Compatibility of Tumor Grades in Pre-Operative Biopsies, Frozen Sections, and Post-Operative Specimens in Patients with Endometrial Cancer

Abstract

OBJECTIVE The aim of this study was to evaluate the compatibility of tumor grades in pre-operative biopsies, frozen sections and post-operative specimens and to evaluate the adequacy of a selective surgical staging policy based on information obtained from intra-operative frozen sections to avoid lymphadenectomy in patients with endometrial cancer (EC). METHODS Ninety patients diagnosed with EC were analyzed. Fifty-four patients were at Stage 1 (60%), 19 were at Stage II (21%) and 17 (19%) were at Stage III. Fifty-four patients (60%) had grades on pre-operative biopsies, 31 patients (34%) had grades on frozen sections and 88 patients (98%) had grades on postoperative specimens. Depth of myometrial invasion was reported in 54 patients (60%) based on frozen sections and in all patients on post-operative specimens. Eight patients (9%) underwent no lymphadenectomy, 32 patients (36%) underwent pelvic lymphadenectomy and 50 patients (55%) underwent pelvic and para-aortic lymphadenectomy. RESULTS There were five patients for whom tumors were up-graded when pre-operative biopsies and frozen sections were. There were 17 patients for whom tumors were up-graded and four patients for whom tumors were down-graded when pre-operative biopsies and post-operative specimens were compared. There were six patients for whom tumors were up-graded when frozen sections and post-operative specimens were compared and the distribution of patients between intra-operatively and post-operatively assigned tumor grade groups was statistically significant. CONCLUSION For surgeons who do not perform complete surgical staging for every patient with EC, clinical judgment should only be efficient when augmented with information obtained from frozen sections.