Kliniğimizde endometrial biyopsi sonucu maling olan hastaların frozen ve ana patoloji sonuçlarının değerlendirilmesi
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Endometrium kanserinin tedavisinde primer tedavi cerrahidir . endometrial biyosi sonucu EK olan hastaların frozen ve ana patoloji sonucuyla uyumunu beliriemek ve frozen yapılan hastalar da cerrahi sürede frozenda tümör histolojisi, grade , servikal tutulumu tümör capi ve myometrial uyumu yönlendirilmesinde oldukça önemlidir. Frozen inceleme ile düşük riskli hastalarda gerekli olmayan cerrahiyi yapmamak hastanın ameliyat süresini, morbiditesi ve maliyeti önemli boyutta azaltır. Yüksek riskli hastalarda ise uygun cerrahinin yapılması hastanın yaşam süresini belirgin olak etkiler . Bu çalışmanın amacı endometrial biyopsi sonucu endometrium karseri olan hastalada frozen inceleme ile ana patoloji arasında uyum oranını değerlendirmek ve ayrıca frozen incelemenin intraoperatif uygun cerrahi tedavi yönetimini değelirlemektir Bu çalışmaya 01 Ocak 2018 ve 30 Aralık 2022 tarihleri arasında, endometrial biyopsi sonucunda endometriun karsinom saptanması nedeniyle Tekirdağ Namık Kemal Üniversitesi Hastanesi Kadın Hastalıkları ve Doğum Anabilim Dalı bölümünde 81 hasta cerrahisi yapılan, frozen ve ana patolojisi mevcut olan 81 hasta tümör çapı,myometrial invazyon, tümör histolojisi, grade ve servikal tutulum açısından retrospektif olarak değerlendirildi. Hastaların kliniko-patolojik verileri hasta dosyaları ve hastane bilgi sisteminden elde edildi. Çalışmada elde edilen bulgula istatistiksel analizler için IBM SPSS Statistics 22 (IBM SPSS, Türkiye) programı kullanıldı. Çalışma verileri değerlendirilirken tanımlayıcı istatistiksel metodların (Ortalama, Standart sapma, frekans) yanısıra niceliksel parametreler arasındaki uyumun belirlenmesinde Sınıf içi korelasyon katsayısı (ICC), niteliksel parametreler arasındaki uyumun belirlenmesinde Kappa uyum katsayısı hesaplandı. Sonuçlar %95 güven aralığında ve anlamlılık p<0.05 düzeyinde değerlendirildi Hastaların Yaş ortalamaları 62,84±8,024 yıldır.en genç hasta 36 yaşında en yaşlı hasta 83 yaşındadır.. Ameliyat süreleri 90 dk ile 150 dk arasında değişmektedir. endometrial biyopsi sonucu EK olan ana patolojide 2 hastanın sonucu beninğ saptanmiştır. %2,4(2/81) Bu hastaya biyopsi sonucu uyumsuzluğu nedeniyle gereksiz cerrahi yapılmiştır.Frozen incelemede ise 3 hasta beninğ( %3,6( 3/81) )saptanmiştır.frozen ile ana patoloji tanısı arasındakı uyum oranı grade, myometrial invazyon, , tümör çapı ve servikal tutulum için Kappa uyumu sırasıyla , %66,4, %77,1, %83,4 ve %97,6 saptandı. 81 hastanın myometrial invazyon ve grade uyumsuzlugu nedeniyle 25 fazladan lenfoktomi yapıldı.2 hastada grade ve myometerial uyumsuzluk nedenıyle gerekli olan cerrahi tedavi yapılmamıştır.Bu çalışmada sonuçlarına bakıldığında biyopsi, frozen ve ana patoloji karsılastırıldığında sonuçlar orta düzeyde uyumlu ve frozen incelemenin yüksek ve düşük riskli endometrium kanserinin ayırt etmede ve dolayısıyla cerrahi planlamada etkinliğinin ve güvenilirliğinin istatistik anlamlı olduğu görüldü. Frozen ve ana patolojide grade ve myometrial invazyon orta derecede uyumdur.tümör çapı ve servikal tutulum arasında neredeyse mükemmele yakın uyum saptanmıştır. Bu faktörler, endometrium kanseri olan hastalarda lenfadenektomi gerekliliği ile ilgili intraoperatif karar vermeyi yönlendirmek için kullanılabilir.
