| Objective : To investigate the diagnostic accuracy of intraoperative frozen pathology and its clinical value,by analyzing 170 patients of endometrial carcinoma with intrauterine membrane cancer clinical data.Methods:From 2006 January to December 2014,those patients of endometrial carcinoma admitted to the department of Gynecology and Obstetrics of our hospital were retrospectively analyzed.We collected complete clinical data,including age,menopause and fertility,with and without abnormal vaginal hemorrhage or vaginal discharge symptoms,with and without comorbidities(obesity,hypertension,diabetes),with and without family history of cancer,preoperative diagnostic curettage or fractional curettage or hysteroscopic localization biopsy results,mode of operation,intraoperative gross observation and pathology,postoperative pathological paraffin,postoperative pathological restaging and postoperative adjuvant therapy.The sensitivity,specificity and crude coincidence rate differences of intraoperative frozen biopsy in the diagnosis of tumor cell level,tumor histological type,depth of myometrial infiltration and cervical involvement of all endometrial carcinoma patients,and clinical influencing factors of rough coincidence rate of intraoperative frozen section pathological examination were analyzed.To analyze the clinical correlation factors of lymph node metastasis,and to evaluate the value of intraoperative frozen pathology in predicting lymph node metastasis.Results:1.Intraoperative frozen pathology of tumor cell level diagnostic efficiency: the sensitivity was 71.6%(106/148),the specificity was 100.0%(4/4),the total crude coincidence rate was 72.4%(110/152).We could exclude accidental factors that lead to sampling error,two types of pathological results had moderate consistency(kappa=0.565,u=9.91,P < 0.05).Among them,the diagnosis crude coincidence rate of poorly differentiated [91.3%(21/24)],was respectively higher than that of well or moderately differentiated [74.7%(62/83),56.1%(23/41)],and the differences were statistically significant(?~2=9.072,31.447;P=0.003,0.000).2.Intraoperative frozen pathology of tumor histological type diagnostic efficiency: the sensitivity was 82.5%(137/166),the specificity was 100%(4/4),the total crude coincidence rate was 82.9%(141/170),and the value of Kappa was no statistical significance(Kappa=0.345,u=0.98,P>0.05).The rough coincidence rate of type I [88.5%(131/148)] was obviously higher than that of type II [33.3%(6 / 18)],the difference was statistically significant(?~2=63.993,P=0.000).3.Intraoperative frozen pathology of depth of myometrial infiltration diagnostic efficiency: the sensitivity was 88.6%(147/166),the specificity was 100.0%(4/4),the total crude coincidence rate was 88.8%(151/170),we could exclude accidental factors that lead to sampling error,two types of pathological results had high consistency(kappa =0.757,u=1.98,P<0.05).Among them,the crude conformity rate of deep myometrial invasion(MI is greater than or equal to 1/2)[92.5%(37/40)] was higher than that of no invasion or limited endometrial invasion or superficial myometrial invasion(MI<1/2)[81.7%(103/126)],the difference was statistically significant(?~2=4.53,P=0.033).4.Intraoperative frozen pathology of cervical involvement diagnostic efficiency: the sensitivity was 20.0%(2/10),the specificity was 100%(160/160),the rough coincidence rate cervical involvement and without cervical involvement was 20.0%(2 /10),100.0%(160/160),the total crude coincidence rate was 95.3%(162/170),the value of Kappa was no statistical significance(Kappa=0.320,u=1.39,P > 0.05).The crude conformity rate of without cervical involvement [100.0%(160/160)] was significantly higher than that of cervical involvement [20.0%(2 / 10)],the difference was statistically significant(?~2=133.33,P = 0.000).5.Among 10 clinical factors of this study,the rough coincidence rate of obesity,type ? tumor histology and poorly differentiated(81.9 %,72.4 %,91.7 %)of endometrial carcinoma patients with intraoperative frozen pathological examination in the diagnosis of tumor cell level,were higher than that of no obesity,type ? tumor histology and well and moderately differentiated(63.8%,0,65.6%),and the differences were statistically significant(P<0.05).The rough coincidence rate of abnormal vaginal bleeding or discharge,obesity,hypertension and(or)diabetes mellitus and uterine cavity depth more than or equal 8 mm(91.4%,94.5%,93.4%,95.2%)of endometrial carcinoma patients with intraoperative frozen section pathological examination in the diagnosis of myometrial infiltration depth,were higher than those of without abnormal vaginal bleeding or discharge,no obesity,no hypertension and(or)diabetes mellitus and uterine cavity depth less than 8 mm(28.6 %,78.3 %,84.3 %,86.0 %),and the differences were statistically significant(P<0.05).6.Among 8 clinical factors of this study,cervical involvement,frozen pathological poorly differentiated,pathological paraffin poorly differentiated,frozen pathological deep myometrial invasion,pathological paraffin deep myometrial invasion,estrogen receptor(ER)positive were able to predict pelvic lymph node metastasis(P = 0.006,0.000,0.000,0.001,0.000,0.000 respectively).They were not able to predict paraaortic lymph node metastasis,with no significant differences.(P > 0.05).Type II endometrial carcinoma patients with pelvic lymph node positive rate [38.5%(5 / 13)] was higher than that of type I [14.8%(13 / 88)],the difference was statistically significant(?~2=14.261,P=0.000).7.Poorly differentiated(OR=6.621,95%CI:1.929-22.725)and deep myometrial invasion(OR=6.232,95%CI:1.848-21.014)in frozen pathology were independent risk factors for predicting lymph node metastasis(P<0.05).Conclusions: Intraoperative frozen pathological examination has a higher accuracy in the depth of myometrial infiltration,having important clinical significance in the pathological staging of endometrial carcinoma.Intraoperative frozen pathological examination has some limitations in the diagnosis of tumor cell level,tumor histological type and cervical involvement.Surgery intraoperative scope of endometrial carcinoma cannot be completely based on the results of frozen pathological examination. |
PDF Full Text Request