Tannous Andrew, Adler Alexzandra, Sheeder Jeanelle, Wolsky Rebecca J, Alldredge Jill
Saint Joseph Hospital, Department of Obstetrics and Gynecology, Denver, CO, USA.
University of Colorado School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Aurora, CO, USA.
Gynecol Oncol Rep. 2025 Jul 25;60:101812. doi: 10.1016/j.gore.2025.101812. eCollection 2025 Aug.
We investigated the utility of pre-operative computerized tomography (CT) abdomen and pelvis on clinical staging and surgical decision making for uterine carcinoma.
This retrospective cohort study included patients treated surgically for uterine carcinoma between 2010 and 2021 at a single academic center. Data on patient demographics, tumor characteristics, CT imaging results, and surgical procedures were collected. Diagnostic accuracy metrics (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) were analyzed to assess the predictive value of CT for determining extrauterine disease, lymphadenopathy, and omental involvement. The impact of CT imaging on surgical management decisions was also evaluated.
Of 409 patients meeting inclusion criteria, 68.9 % underwent pre-operative CT imaging. CT demonstrated moderate sensitivity (67.0 %, 61/91) and high specificity (87.4 %, 145/166) for detecting extrauterine disease, which was comparable across those with low grade endometrioid, high grade endometrioid, and non-endometrioid histotypes. Patients with abnormal CT findings were significantly more likely to have advanced stage disease (FIGO stage III/IV; p < 0.001), undergo tumor debulking (p < 0.001), and receive pelvic (p = 0.001) and -aortic lymphadenectomy (p < 0.001). Conversely, patients with normal CT scans more frequently underwent minimally invasive surgery (MIS) and sentinel lymph node (SLN) procedures (p < 0.001).
Preoperative CT shows moderate sensitivity but high specificity for identifying extrauterine disease in uterine carcinoma, supporting continued use for high risk histotypes. Among patients with low-grade histotypes, risk-adaptive use of CT may be valuable in determining eligibility for either MIS or SLN mapping. This is an increasingly relevant consideration as MIS and SLN are becoming more widely adopted.
我们研究了术前腹部和盆腔计算机断层扫描（CT）在子宫癌临床分期及手术决策中的作用。
这项回顾性队列研究纳入了2010年至2021年在单一学术中心接受子宫癌手术治疗的患者。收集了患者人口统计学、肿瘤特征、CT成像结果及手术过程的数据。分析诊断准确性指标（敏感性、特异性、阳性预测值[PPV]、阴性预测值[NPV]），以评估CT对判断子宫外疾病、淋巴结病变及网膜受累情况的预测价值。还评估了CT成像对手术管理决策的影响。
在409例符合纳入标准的患者中，68.9%接受了术前CT成像。CT检测子宫外疾病的敏感性为中等（67.0%，61/91），特异性较高（87.4%，145/166），在低级别子宫内膜样癌、高级别子宫内膜样癌和非子宫内膜样组织学类型的患者中相当。CT检查结果异常的患者更有可能患有晚期疾病（国际妇产科联盟[FIGO]分期III/IV；p<0.001），接受肿瘤减灭术（p<0.001），以及盆腔（p=0.001）和主动脉旁淋巴结清扫术（p<0.001）。相反，CT扫描正常的患者更常接受微创手术（MIS）和前哨淋巴结（SLN）手术（p<0.001）。
术前CT对识别子宫癌子宫外疾病显示出中等敏感性但较高特异性，支持对高危组织学类型继续使用。在低级别组织学类型的患者中，根据风险适应性使用CT对于确定是否适合MIS或SLN定位可能很有价值。随着MIS和SLN的应用越来越广泛这一考虑日益重要。
