Surgical staging and endometrial carcinoma: preoperative magnetic resonance or intra-operative pathological exam, how best to proceed?

• Autor(a) principal: Santos,Fernanda
• Data de Publicação: 2018
• Outros Autores: Pires,Rafaela, Henriques,Isabel, Águas,Fernanda
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100004
• topic: Endometrial neoplasms; Magnetic Resonance Imaging; Neoplasm staging; Frozen sections; ROC curve

Overview: Endometrial cancer is a common gynecological malignancy, diagnosed at stage I in 80% of cases. In the absence of contra-indication, staging is surgical. Pelvic lymphadenectomy is not recommended in low risk endometrial cancers. Magnetic resonance imaging (MRI) is useful to predict the depth of myometrial invasion in the preoperative assessment, but intra-operative pathological exam could also be used. Aim: To analyze the concordance between final histological exam and pre-operative MRI or intra-operative pathological exam. Study Design: Cross-Sectional Study Methods: It was performed a cross-sectional study of 145 women diagnosed with endometrial carcinoma, in a tertiary clinical center, from January 2010 to December 2015. It was analyzed 60 cases, the ones submitted to MRI and extemporaneous exam. Statistical analysis was performed by STATA 13.1. Results: Sixty cases of endometrial cancers have been rated using MRI and intraoperative histological exam. The observed concordance (MRI versus final invasion) was 81%, with kappa index of 0.54 (moderate concordance). MRI has demonstrated diagnostic sensitivity of 86%, specificity of 80% (AUC:0.84). Adjusting for prevalence, MRI negative predictive value (NPV) was 95% and positive predictive value (PPV) was 55%. When compared to MRI, the extemporaneous exam demonstrates higher sensitivity and specificity (Sensitivity:91%; specificity:93%, AUC:0.92; PPV: 77%, NPV: 98%). The Kappa index was 0.79 (substantial concordance). Comparing the two diagnostic tools, the extemporaneous exam was superior (p= 0.04). Conclusion: Extemporaneous exam has demonstrated diagnostic superiority