1
|
López-González E, García-Jiménez R, Rodríguez-Jiménez A, Rojas-Luna JA, Daza-Manzano C, Gómez-Salgado J, Álvarez RM. Analysis of correlation of pre-therapeutic assessment and the final diagnosis in endometrial cancer: role of tumor volume in the magnetic resonance imaging. Front Oncol 2023; 13:1219818. [PMID: 37655105 PMCID: PMC10467420 DOI: 10.3389/fonc.2023.1219818] [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: 05/12/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Objective To evaluate whether the introduction of tumor volume as new parameter in the MRI assessment could improve both concordance between preoperative and postoperative staging, and the identification of histological findings. Methods A retrospective observational study with 127 patients with endometrial cancer (EC) identified between 2016 and 2021 at the Juan Ramon Jimenez University Hospital, Huelva (Spain) was carried out. Tumor volume was measured in three ways. Analyses of Receiver Operating Characteristic (ROC) curve and the area under the curve (AUC) were performed. Results Although preoperative MRI had an 89.6% and 66.7% sensitivity for the detection of deep mucosal invasion and cervical stroma infiltration, preoperative assessment had an intraclass correlation coefficient of 0.517, underestimating tumor final stage in 12.6% of cases, with a poor agreement between preoperative MRI and postoperative staging (κ=0.082) and low sensitivity (14.3%) for serosa infiltration. The cut-off values for all three volume parameters had good/excellent AUC (0.73-0.85), with high sensitivity (70-83%) and specificity (64-84%) values for all histopathological variables. Excellent/good agreement was found all volume parameters for the identification of deep myometrial invasion (0.71), cervical stroma infiltration (0.80), serosa infiltration (0.81), and lymph node metastases (0.81). Conclusion Tumor volume measurements have good predictive capacity to detect histopathological findings that affect final tumor staging and might play a crucial role in the preoperative assessment of patients with endometrial cancer in the future.
Collapse
Affiliation(s)
- Elga López-González
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Rocío García-Jiménez
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | | | - José Antonio Rojas-Luna
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Cinta Daza-Manzano
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labor Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Program, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Rosa María Álvarez
- Gynecological Oncology and Breast Cancer Unit, Department of Obstetrics and Gynecology, Hospital Universitario Santa Cristina, Madrid, Spain
| |
Collapse
|
2
|
Daix M, Angeles MA, Migliorelli F, Kakkos A, Martinez Gomez C, Delbecque K, Mery E, Tock S, Gabiache E, Decuypere M, Goffin F, Martinez A, Ferron G, Kridelka F. Concordance between preoperative ESMO-ESGO-ESTRO risk classification and final histology in early-stage endometrial cancer. J Gynecol Oncol 2021; 32:e48. [PMID: 33908709 PMCID: PMC8192240 DOI: 10.3802/jgo.2021.32.e48] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/22/2021] [Accepted: 02/06/2021] [Indexed: 01/04/2023] Open
Abstract
Objective To evaluate the concordance between preoperative European Society for Medical Oncology (ESMO)-European Society of Gynaecological Oncology (ESGO)-European SocieTy for Radiotherapy and Oncology (ESTRO) risk classification in early-stage endometrial cancer (EC) assessed by biopsy and magnetic resonance imaging (MRI) with this classification based on histology of surgical specimen. Methods This bicentric retrospective study included women diagnosed with early-stage EC (≤stage II) who had a complete preoperative assessment and underwent a surgical management from January 2011 to December 2018. Patients were preoperatively classified into 3 degrees of risk of lymph node (LN) involvement based on biopsy and MRI. Based on final histological report, patients were re-classified using the preoperative classification. Concordance between the preoperative assessment and definitive histology was calculated with weighted Cohen's kappa coefficient. Results A total of 333 women were included and kappa coefficient of preoperative risk classification was 0.49. The risk was underestimated and overestimated in 37% and 10% of cases, respectively. Twenty-nine percent of patients had an incomplete LN staging according to the degree of risk of re-classification. The observed discordance in the risk classification was attributed to MRI in 75% of cases, to biopsy in 18% and in 7% to both (p<0.001). Kappa coefficient for concordance was 0.25 for MRI and 0.73 for biopsy. Conclusion Concordance between preoperative ESMO-ESGO-ESTRO risk classification and final histology is weak. Given that the risk was underestimated in the majority of patients wrongly classified, sentinel LN procedure instead of no LN dissection could be an option offered to preoperative low-risk patients to decrease the indication of second surgery for re-staging and/or to avoid toxicity of adjuvant radiotherapy.
