Traen Koen, Hølund Berit, Mogensen Ole
Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.
Acta Obstet Gynecol Scand. 2007;86(6):739-41. doi: 10.1080/00016340701322077.
Preoperative prediction of metastases to the regional lymph nodes in women with endometrioid endometrial cancer is a challenge. According to the Danish Gynaecological Cancer Society guidelines, a pelvic lymphadenectomy is warranted in all poorly differentiated tumors and all stage Ic disease. We have evaluated the accuracy of preoperative tumor grade and intraoperative gross examination of myometrial invasion, in predicting the need for a pelvic lymphadenectomy.
Preoperative tumor grade and intraoperative gross examination of myometrial invasion were prospectively registered in 72 women with stage I endometrioid endometrial cancer, operated between 1 September 2004 and 18 April 2006. The pre- and intraoperative findings were compared with the final pathology report.
The preoperative prediction of grade (well, moderate or poorly differentiated) was correct in 96% (69/72) of the patients. Gross examination of myometrial invasion correctly differentiated between stage Ia, Ib, and Ic disease in 89% (64/72) of the patients. The combination of preoperative tumor grade and intraoperative gross examination of myometrial invasion, led to wrong clinical decisions in 11% (8/72) of the patients. Three 'unnecessary' lymphadenectomies were performed, and 5 patients were primary operated upon without 'warranted' lymphadenectomy.
Our data suggest that preoperative tumor grade and intraoperative gross examination of the uterus provide useful information for pre-and intraoperative planning of pelvic lymphadenectomy. However, wrong decisions were made in 11% of the patients, and more reliable evaluation methods are needed.
对子宫内膜样子宫内膜癌女性患者区域淋巴结转移进行术前预测是一项挑战。根据丹麦妇科癌症协会指南，所有低分化肿瘤及所有Ⅰc期疾病均需行盆腔淋巴结清扫术。我们评估了术前肿瘤分级及术中子宫肌层浸润的大体检查在预测盆腔淋巴结清扫术必要性方面的准确性。
前瞻性记录了2004年9月1日至2006年4月18日期间接受手术的72例Ⅰ期子宫内膜样子宫内膜癌女性患者的术前肿瘤分级及术中子宫肌层浸润的大体检查情况。将术前和术中的检查结果与最终病理报告进行比较。
96%（69/72）的患者术前分级（高分化、中分化或低分化）预测正确。子宫肌层浸润的大体检查在89%（64/72）的患者中正确区分了Ⅰa期、Ⅰb期和Ⅰc期疾病。术前肿瘤分级与术中子宫肌层浸润的大体检查相结合，在11%（8/72）的患者中导致了错误的临床决策。进行了3例“不必要”的淋巴结清扫术，5例患者初次手术时未进行“必要”的淋巴结清扫术。
我们的数据表明，术前肿瘤分级及术中子宫大体检查可为盆腔淋巴结清扫术的术前和术中规划提供有用信息。然而，11%的患者做出了错误决策，因此需要更可靠的评估方法。
