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Feasibility of laparoscopic management of presumed stage I endometrial carcinoma and assessment of accuracy of myoinvasion estimates by frozen section: a gynecologic oncology group study
  1. H. D. Homesley*,
  2. G. Boike, and
  3. G. W. Spiegel§
  1. * Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Brookview Research, Nashville, TN
  2. Department of Gynecologic Oncology, Hurley Medical Cancer Center, Flint, MI
  3. § Department of Pathology, Roswell Park Cancer Institute; and State University of New York at Buffalo, Buffalo, NY
  4. Affiliate of Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL.
  1. Address correspondence and reprint requests to: H. D. Homesley, MD, Brookview Research, 2021 Church Street, Suite 402, Nashville, TN 37203. Email: hdh7173{at}aol.com. Reprint address to: Ms D. Mackey, GOG Administrative Office, Four Penn Center, Suite 1020, 1600 John F. Kennedy Boulevard, Philadelphia, PA 19103.

Abstract

Introduction To assess laparoscopic management of presumed stage I endometrial cancer, and to compare gross, frozen, and paraffin section methods measuring myoinvasion.

Patients and methods Eligible patients underwent laparoscopic exploration. Patients with preoperative grade 1 histology underwent laparoscopic-assisted vaginal hysterectomy and bilateral salpingo-oophorectomy (LAVHBSO). Pelvic and periaortic lymph node sampling (PPANS) was performed for deep (≥50%) myoinvasion confirmed by frozen section. Patients with preoperative grade 2 or 3 histology without evidence of extrauterine metastasis underwent PPANS + LAVHBSO.

Results Of 50 eligible patients selected, LAVHBSO was successfully completed in all but five. There was one trocar bowel perforation. Myoinvasion depth was correlated between paraffin section and gross estimate, and between paraffin and frozen section estimate, in 89 and 90% of cases, respectively. Myoinvasion was underestimated by gross versus paraffin in three of five discrepancies, and by frozen versus paraffin section in one of three discrepancies.

Conclusions Laparoscopic surgical staging for early stage endometrial cancer is feasible. Gross/frozen section methods correlate with paraffin section to measure myoinvasion. Tumor grading and gross/frozen section myoinvasion estimates can guide operative management.

  • laparoscopic
  • myoinvasion
  • periaortic lymph node sampling

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