Diagnostic performance of intraoperative assessment in grade 2 endometrioid endometrial carcinoma

Abstract Background Endometrial carcinoma is the most common gynecologic malignancy in developed countries. Grade 2 carcinoma is associated with pelvic lymph-node metastasis, depending on selected risk factors. Intraoperative assessment (IOA) can identify patients at risk for lymph node metastasis who should undergo staging surgery. Our objective was to establish the diagnostic precision of IOA in determining the need for surgical staging in grade 2 endometrioid endometrial carcinoma. Methods Two hundred twenty-two patients underwent IOA. Results were compared to the final pathology report. The accuracy of the IOA parameters was calculated. Variables were evaluated in patients with positive versus negative IOA. Overall and disease-free survivals were calculated according to IOA, lymphadenectomy, and nodal metastasis. Results IOA was positive in 80 patients. It showed an accuracy of 76.13% when compared with the postoperative assessment. The best individual parameter was myometrial invasion. Nodal metastasis was observed in 16 patients in the positive IOA group and 7 patients in the negative group. Patients with lymph node metastasis had a 5-year overall survival rate of 80.9%, whereas patients without metastasis had a 5-year overall survival rate of 97.9%. Conclusions IOA is an adequate tool to identify high-risk patients in grade 2 endometrial carcinoma. Myometrial invasion is the individual parameter that yields the highest diagnostic precision.

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Diagnostic Performance of Intraoperative Assessment in Grade 2 Endometrioid Endometrial Carcinoma

10.21203/rs.3.rs-74863/v1 ◽

2020 ◽

Author(s):

Antonio Bandala-Jacques ◽

David Cantú-de-León ◽

Delia Pérez Montiel ◽

Rosa A. Salcedo-Hernández ◽

Diddier Prada ◽

...

Keyword(s):

Overall Survival ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Endometrial Carcinoma ◽

Myometrial Invasion ◽

Nodal Metastasis ◽

Overall Survival Rate ◽

Individual Parameter ◽

Node Metastasis ◽

Endometrioid Endometrial Carcinoma

Abstract Background: Endometrial carcinoma is the most common gynecologic malignancy in developed countries. Grade 2 carcinoma is associated with pelvic lymph-node metastasis, depending on selected risk factors. Intraoperative assessment (IOA) can identifiy patients at risk for lymph node metastasis who should undergo staging surgery. Our objective was to establish the diagnostic precision of IOA in determining the need for surgical staging in grade 2 endometrioid endometrial carcinoma. Methods: 222 patients underwent IOA. Results were compared to the final pathology report. The accuracy of the IOA parameters was calculated. Variables were evaluated in patients with positive versus negative IOA. Overall and disease-free survivals were calculated according to IOA, lymphadenectomy, and nodal metastasis.Results: IOA was positive in 80 patients. It showed an accuracy of 76.13% when compared with the postoperative assessment. The best individual parameter was myometrial invasion. Nodal metastasis was observed in 16 patients in the positive IOA group and 7 patients in the negative group. Patients with lymph node metastasis had a 5-year overall survival rate of 80.9%, whereas patients without metastasis had a 5-year overall survival rate of 97.9%. Conclusions: IOA is an adequate tool to identify high-risk patients in grade 2 endometrial carcinoma. Myometrial invasion is the individual parameter that yields the highest diagnostic precision.

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Diagnostic Performance of Intraoperative Assessment in Grade 2 Endometrioid Endometrial Carcinoma

10.21203/rs.3.rs-74863/v2 ◽

2020 ◽

Author(s):

Antonio Bandala-Jacques ◽

David Cantú-de-León ◽

Delia Pérez Montiel ◽

Rosa A. Salcedo-Hernández ◽

Diddier Prada ◽

...

Keyword(s):

Overall Survival ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Endometrial Carcinoma ◽

Myometrial Invasion ◽

Nodal Metastasis ◽

Overall Survival Rate ◽

Individual Parameter ◽

Node Metastasis ◽

Endometrioid Endometrial Carcinoma

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Long-Term Survival in Patients With Para-Aortic Lymph Node Metastasis With Systematic Retroperitoneal Lymphadenectomy Followed by Adjuvant Chemotherapy in Endometrial Carcinoma

International Journal of Gynecological Cancer ◽

10.1111/igc.0b013e3181d80aff ◽

2010 ◽

Vol 20 (6) ◽

pp. 1000-1005 ◽

Cited By ~ 11

Author(s):

Masamichi Hiura ◽

Takayoshi Nogawa ◽

Takashi Matsumoto ◽

Takashi Yokoyama ◽

Yuko Shiroyama ◽

...

