Overdiagnosis of Endometrium Cancer: A Retrospective Study

Objective: The deep myometrial invasion (MI) is a risk factor for lymph node metastases in endometrial cancer (EC). There is no consensus regarding which diagnostic method should be preferred for evaluating deep MI. Preoperative magnetic resonance imaging (MRI) and intraoperative frozen section (FS) examinations are the most definitive two diagnostic methods for evaluating deep MI. This study was designed to compare the diagnostic accuracy of preoperative MRI and intraoperative FS examinations in predicting deep MI and review their impact on clinical management and cost on health care. Methods: MRI and FS findings of 65 patients with surgically staged EC between 2016 and 2019 were evaluated for deep MI. A definitive diagnosis of paraffin sections was used as the gold standard diagnosis. Results: For detection of deep MI, accuracy, sensitivity, and specificity of MRI were 53.06%, 61.9%, and 65.9% respectively and significantly low consistency was observed between the final pathology results (p=0.034). Significant strong consistency was observed between the FS and the final pathology results for the detection of deep MI. Accuracy, sensitivity, and specificity were 77.18%, 85.7%, and 95.5%, respectively (p=0.000). Laparotomy rate (p=0.026), operation time (p=0.047), total days of hospitalization (p=0.004), rate of intensive care administration (p=0.027), and the total health-care cost were significantly higher in the MRI inconsistent group (p=0.015). Conclusion: For the diagnostic approach and staging algorithm of EC, each clinic should take into account the accuracy of their diagnostic tests and individualize on a patient and clinical basis.