Accuracy of Intraoperative Gross Visual Assessment of Myometrial Invasion and Tumour Size to Guide Pelvic Lymphadenectomy in Early Stage Endometrial Cancer: A Retrospective Single Center Study in Sarawak, Malaysia

Abstract

Aims: To identify the accuracy of intra-operative gross visual assessment of myometrial invasion and tumour size in endometrial cancer as a tool for predictor of extent of surgical staging. Study Design: A retrospective analysis of women diagnosed with endometrial cancer in Sarawak General Hospital. Place and Duration of Study: Gynaecology-oncology Unit, Obstetric and Gynaecology Department, Sarawak General Hospital, Malaysia between January 2021 and December 2023. Methodology: A total of 94 medical records of women diagnosed with endometrial cancer between January 2021 and December 2023 were reviewed. 39 out 94 women diagnosed with endometrial cancer had their uterus examined intraoperatively by the gynaecologic oncologist. Statistical analyses, including Kappa-Cohen statistic was used to compare whether there is an agreement between intra-operative findings by the gynaeoncologist and final histopathology report. Results: Patients diagnosed with endometrial cancer were mainly between 26 to 72 years old, with mean age of 52 years. The mean body mass index (BMI) was 30.4. Majority of the patients were of Malay ethnicity, 37.2%. Most of the patients were diagnosed in the early stages 42.6% stage IA and 25.5% stage IB (FIGO 2009 staging). Endometrioid histology comprised of 90.4%. 26.5% of the patients had endometrial hyperplasia with or without atypia with a final histopathological report of endometrial cancer. There was a moderate agreement between intraoperative findings of myometrial invasion and final histopathology (kappa=0.59). For intraoperative tumour size estimation, there was only slight agreement (kappa=0.16). Conclusion: Intraoperative gross assessment of myometrial invasion shows moderate agreement with the final histopathology compared to tumour size assessment. Therefore, intraoperative assessment done by a trained gynaecologic oncologist can be used as a cost effective tool to determine the need for pelvic lymphadenectomy in tumours confined to the uterus in places where more advanced techniques are not available.