Keyword(s):

Overall Survival ◽

Lymph Node ◽

Adjuvant Chemotherapy ◽

Lymph Node Metastasis ◽

Endometrial Carcinoma ◽

Peritoneal Cytology ◽

Term Survival ◽

Long Term Survival ◽

Node Metastasis

Objective:The purposes of this study were to assess modified radical hysterectomy including systematic pelvic and para-aortic lymphadenectomy followed by adjuvant chemotherapy in patients with para-aortic lymph node (PAN) metastasis in endometrial carcinoma and to identify the multivariate independent prognostic factors for long-term survival during the past 10 years.Methods:Between December 1987 and December 2002, we performed modified radical hysterectomy with bilateral salpingo-oophorectomy including systematic pelvic and para-aortic lymphadenectomy and peritoneal cytology in 284 endometrial carcinoma patients according to the classification of the International Federation of Gynecology and Obstetrics (stage IA, n = 66; stage IB, n = 96; stage IC, n = 33; stage IIA, n = 5; stage IIB, n = 20; stage IIIA, n = 28; stage IIIC, n = 28; and stage IV, n = 8) who gave informed consents at our institute. Patients with tumor confined to the uterus (stages IC and II) were treated by 3 courses of cyclophosphamide 750 mg/m2, epirubicin 50 mg/m2, and cisplatin 75 mg/m2 regimen 3 to 4 weeks apart, and patients with extrauterine lesions involving adnexa and/or pelvic lymph node (PLN) were treated by 5 courses. In addition, 10 courses were given to patients with PAN metastasis. Patients with PLN metastasis received adjuvant chemotherapy, and adjuvant radiation was not part of our institutional protocol. For multivariate regression modeling with proportional hazards, the regression model of Cox was used. Survival curves were analyzed by the Kaplan-Meier method, and analysis of the differences was performed by the log-rank test.Results:The overall incidence of retroperitoneal lymph node metastasis assessed by systematic pelvic and para-aortic lymphadenectomy was 12.0% (34/284) in stages I to IV endometrial carcinoma, and incidences of PLN and PAN metastases were 9.2% (26/284) and 7.4% (21/284), respectively. However, PAN metastasis rate is 50% (13/26) in patients with PLN metastasis. Univariate analysis of prognostic factors revealed that International Federation of Gynecology and Obstetrics clinical stage (P < 0.0001), histological finding (P = 0.0292), myometrial invasion (P < 0.0001), adnexal metastasis (P < 0.0001), lymphovascular space invasion (P < 0.0001), tumor diameter (P = 0.0108), peritoneal cytology (P = 0.0001), and retroperitoneal lymph node metastasis (P < 0.0001) were significantly associated with 10-year overall survival. Survival was not associated with age (P = 0.1558) or cervical involvement (P = 0.1828). A multivariate analysis showed that adnexal metastasis (P = 0.0418) and lymphovascular space invasion (P = 0.0214) were significantly associated with 10-year overall survival. The 5- and 10-year overall survival rates in patients with negative PAN were 96% and 93% versus 72% and 62% in patients with positive PAN (P = 0.006).Conclusions:It is suggested that surgery with systematic pelvic and para-aortic lymphadenectomy followed by adjuvant chemotherapy could improve long-term survival in patients with PAN metastasis, although there are only 21 patients with PAN metastasis.

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Cervical invasion, lymphovascular space invasion, and ovarian metastasis as predictors of lymph node metastasis and poor outcome on stages I to III endometrial cancers: a single-center retrospective study

World Journal of Surgical Oncology ◽

10.1186/s12957-019-1733-2 ◽

2019 ◽

Vol 17 (1) ◽

Author(s):

Min Li ◽

Shuwei Wu ◽

Yangqin Xie ◽

Xiaohui Zhang ◽

Zhanyu Wang ◽

...

