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Clinical Utility of Preoperative Computed Tomography in Patients With Endometrial Cancer
  1. Giorgio Bogani, MD, PhD*,
  2. Bobbie S. Gostout, MD*,
  3. Sean C. Dowdy, MD*,
  4. Francesco Multinu, MD*,
  5. Jvan Casarin, MD*,
  6. William A. Cliby, MD*,
  7. Luigi Frigerio, MD,
  8. Bohyun Kim, MD, PhD,
  9. Amy L. Weaver, MS§,
  10. Gretchen E. Glaser, MD*, and
  11. Andrea Mariani, MD*
  1. *Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN;
  2. Division of Obstetrics and Gynecology, Ospedale Papa Giovanni XXIII, Bergamo, Italy; and
  3. Division of Medical Oncology,
  4. Department of Radiology, and
  5. §Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
  1. Address correspondence and reprint requests to Andrea Mariani, MD, Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail: mariani.andrea@mayo.edu.

Abstract

Objective The aim of this study was to determine the clinical utility of routine preoperative pelvic and abdominal computed tomography (CT) examinations in patients with endometrial cancer (EC).

Methods We retrospectively reviewed records from patients with EC who underwent a preoperative endometrial biopsy and had surgery at our institution from January 1999 through December 2008. In the subset with an abdominal CT scan obtained within 3 months before surgery, we evaluated the clinical utility of the CT scan.

Results Overall, 224 patients (18%) had a preoperative endometrial biopsy and an available CT scan. Gross intra-abdominal disease was observed in 10% and 20% of patients with preoperative diagnosis of endometrioid G3 and type II EC, respectively, whereas less than 5% of patients had a preoperative diagnosis of hyperplasia or low-grade EC. When examining retroperitoneal findings, we observed that a negative CT scan of the pelvis did not exclude the presence of pelvic node metastasis. Alternately, a negative CT scan in the para-aortic area generally reduced the probability of finding para-aortic dissemination but with an overall low sensitivity (42%). However, the sensitivity for para-aortic dissemination was as high as 67% in patients with G3 endometrioid cancer. In the case of negative para-aortic nodes in the CT scan, the risk of para-aortic node metastases decreased from 18.8% to 7.5% in patients with endometrioid G3 EC. Up to 15% of patients with endometrioid G3 cancer had clinically relevant incidental findings that necessitated medical or surgical intervention.

Conclusions In patients with endometrioid G3 and type II EC diagnosed by the preoperative biopsy, CT scans may help guide the operative plan by facilitating preoperative identification of gross intra-abdominal disease and enlarged positive para-aortic nodes that are not detectable during physical examinations. In addition, CT may reveal other clinically relevant incidental findings.

  • Computed tomography
  • Costs
  • Endometrial cancer
  • Minimally invasive surgery
  • Staging
  • ASA—American Society of Anesthesiologists
  • CR-IF—clinically relevant incidental finding
  • CT—computed tomography
  • EC—endometrial cancer
  • GID—gross intra-abdominal disease
  • LR—likelihood ratio
  • PAMR—positive para-aortic nodal metastases or recurrence
  • PELVMR—positive pelvic nodal metastases or recurrence

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Footnotes

  • G.B. is now with the Department of Gynecologic Surgery, Istituto dei Tumori di Milano, Milan, Italy.

  • F.M. is a research fellow supported by the Division of Obstetrics and Gynecology, University of Cagliari, Italy. J.C. is a research fellow supported by the Division of Obstetrics and Gynecology, University of Insubria-Varese, Varese, Italy.

  • Portions of this article were presented as an abstract at the Society of Gynecologic Oncology’s 45th Annual Meeting on Women’s Cancer; Tampa, FL; March 22 to 25, 2014.

  • The authors declare no conflicts of interest.

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