A Quick and Inexpensive Alternative to Frozen Section for Diagnosing Myometrial Invasion in Endometrial Cancer

Objective: Depth of myometrial invasion is an important determinant for performing lymphadenectomy to remove endometrial cancer. Frozen section of the uterus correlates with final pathology 87%-92% of the time but is associated with increased time and expense. The current study investigated the effectiveness of a technique we developed to use in the operating room immediately after the uterus is removed. The research was conducted to determine if the technique could be used to predict the depth of invasion accurately, compared to use of frozen section. Materials and Methods: Fifteen women with endometrial cancer, who were undergoing hysterectomy and bilateral salpingo-oophorectomy with possible lymphadenectomy, were recruited for this study. Each patient was injected intravenously with fluorescein dye prior to ligating the uterine arteries. The hysterectomy specimen was taken to the pathology department, bivalved, and the most suspicious areas were excised as a transverse section incorporating the endometrium and myometrium. Under ultraviolet light a measurement of the tumor (nonfluorescent) compared with the full thickness was taken. Identical specimens were subjected to frozen section of the same area, and these values were compared with the final pathology results. Pearson's correlation coefficient was used to compare results between the groups. Results: The correlation between depth of invasion predicted by fluorescein and final pathology was high, with an r value of 0.8765 (p<0.05) and was comparable to the frozen-section correlation with final pathology results (r=0.8707 [p<0.05]). When patients' specimens were categorized as either <50% or >50% invasion, chi(2) analysis revealed fluorescein to be significantly predictive of final pathology results (p=0.01). Conclusions: These results suggest that a rapid and inexpensive test in the operating room can help determine which patients require lymphadenectomy for invasive endometrial cancer.