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Pino I, Gozzini E, Radice D, Boveri S, Iacobone AD, Vidal Urbinati AM, Multinu F, Gullo G, Cucinella G, Franchi D. Advancing Tailored Treatments: A Predictive Nomogram, Based on Ultrasound and Laboratory Data, for Assessing Nodal Involvement in Endometrial Cancer Patients. J Clin Med 2024; 13:496. [PMID: 38256630 PMCID: PMC10816430 DOI: 10.3390/jcm13020496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
Assessing lymph node metastasis is crucial in determining the optimal therapeutic approach for endometrial cancer (EC). Considering the impact of lymphadenectomy, there is an urgent need for a cost-effective and easily applicable method to evaluate the risk of lymph node metastasis in cases of sentinel lymph node (SLN) biopsy failure. This retrospective monocentric study enrolled EC patients, who underwent surgical staging with nodal assessment. Data concerning demographic, clinicopathological, ultrasound, and surgical characteristics were collected from medical records. Ultrasound examinations were conducted in accordance with the IETA statement. We identified 425 patients, and, after applying exclusion criteria, the analysis included 313 women. Parameters incorporated into the nomogram were selected via univariate and multivariable analyses, including platelet count, myometrial infiltration, minimal tumor-free margin, and CA 125. The nomogram exhibited good accuracy in predicting lymph node involvement, with an AUC of 0.88. Using a cutoff of 10% likelihood of nodal involvement, the nomogram displayed a low false-negative rate of 0.04 (95% CI 0.00-0.19) in the training set. The adaptability of this straightforward model renders it suitable for implementation across diverse clinical settings, aiding gynecological oncologists in preoperative patient evaluations and facilitating the design of personalized treatments. However, external validation is mandatory for confirming diagnostic accuracy.
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Affiliation(s)
- Ida Pino
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.D.I.); (A.M.V.U.); (D.F.)
| | - Elisa Gozzini
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy;
| | - Davide Radice
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Sara Boveri
- Laboratory of Biostatistics and Data Management, Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy;
| | - Anna Daniela Iacobone
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.D.I.); (A.M.V.U.); (D.F.)
| | - Ailyn Mariela Vidal Urbinati
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.D.I.); (A.M.V.U.); (D.F.)
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy;
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
- Laboratory of Biostatistics and Data Management, Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy;
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Francesco Multinu
- Department of Gynecologic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy;
| | - Giuseppe Gullo
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.)
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.)
| | - Dorella Franchi
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.D.I.); (A.M.V.U.); (D.F.)
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Owen C, Bendifallah S, Jayot A, Ilenko A, Arfi A, Boudy AS, Richard S, Varinot J, Thomassin-Naggara I, Bazot M, Daraï É. [Lymph node management in endometrial cancer]. Bull Cancer 2019; 107:686-695. [PMID: 31648773 DOI: 10.1016/j.bulcan.2019.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/16/2019] [Indexed: 01/03/2023]
Abstract
In 2018, around 382,100 new cases of endometrial cancer (EC) were reported worldwide, accounting for about 4.4% of all new cases of cancer in women. In France, in 2018, the EC is the first gynecological cancer in incidence and the fourth cancer in women. The rationale for the therapeutic management of EC is based on the estimation of a theoretical risk of recurrence and lymph node metastasis using MRI and preoperative biopsy criteria. However, lymph node status remains the determining factor of adjuvant treatment. In order to reduce the morbidity of lymphadenectomy, the concept of sentinel lymph node biopsy (SLN) has been developed. The SLN technique has evolved in recent years, thanks to the advent of robotics and the creation of fluorescence detection cameras. It has been shown that detection of SLN with Indocyanine Green (ICG) allows for more frequent bilateral migration of 88 to 100% and better detection of pelvic GS in 97% of cases with a decrease in morbidity. Recently, in view of the absence of a therapeutic role of lymph node staging, the operational risks and the delay of adjuvant treatments, in case of pelvic lymph node metastasis on definitive histological examination, the question of secondarily performing paraaortic lymphadenectomy arises. The SLN procedure, extended to all early-stage endometrial cancers, should lead to a major reduction in the use of secondary staging and better adaptation of adjuvant therapy.
