while age(p=0.291)and CA125(p<0.058)had no significant effect on the accuracy of intraoperative frozen pathology.Although there was significant difference in secondary operation(p<0.001)and recurrence and metastasis(p<0.001)between the two groups of patients with underestimated and accurate diagnosis of frozen pathology,there was no significant difference in 3-year survival rate(p<0.211).Conclusions:1.The prognosis of patients with low-risk IA stage endometrial carcinoma is better,and the diagnostic accuracy of intraoperative frozen pathology is higher.Intraoperative frozen pathological examination can effectively obtain the preliminary diagnosis of low-risk IA stage endometrial carcinoma.2.In terms of the depth of myometrial invasion,the diagnostic accuracy of intraoperative frozen pathology is better than that of the naked eye,and it is not recommended to judge the depth of myometrial invasion only by the naked eye3.In terms of histological grading,the diagnostic coincidence rate of intraoperative frozen pathology in the well differentiated group was higher than that in the moderately differentiated group,and the patients diagnosed as moderately differentiated by intraoperative frozen pathology should be vigilant and evaluated comprehensively in combination with other examinations4.Age,CA125,depth of myometrial invasion,histological grade,pathological type and surgical-pathological stage were all risk factors for recurrence of endometrial carcinoma5.The accuracy of frozen pathological diagnosis in patients with endometrial carcinoma is limited in histological grading and pathological types,especially serous carcinoma,which should be carefully diagnosed in combination with other high risk factors.