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Original Article
Using simple radiologic measurements to anticipate surgical challenge in endometrial cancer: a prospective study
  1. Ross F Harrison1,2,
  2. Jeremiah E Mcnamara2,3,
  3. Claire B Beaumont4,5,
  4. Elizabeth A Sadowski4,
  5. Richard J Chappell6,
  6. Mian M Shahzad7,
  7. Ryan J Spencer8,
  8. Ahmed N Al-Niaimi8,
  9. Lisa M Barroilhet8,
  10. Stephen L Rose8 and
  11. David M Kushner8
  1. 1 Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2 Department Of Obstetrics and Gynecology, University of Wisconsin – Madison, Madison, Wisconsin, USA
  3. 3 Boulder Women's Care, Boulder, Colorado, USA
  4. 4 Department of Radiology, University of Wisconsin – Madison, Madison, Wisconsin, USA
  5. 5 Baptist Health, Little Rock, Arkansas, USA
  6. 6 Department of Biostatistics and Medical Informatics, University of Wisconsin – Madison, Madison, Wisconsin, USA
  7. 7 H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
  8. 8 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Of Wisconsin – Madison, Madison, Wisconsin, USA
  1. Correspondence to David M Kushner, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin – Madison, Madison, WI 53706, USA; dmkushner{at}wisc.edu

Abstract

Objectives To determine if linear measurements of adiposity from pre-operative imaging can improve anticipation of surgical difficulty among endometrial cancer patients.

Methods Eighty patients with newly diagnosed endometrial cancer were enrolled. Routine pre-operative imaging (MRI or CT) was performed. Radiologic linear measurements of the following were obtained: anterior-to-posterior skin distance; anterior skin to anterior edge of L5 distance (total anterior); anterior peritoneum to anterior edge of L5 distance (visceral obesity); and posterior edge of L5 to posterior skin distance (total posterior). Surgeons completed questionnaires quantifying preoperative anticipated operative difficulty and postoperative reported operative difficulty. The primary objective was to assess for a correlation between linear measurements of visceral fat and reported operative difficulty.

Results Seventy-nine patients had questionnaires completed, preoperative imaging obtained, and surgery performed. Univariate analysis showed all four linear measurements, body mass index, weight, and anticipated operative difficulty were associated with increased reported operative difficulty (P< 0.05). Multivariate analysis demonstrated that body mass index and linear measurements visceral obesity and total posterior were independently associated with increased reported operative difficulty (P< 0.05). Compared with body mass index, the visceral obesity measurement was more sensitive and specific for predicting increased reported operative difficulty (visceral obesity; sensitivity 54%, specificity 91 %; body mass index; sensitivity 38%, specificity 89%). A difficulty risk model combining body mass index, visceral obesity, and total posterior demonstrated better predictive performance than any individual preoperative variable.

Conclusions Simple linear measurements of visceral fat obtained from preoperative imaging are more predictive than body mass index alone in anticipating surgeon-reported operative difficulty. These easily obtained measurements may assist in preoperative decision making in this challenging patient population.

  • endometrial cancer
  • imaging
  • obesity
  • surgery

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, an indication of whether changes were made, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/ijgc-2018-000037

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    Footnotes

    • Presented at Presented at the 2016 Annual Meeting of the Society of Gynecologic Oncology (San Diego, CA; 19–22 Mar 2016).

    • Funding This study was supported by the Department of Obstetrics & Gynecology at the University of Wisconsin – Madison in Madison, WI. The Department provided support for data collection, analysis, and interpretation. No outside support, financial or otherwise, was received from any other source

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This investigation was reviewed and approved by the University of Wisconsin Institutional Review Board. The reference number and name are OS12708: Visceral Obesity as a Predictor of Operative Difficulty in Patients with Endometrial Cancer.

    • Provenance and peer review Not commissioned; externally peer reviewed.