Department of Medicine and Surgery, University of Parma, Parma, Italy.
Department of Gynecologic Oncology, University of Palermo, Palermo, Italy.
Ann Surg Oncol. 2022 Apr;29(4):2594-2599. doi: 10.1245/s10434-021-11083-x. Epub 2021 Nov 26.
Sentinel lymph node (SLN) biopsy is considered the standard of care in early-stage endometrial cancer (EC). For SLN failure, a side-specific lymphadenectomy is recommended. Nevertheless, most hemipelvises show no nodal involvement. The authors previously published a predictive score of lymphovascular involvement in EC. In case of a negative score (value 3-4), the risk of nodal metastases was extremely low. This multicenter study aimed to analyze a predictive score of nodal involvement in EC patients.
The study enrolled patients with EC who had received comprehensive surgical staging with nodal assessment. A preoperative predictive score of nodal involvement was calculated for all the patients before surgery. The score included myometrial infiltration, tumor grading (G), tumor diameter, and Ca125 assessment. The STARD (standards for Reporting Diagnostic accuracy studies) guidelines were followed for score accuracy.
The study analyzed 1038 patients and detected 155 (14.9%) nodal metastases. The score was negative (3 or 4) for 475 patients and positive (5-7) for 563 of these patients. The score had a sensitivity of 83.2%, a specificity of 50.8%, a negative predictive value of 94.5%, and a diagnostic value of 55.7%. The area under the curve was 0.75. The logistic regression showed a significant correlation between a negative score and absence of nodal metastasis (odds ration [OR], 5.133, 95% confidence interval [CI], 3.30-7.98; p < 0.001).
The proposed predictive score is a useful test to identify patients at low risk of nodal involvement. In case of SLN failure, the application of the current score in the SLN algorithm could allow avoidance of unnecessary lymphadenectomies.
前哨淋巴结（SLN）活检被认为是早期子宫内膜癌（EC）的标准治疗方法。对于 SLN 失败，建议进行侧特异性淋巴结清扫术。然而，大多数半骨盆没有淋巴结受累。作者之前发表了一种预测 EC 中淋巴管侵犯的评分。如果评分（值为 3-4）为阴性，则淋巴结转移的风险极低。这项多中心研究旨在分析 EC 患者的淋巴结受累预测评分。
该研究纳入了接受全面手术分期和淋巴结评估的 EC 患者。所有患者在术前均计算了淋巴结受累的预测评分。该评分包括肌层浸润、肿瘤分级（G）、肿瘤直径和 Ca125 评估。该研究遵循 STARD（诊断准确性研究报告标准）指南来评估评分的准确性。
该研究共分析了 1038 例患者，发现 155 例（14.9%）淋巴结转移。475 例患者的评分阴性（3 或 4），563 例患者的评分阳性（5-7）。评分的敏感性为 83.2%，特异性为 50.8%，阴性预测值为 94.5%，诊断值为 55.7%。曲线下面积为 0.75。逻辑回归显示，阴性评分与无淋巴结转移之间存在显著相关性（比值比[OR]，5.133，95%置信区间[CI]，3.30-7.98；p<0.001）。
该预测评分是一种有用的测试，可以识别淋巴结受累风险较低的患者。在 SLN 失败的情况下，当前评分在 SLN 算法中的应用可以避免不必要的淋巴结清扫术。
