Cheng W F, Chen C A, Lee C N, Chen T M, Huang K T, Hsieh C Y, Hsieh F J
Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
Gynecol Oncol. 1998 Dec;71(3):424-7. doi: 10.1006/gyno.1998.5164.
The objective of this study was to evaluate the efficacy of preoperative ultrasound (US) findings such as tumor size, status of myometrial invasion, and intratumoral "resistance index" (RI) in predicting lymph node metastasis in endometrial carcinoma patients.
Forty-two patients with endometrial cancer were enrolled. All patients underwent total abdominal hysterectomy, pelvic lymph node dissection or sampling, and para-aortic lymph node sampling. Two-dimensional and color Doppler US were performed before surgery to measure tumor size, depth of myometrial invasion, and intratumoral arterial RI. Formalin-fixed, paraffin-embedded pathologic slides from surgical specimens were reviewed by a senior pathologist to evaluate histologic type and grade, depth of myometrial invasion, cervical involvement, lymph-vascular emboli, and status of lymph node metastasis.
There were 12 patients with pelvic and/or para-aortic lymph node metastases and 30 patients without nodal metastases. Patients with tumors larger than 2.5 cm by US (11/12 vs 14/30, P = 0.008), more than half myometrial invasion by US (9/12 vs 5/30, P < 0.001), and intratumoral RI values less than 0.4 by US (12/12 vs 4/30, P < 0.001) had a significantly higher incidence of nodal metastases as compared with patients with tumors smaller than 2.5 cm, no or superficial myometrial invasion, and RI values higher than 0.4, respectively. Multiple regression analysis showed that only intratumoral RI values less than 0.4 were significantly correlated with nodal metastasis (P < 0.001, r2 = 0. 650). We used the intratumoral RI value as the parameter to evaluate nodal metastasis in endometrial cancer patients. Twelve of sixteen patients with intratumoral RI values <0.4 had a high incidence of nodal metastases. None of the 26 patients with intratumoral RI values >0.4 had nodal metastases.
Preoperative ultrasound features can offer important information for predicting lymph node metastasis in endometrial cancer patients. Patients with tumors with intratumoral RI values less than 0.4 should be highly suspected of having lymph node metastases and further management such as pelvic lymph node dissection or postoperative pelvic radiotherapy would be needed for these patients.
本研究的目的是评估术前超声（US）检查结果，如肿瘤大小、肌层浸润情况及瘤内“阻力指数”（RI）在预测子宫内膜癌患者淋巴结转移方面的效能。
纳入42例子宫内膜癌患者。所有患者均接受了全腹子宫切除术、盆腔淋巴结清扫或取样以及腹主动脉旁淋巴结取样。术前进行二维及彩色多普勒超声检查，以测量肿瘤大小、肌层浸润深度及瘤内动脉RI。由一位资深病理学家对手术标本的福尔马林固定、石蜡包埋病理切片进行复查，以评估组织学类型和分级、肌层浸润深度、宫颈受累情况、淋巴管栓子及淋巴结转移状况。
12例患者有盆腔和/或腹主动脉旁淋巴结转移，30例患者无淋巴结转移。超声显示肿瘤大于2.5 cm的患者（11/12 vs 14/30，P = 0.008）、肌层浸润超过一半的患者（9/12 vs 5/30，P < 0.001）以及瘤内RI值小于0.4的患者（12/12 vs 4/30，P < 0.001），与肿瘤小于2.5 cm、无或浅肌层浸润以及RI值高于0.4的患者相比，淋巴结转移发生率显著更高。多元回归分析显示，只有瘤内RI值小于0.4与淋巴结转移显著相关（P < 0.001，r2 = 0.650）。我们将瘤内RI值作为评估子宫内膜癌患者淋巴结转移的参数。瘤内RI值<0.4的16例患者中有12例淋巴结转移发生率高。瘤内RI值>0.4的26例患者均无淋巴结转移。
术前超声特征可为预测子宫内膜癌患者淋巴结转移提供重要信息。瘤内RI值小于0.4的肿瘤患者应高度怀疑有淋巴结转移，这些患者需要进一步治疗，如盆腔淋巴结清扫或术后盆腔放疗。