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Affiliation(s)
- Clémentine Owen
- AP-HP, université Sorbonne, hôpital Tenon, service de gynécologie obstétrique et médecine de la reproduction humaine, 4, rue de La Chine, 75020 Paris, France.
| | - Sofiane Bendifallah
- AP-HP, université Sorbonne, hôpital Tenon, service de gynécologie obstétrique et médecine de la reproduction humaine, 4, rue de La Chine, 75020 Paris, France; Université Sorbonne, GRC 6 -UPMC : Centre expert en endométriose (C3E), 75005 Paris, France; Faculté de Médecine Sorbonne Université, Site Saint-Antoine, 27, rue Chaligny, 75571 Paris cedex 12, France
| | - Aude Jayot
- AP-HP, université Sorbonne, hôpital Tenon, service de gynécologie obstétrique et médecine de la reproduction humaine, 4, rue de La Chine, 75020 Paris, France
| | - Anna Ilenko
- AP-HP, université Sorbonne, hôpital Tenon, service de gynécologie obstétrique et médecine de la reproduction humaine, 4, rue de La Chine, 75020 Paris, France
| | - Alexandra Arfi
- AP-HP, université Sorbonne, hôpital Tenon, service de gynécologie obstétrique et médecine de la reproduction humaine, 4, rue de La Chine, 75020 Paris, France
| | - Anne Sophie Boudy
- AP-HP, université Sorbonne, hôpital Tenon, service de gynécologie obstétrique et médecine de la reproduction humaine, 4, rue de La Chine, 75020 Paris, France
| | - Sandrine Richard
- AP-HP, université Sorbonne, Alliance pour la recherche en cancérologie (APREC), service d'oncologie médicale, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Justine Varinot
- AP-HP, université Sorbonne, service d'anatomopathologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Isabelle Thomassin-Naggara
- AP-HP, université Sorbonne, service d'anatomopathologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Marc Bazot
- AP-HP, université Sorbonne, UPMC université Paris 6, institut universitaire de cancérologie, hôpital Tenon, service d'imagerie, 4, rue de la Chine, 75020 Paris, France
| | - Émile Daraï
- AP-HP, université Sorbonne, hôpital Tenon, service de gynécologie obstétrique et médecine de la reproduction humaine, 4, rue de La Chine, 75020 Paris, France; Université Sorbonne, GRC 6 -UPMC : Centre expert en endométriose (C3E), 75005 Paris, France; Faculté de Médecine Sorbonne Université, Site Saint-Antoine, 27, rue Chaligny, 75571 Paris cedex 12, France
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Honda M, Tsuchiya A, Isono W, Takahashi M, Fujimoto A, Kawamoto M, Nishii O. Endophytic-Type Endometrial Cancer with Adenomyosis Successfully Diagnosed with Hysteroscopic Endometrial Biopsy Using an 8.3-mm Operative Resectoscope: A Case Report. Case Rep Oncol 2018; 11:311-317. [PMID: 29928209 PMCID: PMC6006659 DOI: 10.1159/000489084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 11/21/2022] Open
Abstract
In order to diagnose endometrial cancer preoperatively, outpatient endometrial biopsy with a curette is frequently performed owing to its convenience. However, in some cases, gynecologists fail to diagnose endometrial cancer via outpatient endometrial biopsy because of the cancer's distribution in the uterus and its consistency. A 57-year-old Japanese woman (gravida 4 para 4) presented with a 6-month history of light but intermittent postmenopausal vaginal bleeding. A malignant uterine tumor was strongly suspected after imaging using ultrasound examination and magnetic resonance imaging; however, a precise pathological diagnosis was not achieved despite multiple outpatient endometrial biopsies with the aid of office hysteroscopy. Based on an endometrial biopsy obtained using a cutting loop electrode on an 8.3-mm operative resectoscope, we reached a diagnosis of endophytic-type endometrial cancer, which is in accordance with the final pathological diagnosis after abdominal hysterectomy. Three months after her first visit to our hospital, total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic/para-aortic lymph node dissection were performed. Macroscopically, the endometrium was atrophic, and there was no obvious mass in the uterine cavity; however, microscopically, the cancer cells mainly existed in the deep myometrium and the final diagnosis was International Federation of Gynecology and Obstetrics (FIGO) stage IB endometrial cancer. Operative biopsy of the uterine endometrium and deep myometrium using hysteroscopy confirmed an accurate preoperative diagnosis of uterine endometrial cancer specifically of the endophytic type.
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Affiliation(s)
- Michiko Honda
- Department of Obstetrics and Gynecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Japan
| | - Akira Tsuchiya
- Department of Obstetrics and Gynecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Japan
| | - Wataru Isono
- Department of Obstetrics and Gynecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Japan
| | - Mikiko Takahashi
- Department of Pathology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Japan
| | - Akihisa Fujimoto
- Department of Obstetrics and Gynecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Japan
| | - Masashi Kawamoto
- Department of Pathology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Japan
| | - Osamu Nishii
- Department of Obstetrics and Gynecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Japan
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