Department of Obstetrics and Gynecology, Chung-Ang University College of Medicine, Seoul, Korea.
Acta Obstet Gynecol Scand. 2010;89(2):168-74. doi: 10.3109/00016340903370114.
To evaluate whether we could accurately predict lymph node (LN) metastasis with preoperative tests in endometrial cancer. Design. Retrospective study.
Seoul National University Hospital, South Korea. Population. Three hundred patients with endometrial cancer who underwent surgical staging including lymphadenectomy between January 1999 and July 2007.
We reviewed the medical records of 300 patients with endometrial cancer. The preoperative factors used to predict LN metastasis were as follows: old age (> or = 55 years), serum CA-125 level [level > or = 20 U/mL (if age < 50 years), level > or = 28 U/mL (if age > or = 50 years)], non-endometrioid histologic type and Grade 3, metastatic LN assessed by pelvic MRI or CT, and deep myometrial invasion assessed by pelvic MRI only. Logistic regression analysis was used to determine the significant predictive factors.
Sensitivity/specificity and false positive/negative rates.
Thirty patients had LN metastasis. Although LN evaluation by pelvic MRI or CT and high CA-125 level were the significant independent predictors for LN metastasis, the sensitivity/specificity and false positive/negative rates for LN metastasis by these two combined preoperative tests were 86.7%/71.4% and 68.7%/2.7%, respectively. However, the sensitivity/specificity and false positive/negative rates for LN metastasis by six combined preoperative tests were 100%/28.9% and 84.6%/0%, respectively.
The six combined preoperative tests are useful in selecting patients without LN metastasis in endometrial cancer. Lymphadenectomy could be avoided in about 29% of patients with endometrial cancer who have no LN metastasis by using six combined preoperative tests.
评估术前检查是否能准确预测子宫内膜癌的淋巴结（LN）转移。设计：回顾性研究。
韩国首尔国立大学医院。人群：1999 年 1 月至 2007 年 7 月间 300 例接受包括淋巴结切除术在内的手术分期的子宫内膜癌患者。
我们回顾了 300 例子宫内膜癌患者的病历。用于预测 LN 转移的术前因素如下：高龄（≥55 岁）、血清 CA-125 水平[年龄＜50 岁时水平＞20 U/mL（如果年龄≥50 岁），水平＞28 U/mL]、非子宫内膜样组织学类型和 3 级、盆腔 MRI 或 CT 评估的转移性 LN、盆腔 MRI 仅评估的深层肌层浸润。采用逻辑回归分析确定显著预测因素。
灵敏度/特异性和假阳性/阴性率。
30 例患者发生 LN 转移。尽管盆腔 MRI 或 CT 评估的 LN 和高 CA-125 水平是 LN 转移的独立显著预测因素，但这两种术前检查联合用于 LN 转移的灵敏度/特异性和假阳性/阴性率分别为 86.7%/71.4%和 68.7%/2.7%。然而，六种联合术前检查用于 LN 转移的灵敏度/特异性和假阳性/阴性率分别为 100%/28.9%和 84.6%/0%。
六种联合术前检查有助于选择无 LN 转移的子宫内膜癌患者。通过使用六种联合术前检查，约 29%无 LN 转移的子宫内膜癌患者可以避免淋巴结切除术。