Keyword(s):

Overall Survival ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Regression Models ◽

Cox Regression ◽

Myometrial Invasion ◽

Ovarian Metastasis ◽

Surgical Staging ◽

Tumor Diameter ◽

Node Metastasis

Abstract Background The aim of this study is to determine pathological factors that increase the risk of LNM and indicate poor survival of patients diagnosed with endometrial cancer and treated with surgical staging. Method Between January 2010 and November 2018, we enrolled 874 eligible patients who received staging surgery in the First Affiliated Hospital of Anhui Medical University. The roles of prognostic risk factors, such as age, histological subtype, tumor grade, myometrial infiltration, tumor diameter, cervical infiltration, lymphopoiesis space invasion (LVSI), CA125, and ascites, were evaluated. Multivariable logistic regression models were used to identify the predictors of LNM. Kaplan–Meier and COX regression models were utilized to study the overall survival. Results Multivariable regression analysis confirmed cervical stromal invasion (OR 3.412, 95% CI 1.631–7.141; P < 0.01), LVSI (OR 2.542, 95% CI 1.061–6.004; P = 0.04) and ovarian metastasis (OR 6.236, 95% CI 1.561–24.904; P = 0.01) as significant predictors of nodal dissemination. Furthermore, pathological pattern (P = 0.03), myometrial invasion (OR 2.70, 95% CI 1.139–6.40; P = 0.01), and lymph node metastasis (OR 9.675, 95% CI 3.708–25.245; P < 0.01) were independent predictors of decreased overall survival. Conclusions Cervical invasion, lymphopoiesis space invasion, and ovarian metastasis significantly convey the risk of LNM. Pathological type, myometrial invasion, and lymph node metastasis are all important predictors of survival and should be scheduled for completion when possible in the surgical staging procedure.

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Incidence of sentinel lymph node metastasis in endometrial carcinoma: Correlation with tumor grade and myometrial invasion

Gynecologic Oncology ◽

10.1016/j.ygyno.2011.12.386 ◽

2012 ◽

Vol 125 ◽

pp. S157 ◽

Cited By ~ 1

Author(s):

F. Khoury Collado ◽

O. Alchyib ◽

C. Kim ◽

J. Barlin ◽

D. Cassella ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Node Metastasis ◽

Endometrial Carcinoma ◽

Myometrial Invasion ◽

Tumor Grade ◽

Sentinel Lymph Node Metastasis ◽

Node Metastasis

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Pitfalls in pre-operative prediction of lymph node metastasis in early endometrial cancer

10.1101/2020.10.21.20216622 ◽

2020 ◽

Author(s):

Pampapati Veena ◽

Rajalakshmi Ilango ◽

Jayalakshmi Durairaj

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Tertiary Care ◽

Myometrial Invasion ◽

Tumor Grade ◽

Nodal Metastasis ◽

Lymph Nodal Metastasis ◽

Node Metastasis ◽

Lymphovascular Space Invasion

AbstractObjectiveThe role of lymphadenectomy in early stage endometrial cancer is controversial as it is associated with intra-operative complications and its therapeutic benefit is not established. Prediction of lymph nodal metastasis so as to perform selective lymph node dissection is desirable. This study was conducted to study grade of the tumor obtained by endometrial biopsy specimen and depth of myometrial invasion assessed by imaging pre-operatively as predictors of lymph nodal metastasis in early endometrial cancers.MethodsOur study was a cross sectional study done in a tertiary care center in south India, where 100 patients were studied from August 2016 to May 2018. After Ethical Committee clearance, all patients who were diagnosed with early endometrial cancer and who underwent surgery in our hospital were included in the study after getting informed consent. Pre-operative tumor grade and depth of myometrial invasion were studied as predictors of lymph nodal metastasis. They were also correlated with post-operative grade and myometrial invasion.ResultsThe present study recruited 100 women of which 3 cases were excluded because of non-endometrioid histology. The incidence of positive lymph node metastasis in our study was 18.6%. Both pre-operative tumor grade and depth of myometrial invasion were not significantly associated with lymph node metastasis. There was significant variation between pre-operative and post-operative tumor grade and depth of myometrial invasion. Among post-operative histopathological factors, only lymphovascular space invasion was found to be significantly associated with lymph node metastasis.ConclusionIn our study, neither pre-operative nor post-operative grade of the tumor and depth of myometrial invasion were significantly associated with lymph node metastasis. There was considerable variation between pre-op and post-op grade of the tumor making pre-op grade an unreliable factor in predicting lymph node metastasis in endometrial cancer. Among post-operative histopathological factors, only lymphovascular space invasion was found to be significantly associated with lymph node metastasis.Key messageConsiderable variation between pre-op and post-op grade of the tumor makes pre-op grade an unreliable factor in predicting lymph node metastasis in endometrial cancer

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