The primary treatment for endometrial cancer is surgery. It is important to determine the concordance between frozen and final pathology results to direct tumor histology, grade, cervical involvement, tumor size, and myometrial invasion during surgery. Performing unnecessary surgery in low-risk patients can significantly reduce surgical time, morbidity, and cost. In high-risk patients, appropriate surgery affects the patient's lifespan. The aim of this study is to evaluate the concordance rate between frozen and final pathology in patients with endometrial cancer diagnosed by endometrial biopsy and to assess the intraoperative appropriate surgical treatment management with frozen examination. Between January 01, 2018, and December 30, 2022, 81 patients who underwent surgery due to endometrial carcinoma diagnosed by endometrial biopsy at Tekirdağ Namık Kemal University Hospital's Department of Obstetrics and Gynecology had frozen and final pathology results available. The tumor size, myometrial invasion, tumor histology, grade, and cervical involvement of these patients were retrospectively evaluated. The clinical pathological data of the patients were obtained from patient files and the hospital information system. IBM SPSS Statistics 22 (IBM SPSS, Turkey) was used for statistical analyses. Descriptive statistical methods (mean, standard deviation, frequency) were used, and the intra-class correlation coefficient (ICC) was calculated to determine the concordance between quantitative parameters, and the kappa concordance coefficient was calculated to determine the concordance between qualitative parameters. The results were evaluated at a confidence interval of 95% and a significance level of p <0.05. The mean age of the patients was 62.84±8.024 years. The youngest patient was 36 years old, and the oldest was 83 years old. The duration of surgery ranged from 90 minutes to 150 minutes. Two of the 81 patients had benign results in the final pathology, according to the endometrial biopsy results. These patients underwent unnecessary surgery due to the discordance between the biopsy and final pathology results. In frozen examination, three patients had benign results (%3.6 (3/81)). The concordance rate between frozen examination and final pathology diagnosis was Kappa uyumu sırasıyla , %66,4, %77,1, %83,4 and %97,6 for grade, myometrial invasion, tumor size, and cervical involvement, respectively. In 25 patients, additional lymphadenectomy was performed due to discordance in myometrial invasion and grade among the 81 patients. Surgical treatment was not performed in two patients due to discordance in grade and myometrial invasion. The results of this study show that there is significant concordance between biopsy, frozen, and final pathology results, and frozen examination is statistically significant in distinguishing between high and low-risk endometrial cancer and, therefore, in surgical planning. There is moderate concordance between grade and myometrial invasion in frozen and final pathology. There is almost complete concordance between tumor size and cervical involvement
The primary treatment for endometrial cancer is surgery. It is important to determine the concordance between frozen and final pathology results to direct tumor histology, grade, cervical involvement, tumor size, and myometrial invasion during surgery. Performing unnecessary surgery in low-risk patients can significantly reduce surgical time, morbidity, and cost. In high-risk patients, appropriate surgery affects the patient's lifespan. The aim of this study is to evaluate the concordance rate between frozen and final pathology in patients with endometrial cancer diagnosed by endometrial biopsy and to assess the intraoperative appropriate surgical treatment management with frozen examination. Between January 01, 2018, and December 30, 2022, 81 patients who underwent surgery due to endometrial carcinoma diagnosed by endometrial biopsy at Tekirdağ Namık Kemal University Hospital's Department of Obstetrics and Gynecology had frozen and final pathology results available. The tumor size, myometrial invasion, tumor histology, grade, and cervical involvement of these patients were retrospectively evaluated. The clinical pathological data of the patients were obtained from patient files and the hospital information system. IBM SPSS Statistics 22 (IBM SPSS, Turkey) was used for statistical analyses. Descriptive statistical methods (mean, standard deviation, frequency) were used, and the intra-class correlation coefficient (ICC) was calculated to determine the concordance between quantitative parameters, and the kappa concordance coefficient was calculated to determine the concordance between qualitative parameters. The results were evaluated at a confidence interval of 95% and a significance level of p <0.05. The mean age of the patients was 62.84±8.024 years. The youngest patient was 36 years old, and the oldest was 83 years old. The duration of surgery ranged from 90 minutes to 150 minutes. Two of the 81 patients had benign results in the final pathology, according to the endometrial biopsy results. These patients underwent unnecessary surgery due to the discordance between the biopsy and final pathology results. In frozen examination, three patients had benign results (%3.6 (3/81)). The concordance rate between frozen examination and final pathology diagnosis was Kappa uyumu sırasıyla , %66,4, %77,1, %83,4 and %97,6 for grade, myometrial invasion, tumor size, and cervical involvement, respectively. In 25 patients, additional lymphadenectomy was performed due to discordance in myometrial invasion and grade among the 81 patients. Surgical treatment was not performed in two patients due to discordance in grade and myometrial invasion. The results of this study show that there is significant concordance between biopsy, frozen, and final pathology results, and frozen examination is statistically significant in distinguishing between high and low-risk endometrial cancer and, therefore, in surgical planning. There is moderate concordance between grade and myometrial invasion in frozen and final pathology. There is almost complete concordance between tumor size and cervical involvement
Açıklama
Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı
Anahtar Kelimeler
Kadın Hastalıkları ve Doğum, Obstetrics and Gynecology
