Combined use of magnetic resonance imaging, CA 125 assay, histologic type, and histologic grade in the prediction of lymph node metastasis in endometrial carcinoma.

OBJECTIVE The aim of this study was to predict retroperitoneal lymph node metastasis during the preoperative examination of patients with endometrial carcinoma and to determine whether lymphadenectomy must be performed. STUDY DESIGN This study was carried out on 214 patients with endometrial carcinoma. Preoperative evaluators were volume index, depth of myometrial invasion (as assessed by magnetic resonance imaging), serum CA 125 level, histologic type, and histologic grade. With the use of receiver operating characteristic curves, cutoff values of volume index and serum CA 125 levels were determined. The relationships of these evaluators with pelvic lymph node metastasis were investigated by multivariate analysis with a logistic regression model. The relationships of these evaluators with para-aortic lymph node metastasis were investigated in the same way. RESULTS Histologic type, volume index, histologic grade, and serum CA 125 level were found to be independent risk factors for pelvic lymph node metastasis; serum CA 125 level and volume index were found to be independent risk factors for para-aortic lymph node metastasis. Among 110 cases with no risk factors for pelvic lymph node metastasis, pelvic lymph node metastasis was observed in 4 cases (3.6%). On the other hand, only 1 case of 128 cases (0.7%) with no risk factors for para-aortic lymph node metastasis actually had metastasis. CONCLUSION Careful consideration of the possibility of the elimination of the requirement of retroperitoneal lymphadenectomy is needed in cases with no risk factors for lymph node metastasis. However, our results suggest that para-aortic lymphadenectomy may not be necessary in cases with no risk factors for para-aortic lymph node metastasis.

[1]  N. Sakuragi,et al.  Prognostic significance of serous and clear cell adenocarcinoma in surgically staged endometrial carcinoma , 2000, Acta obstetricia et gynecologica Scandinavica.

[2]  P. Speiser,et al.  Endometrial cancer: accuracy of the finding of a well differentiated tumor at dilatation and curettage compared to the findings at subsequent hysterectomy. , 1999, International journal of gynecological cancer : official journal of the International Gynecological Cancer Society.

[3]  M. Segal,et al.  Radiologic staging in patients with endometrial cancer: a meta-analysis. , 1999, Radiology.

[4]  K. Shinn,et al.  Staging of early endometrial carcinoma: assessment with T2-weighted and gadolinium-enhanced T1-weighted MR imaging. , 1999, Radiographics : a review publication of the Radiological Society of North America, Inc.

[5]  N. Sakuragi,et al.  Cox multivariate regression models for estimating prognosis of patients with endometrioid adenocarcinoma of the uterine corpus who underwent thorough surgical staging , 1998, International journal of cancer.

[6]  T. Nishimura,et al.  Determination of a normal level of serum CA125 in postmenopausal women as a tool for preoperative evaluation and postoperative surveillance of endometrial carcinoma. , 1998, Gynecologic oncology.

[7]  R. Burger,et al.  Value of Preoperative CA 125 Level in the Management of Uterine Cancer and Prediction of Clinical Outcome , 1997, Obstetrics and gynecology.

[8]  R. Lange,et al.  Clinical stage I endometrial carcinoma: pitfalls in preoperative assessment with MR imaging. Work in progress. , 1995, Radiology.

[9]  P. Hantschmann,et al.  Prognostic factors that predict pelvic lymph node metastasis from endometrial carcinoma , 1994, Cancer.

[10]  J. Cain,et al.  Uterine papillary serous carcinoma: patterns of metastatic spread. , 1994, Gynecologic oncology.

[11]  Y. Hirai,et al.  Combined assay of serum levels of CA125 and CA19-9 in endometrial carcinoma. , 1994, Gynecologic oncology.

[12]  P. Disaia,et al.  What is a normal CA125 level? , 1994, Gynecologic oncology.

[13]  C. Belloni,et al.  Myometrial invasion by endometrial carcinoma: assessment with plain and gadolinium-enhanced MR imaging. , 1992, Radiology.

[14]  H. Hricak,et al.  MR imaging evaluation of endometrial carcinoma: results of an NCI cooperative study. , 1991, Radiology.

[15]  V. Abeler,et al.  Serous papillary carcinoma of the endometrium: a histopathological study of 22 cases. , 1990, Gynecologic oncology.

[16]  R. Bast,et al.  Preoperative evaluation of serum CA 125, TAG 72, and CA 15-3 in patients with endometrial carcinoma. , 1990, American journal of obstetrics and gynecology.

[17]  G. Eklund,et al.  Prospective evaluation of serum CA 125 levels in a normal population, phase I: the specificities of single and serial determinations in testing for ovarian cancer. , 1990, Gynecologic oncology.

[18]  P. O'Brien,et al.  Evaluation of unfavorable histologic subtypes in endometrial adenocarcinoma. , 1990, American journal of obstetrics and gynecology.

[19]  B. Bundy,et al.  Surgical pathologic spread patterns of endometrial cancer: A gynecologic oncology group study , 1987, Cancer.

[20]  M. Lagios,et al.  Clear cell carcinoma of the endometrium , 1987, American journal of obstetrics and gynecology.

[21]  H. Hricak,et al.  Endometrial carcinoma staging by MR imaging. , 1987, Radiology.

[22]  H. Hricak,et al.  Uterine MR imaging: effects of hormonal stimulation. , 1986, Radiology.

[23]  P. Disaia,et al.  Risk factors and recurrent patterns in Stage I endometrial cancer. , 1985, American journal of obstetrics and gynecology.

[24]  J A Blessing,et al.  Surgical Staging in Endometrial Cancer: Clinical—Pathologic Findings of a Prospective Study , 1984, Obstetrics and gynecology.

[25]  Y. Yamashita,et al.  Assessment of myometrial invasion by endometrial carcinoma: transvaginal sonography vs contrast-enhanced MR imaging. , 1993, AJR. American journal of roentgenology.