Evaluation of preoperative, intraoperative and postoperative myometrial invasion in endometrial cancers: comparıson of MRI, frozen and final pathology results

Abstract

Aim: Endometrial cancer is a gynecological malignancy that accounts for approximately 7% of new cancer cases and 4% of cancer-related deaths in women. The most important factor determining the prognosis of this ailment isthe depth of myometrial invasion, which has been reported to be associated with the tumor grade, lymph node metastasis, and patient survival. The aim of this study was to investigate the effectiveness of magnetic resonance imaging (MRI) and frozen results in determining the depth of myometrial invasion needed to guide the intraoperative decision-making process in endometrial cancer patients by comparing them with paraffin results, to evaluate the accuracy rate and to establish a reliable estimation model by using other data in the study.Methods: In this study, the files of patients who underwent surgery for endometrial cancer between January 01, 2012 and January 31, 2019 in Kocaeli Derince Training and Research Hospital, Department of Obstetrics and Gynecology, were evaluated retrospectively.Results: The results of the paraffin examination were found to be in good agreement with the frozen results, while the MRI showed a moderate agreement (Kappa coefficient 0.741 and 0.414, respectively). A logistic regression model based on the MRI and frozen results included MRI (less or more 50% invasion), frozen (less or more 50% invasion), age, gravida, parity, and CA 125 (U/ml). The Nagelkerke R square value for this model was 84,0%, and the sensitivity and specificity of the model for predicting paraffin examination results were 90,5% and 97.3%, respectively.Conclusion: Compared to MRI, frozen results are more reliable in determining myometrial invasion when the paraffin result is accepted as the gold standard. Myometrial invasion can be estimated with high sensitivity and specificity using a model including MRI, frozen, CA 125, age, parity.