Maria Caparros

Intraoperative Gross Examination and Intraoperative Frozen Section in Patients With Endometrial Cancer for Detecting Deep Myometrial Invasion: A Systematic Review and Meta-analysis.

Objective The aim of this study was to perform a meta-analysis comparing diagnostic performance of intraoperative gross evaluation (IGE) and intraoperative frozen section (IFS) for the assessment of myometrial invasion in patients with endometrial cancer. Methods An extensive search was performed in several databases from January 1989 to May 2015. Eligibility criteria were studies using intraoperative gross evaluation or intraoperative frozen section to determine deep myometrial invasion in patients with endometrial cancer using the final histopathology report with reference standard. Quality was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results Forty-seven articles were identified. Of these, 35 studies were selected and included in the meta-analysis. A total of 6387 women were evaluated intraoperatively with any of the 2 methods mentioned. Pooled sensitivity and specificity for IGE were 71% (95% confidence interval [CI], 63%–77%) and 91% (95% CI, 89%–93%), respectively. Heterogeneity was found high for sensitivity (I2: 83.6%; Cochran Q: 79.4; P < 0.001) and moderate for specificity (I 2, 51.4%; Cochran Q, 29.8; P =0.01). Pooled sensitivity and specificity for IFS were 85% (95% CI, 81%–88%) and 97% (95% CI, 96%–98%), respectively. Heterogeneity was found moderate for sensitivity (I 2, 56.4%; Cochran Q, 45.9; P < 0.001) and high for specificity (I 2, 83.2%; Cochran Q, 118.9; P < 0.001). Both sensitivity (P = 0.0008) and specificity (P = 0.0021) were significantly higher for IFS compared to IGE. Conclusion Intraoperative frozen section has better diagnostic performance than intraoperative gross evaluation for the intraoperative diagnosis of deep myometrial invasion in patients with endometrial cancer.

Transvaginal/transrectal ultrasound for preoperative identification of high‐risk cases in well or moderately differentiated endometrioid carcinoma of the endometrium

To evaluate the role of transvaginal/transrectal ultrasound for preoperative identification of high‐risk cases among women with well‐differentiated (G1) or moderately differentiated (G2) endometrioid carcinoma of the endometrium.

Transvaginal/transrectal ultrasound for preoperative identification of high-risk cases in well- or moderately differentiated endometrioid carcinoma.

To evaluate the role of transvaginal/transrectal ultrasound for preoperative identification of high‐risk cases among women with well‐differentiated (G1) or moderately differentiated (G2) endometrioid carcinoma of the endometrium.

Agreement between preoperative transvaginal ultrasound and intraoperative macroscopic examination for assessing myometrial infiltration in low‐risk endometrioid carcinoma

To compare diagnostic performance of preoperative transvaginal ultrasound (TVS) and intraoperative macroscopic examination for determining myometrial infiltration in women with low‐risk endometrial cancer, and to estimate the agreement between the two methods.

Agreement between preoperative transvaginal ultrasound and intraoperative macroscopic examination for assessing myometrial infiltration in low risk endometrioid carcinoma of the endometrium

To compare diagnostic performance of preoperative transvaginal ultrasound (TVS) and intraoperative macroscopic examination for determining myometrial infiltration in women with low‐risk endometrial cancer, and to estimate the agreement between the two methods.

OC14.03: Preoperative assessment of the extent of disease in ovarian cancer: comparative study of ultrasound and CT scan

women were postmenopausal, and 1296 (84.2%) reported abnormal vaginal bleeding. Gray-scale and colour Doppler features changed with increasing grade and stage. High-risk tumours (stage 1A, grade 3 or non-endometrioid or > stage 1B) were less likely to have regular endometrial myometrial border (difference of -23%, 95% CI -27 to -18%), whilst they were larger (mean endometrial thickness; difference of +9mm, 95% CI +8 to +11mm), more frequently had non-uniform echogenicity (difference of -10%, 95% CI -15 to -5%), the multiple, multifocal vessel pattern (difference of +21%, 95% CI +16 to +26%), and a moderate or high colour score (difference of +22%, 95% CI +18 to +27%), than low-risk tumours. Conclusions: Gray-scale and colour Doppler ultrasound features of endometrial tumours vary by grade and stage. This knowledge may improve preoperative ultrasound discrimination between low and high-risk cancer.