title: Does Preoperative Diagnosis of Endometrial Hyperplasia Necessitate Intraoperative Frozen Section Consultation?
abstract: BACKGROUND
  In women with endometrial hyperplasia, there is a risk for co-existent endometrial cancer when patients are subjected to immediate surgical treatment.
  
  
  OBJECTIVE
  The aim of this study was to investigate the frequency of endometrial cancer and the accuracy of frozen section analysis at the time of hysterectomy among patients with endometrial hyperplasia, to reveal whether or not a preoperative diagnosis of endometrial hyperplasia necessitates frozen section consultation.
  
  
  METHODS
  Retrospective cross-sectional study.
  
  
  METHODS
  A department database review was performed to identify patients who were subjected to hysterectomy with a preoperative diagnosis of endometrial hyperplasia, during the period from 2007 to 2014.
  
  
  RESULTS
  The study group included 189 cases. The final pathological examination revealed endometrial cancer in 16 women (8.4%). The risk of cancer in patients with endometrial hyperplasia was 1 of 125 (0.8%) in simple hyperplasia without atypia, 1 of 21 (4.8%) in complex hyperplasia without atypia and 14 of 43 (32.5%) in atypical hyperplasia. Of women with cancer, 2 of 16 (12.5%) had high-risk features. Frozen section analysis was requested in 46 cases. Frozen sections helped to identify six out of 11 cases of endometrial cancer (54.5%). The sensitivity, specificity and positive and negative predictive values of frozen section analysis for the detection of endometrial cancer among women with endometrial hyperplasia were 54.4%, 97.2%, 85.7% and 87.5%, respectively.
  
  
  CONCLUSIONS
  Although a significant proportion of patients with atypical endometrial hyperplasia are diagnosed with endometrial cancer following hysterectomy, most of these cases have low-risk features and do not require surgical staging. Additionally, intraoperative frozen section analysis if not helpful for diagnosing concurrent endometrial cancer in patients with endometrial hyperplasia. Therefore, it seems that patients with endometrial hyperplasia can be operated upon in settings with no available method for obtaining frozen sections intraoperatively.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Boyraz
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Derman
authors.initials: D
authors.lastname: Başaran
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Mehmet C
authors.initials: MC
authors.lastname: Salman
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Nejat
authors.initials: N
authors.lastname: Özgül
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Kunter
authors.initials: K
authors.lastname: Yüce
keywords: Endometrial hyperplasia; endometrial cancer; frozen sections