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Diagnostic Usefulness of Intraoperative Ultrasonography in Avoiding Unnecessary Para-Aortic Lymphadenectomy in Women With Endometrial Carcinoma
  1. Eiji Ryo, MD*,
  2. Toshiharu Yasugi, MD,
  3. Katsumi Mizutani, MD,
  4. Tsunekazu Kita, MD*,
  5. Shigeki Takeshita, MD* and
  6. Takuya Ayabe, MD*
  1. *Department of Obstetrics and Gynecology, Teikyo University, Tokyo 173-8606, Japan; and
  2. Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
  1. Address correspondence and reprint requests to Eiji Ryo, MD, Department of Obstetrics and Gynecology, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8606, Japan. E-mail: yonchi{at}med.teikyo-u.ac.jp.

Abstract

Objective: To evaluate the usefulness of intraoperative ultrasonography (IU) in reducing the number of unnecessary para-aortic lymphadenectomy in women with endometrial carcinoma.

Methods: Computed tomography (CT) and IU were used to assess whether para-aortic lymph nodes were enlarged in 91 women with endometrial carcinoma. All women underwent hysterectomy and systematic pelvic and para-aortic lymphadenectomy. On the basis of the intrauterine pathological findings (IPF) of the removed uterus, the women were classified into low- and high-risk groups. It was assumed that para-aortic lymphadenectomy would be performed only when enlarged nodes were detected by CT or IU or only when women were classified into the high-risk group. The numbers of women who would have had missed metastases and who could have avoided para-aortic lymphadenectomy were calculated.

Results: Eighteen women had pathological para-aortic node metastases. Theoretically, the number of women who would have had missed metastases on the basis of CT, IU, and IPF were 11, 2, and 2, respectively; more metastases were missed with CT than with the other 2 methods. The number of women who could have avoided para-aortic lymphadenectomy on the basis of CT, IU, and IPF were 84, 59, and 29, respectively; compared to IPF, IU helped avoid para-aortic lymphadenectomy in more women.

Conclusions: Intraoperative ultrasonography is the most efficient method for avoiding both unnecessary para-aortic lymphadenectomy and missed para-aortic node metastases in women with endometrial carcinoma.

  • Endometrial carcinoma
  • Intraoperative ultrasonography
  • Lymphadenectomy
  • Para-aortic lymph node
  • Ultrasound

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Footnotes

  • The authors declare that no funding was received for this work, and there are no conflicts of interest.

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