Intraoperative assessment of depth of myometrial invasion in endometrial carcinoma

Objective: To evaluate the adequacy of intraoperative assessment of depth o f myometrial invasion in patients with endometrial adenocarcinoma. Methods: Of the 58 evaluable cases, depth of myometrial invasion was estima ted by gross examination of fresh tissue by an experienced surgeon and a pa thologist and on the frozen section by the same pathologist. This was compa red with the depth of invasion on the final microscopic examination perform ed by another pathologist. Results: The depth of invasion was accurately predicted by the surgeon in 8 9.7% of the patients, while the pathologist's accurate prediction rates on fresh tissue and frozen section were 86.2% and 91.4%, respectively. The acc urate prediction rate gradually diminished for both the surgeon and the pat hologist as the histologic grade increased. Frozen section examination was reliable in grade I cancer (100%), while gross examination of the surgeon a nd the pathologist had a significant error rate in predicting accurate dept h of invasion (7.6%-33%). Conclusion: If frozen section shows that myometrial invasion in patients wi th grade 1 endometrial carcinoma is less than 1/3, lymphadenectomy may be o mitted. In all other cases radical surgery and surgical staging is mandator y to avoid undertreatment.