Ali Maria, Mumtaz Mehwish, Naqvi Zehra, Farooqui Rabia, Shah Sania A
Obstetrics and Gynaecology, Liaquat National Hospital and Medical College, Karachi, PAK.
Paediatrics, Abbasi Shaheed Hospital, Karachi, PAK.
Cureus. 2022 Mar 14;14(3):e23135. doi: 10.7759/cureus.23135. eCollection 2022 Mar.
Introduction Lymphatic spread is the most common route of spread of endometrial carcinoma, and the most frequently involved lymph nodes are those of the external iliac group. MRI is one of the best imaging tools for the preoperative evaluation of patients with endometrial carcinoma. The objective of the current study is to analyze the relationship between tumor size and lymph node metastasis in patients with type I endometrial carcinoma. Methods This is a prospective observational study performed in the Department of Obstetrics and Gynaecology at Liaquat National Hospital, Karachi, Pakistan. The duration of the study was from January 2020 to January 2021. During this period, 86 patients with biopsy-proven type I endometrial carcinoma were selected. Tumor size was measured by MRI. All participants underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy. Histopathological evaluation was performed according to the College of American Pathologists (CAP) protocols, and staging was performed using the 2009 International Federation of Gynecology and Obstetrics (FIGO) staging system. Lymph nodes were considered positive or negative, irrespective of their number. Result Of the 86 patients, 25 (29.1%) had positive lymph node metastasis. The mean tumor size with positive lymph node metastasis by MRI and histopathology was 7.86 cm and 10.21 cm, respectively. Tumor size determined by MRI and histopathology was significantly associated with lymph node metastasis (p < 0.01 and p < 0.01, respectively). Tumor size was positively correlated with lymph node metastasis (r = 0.715). The cutoff value of >6.5 cm by MRI was established as the statistically significant differentiator of lymph node metastasis. The calculated sensitivity and specificity were 88% and 90.16%, respectively, with an area under the curve (AUC) of 0.920. The cutoff value of >8 cm by histopathology was established as the statistically significant differentiator of lymph node metastasis. The calculated sensitivity and specificity were 80% and 88.52%, respectively, with an AUC of 0.907. Conclusion Our results showed that lymph node metastasis in patients with type I endometrial carcinoma can be predicted by tumor size. This may help incorporate adequate surgical skills and management plans in the treatment course of type I endometrial carcinoma.
引言
淋巴转移是子宫内膜癌最常见的转移途径，最常累及的淋巴结是髂外组淋巴结。磁共振成像（MRI）是子宫内膜癌患者术前评估的最佳影像学工具之一。本研究的目的是分析I型子宫内膜癌患者肿瘤大小与淋巴结转移之间的关系。
方法
这是一项在巴基斯坦卡拉奇利亚卡特国家医院妇产科进行的前瞻性观察性研究。研究持续时间为2020年1月至2021年1月。在此期间，选取了86例经活检证实为I型子宫内膜癌的患者。通过MRI测量肿瘤大小。所有参与者均接受了全腹子宫切除术、双侧输卵管卵巢切除术和双侧盆腔淋巴结清扫术。根据美国病理学家学会（CAP）方案进行组织病理学评估，并使用2009年国际妇产科联盟（FIGO）分期系统进行分期。无论淋巴结数量多少，均视为阳性或阴性。
结果
86例患者中，25例（29.1%）有阳性淋巴结转移。MRI和组织病理学检查显示有阳性淋巴结转移的患者的平均肿瘤大小分别为7.86 cm和10.21 cm。MRI和组织病理学检查确定的肿瘤大小与淋巴结转移显著相关（分别为p < 0.01和p < 0.01）。肿瘤大小与淋巴结转移呈正相关（r = 0.715）。MRI测量>6.5 cm的临界值被确定为淋巴结转移的统计学显著区分指标。计算得出的敏感性和特异性分别为88%和90.16%，曲线下面积（AUC）为0.920。组织病理学检查>8 cm的临界值被确定为淋巴结转移的统计学显著区分指标。计算得出的敏感性和特异性分别为80%和88.52%，AUC为0.907。
结论
我们的结果表明，I型子宫内膜癌患者的淋巴结转移可以通过肿瘤大小来预测。这可能有助于在I型子宫内膜癌的治疗过程中纳入适当的手术技巧和管理计划。