Collapse
Affiliation(s)
- Manon Daix
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France.,Department of Gynecology, Centre Hospitalier Universitaire, Liège, Belgium.,Department of Gynecology, Centre Hospitalier Chrétien - Mont Légia, Liège, Belgium.
| | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France
| | - Federico Migliorelli
- Department of Gynecology, Centre Hospitalier Intercommunal des Vallées de l'Ariège, Saint Jean de Verges, France
| | - Athanasios Kakkos
- Department of Gynecology, Centre Hospitalier Universitaire, Liège, Belgium
| | - Carlos Martinez Gomez
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France.,Inserm CRCT, Toulouse, France
| | - Katty Delbecque
- Department of Pathology, Centre Hospitalier Universitaire, Liège, Belgium
| | - Eliane Mery
- Department of Pathology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France
| | - Stéphanie Tock
- Department of Gynecology, Centre Hospitalier Chrétien - Mont Légia, Liège, Belgium
| | - Erwan Gabiache
- Department of Medical Imaging, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France
| | | | - Frédéric Goffin
- Department of Gynecology, Centre Hospitalier Universitaire, Liège, Belgium
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France.,Inserm CRCT, Toulouse, France
| | - Gwénaël Ferron
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France.,Inserm CRCT, Toulouse, France
| | - Frédéric Kridelka
- Department of Gynecology, Centre Hospitalier Universitaire, Liège, Belgium
| |
Collapse
|
3
|
Bougherara L, Azaïs H, Béhal H, Canlorbe G, Ballester M, Bendifallah S, Coutant C, Lavoue V, Ouldamer L, Graesslin O, Touboul C, Estevez JP, Collinet P. Does lymphadenectomy improve survival in patients with intermediate risk endometrial cancer? A multicentric study from the FRANCOGYN Research Group. Int J Gynecol Cancer 2018; 29:282-289. [DOI: 10.1136/ijgc-2018-000051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 11/04/2022] Open
Abstract
ObjectiveThe role of lymphadenectomy in intermediate risk endometrial cancer remains uncertain. We evaluated the impact of lymphadenectomy on overall survival and relapse-free survival for patients with intermediate risk endometrial cancer.MethodsWe retrospectively reviewed patients from the FRANCOGYN database with intermediate risk endometrial cancer, based on pre-operative and post-operative criteria (type 1, grade 1–2 tumors with deep (> 50%) myometrial invasion and no lymphovascular space invasion), who received primary surgical treatment between November 2002 and August 2013. We compared overall survival and relapse-free survival between staged and unstaged patients.ResultsFrom 1235 screened patients, we selected 108 patients with intermediate risk endometrial cancer. Eighty-two (75.9%) patients underwent nodal staging (consisting of pelvic +/- para-aortic lymphadenectomy). Among them, 35 (32.4%) had lymph node disease. The median follow-up was 25 months (range 0.4 to 155.0). The overall survival rates were 82.5% for patients staged (CI 64.2 to 91.9) vs 77.9 % for unstaged patients (CI 35.4 to 94.2) (P = 0.73). The relapse-free survival rates were 68.9% for staged patients (CI 51.2 to 81.3) vs 68.8% for unstaged patients (CI 29.1 to 89.3) (P=0.67).ConclusionSystematic nodal staging does not appear to improve overall survival and relapse-free survival for patients with IR EC but could provide information to tailor adjuvant therapy. Sentinel lymph node dissection may be an effective and less invasive alternative staging technique and should provide a future alternative for this population.
Collapse
|
4
|
Komiyama S, Takeya C, Takahashi R, Nagasaki S, Kubushiro K. Less Invasive Endometrial Cancer Surgery with Extraperitoneal Pelvic and Para-aortic Lymphadenectomy via a Small Midline Abdominal Incision and the Retroperitoneal Approach. J Cancer 2016; 7:890-9. [PMID: 27313778 PMCID: PMC4910580 DOI: 10.7150/jca.14987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/15/2016] [Indexed: 11/17/2022] Open
Abstract
[Objective] To achieve less invasive lymphadenectomy in endometrial cancer patients, we performed extraperitoneal pelvic and para-aortic lymphadenectomy via a small midline abdominal incision with retroperitoneal approach. The feasibility and safety of this method were investigated. [Methods] Inclusion criteria were 1) endometrioid adenocarcinoma diagnosed by preoperative biopsy, 2) myometrial invasion by magnetic resonance imaging, and 3) no peritoneal dissemination or distant metastasis by computed tomography. Systematic extraperitoneal dissection of pelvic and para-aortic lymph nodes was performed via an approximately 12-cm midline lower abdominal incision, after which hysterectomy and bilateral salpingo-oophorectomy were done (extraperitoneal group). The historical control group was patients who underwent standard transperitoneal lymphadenectomy followed by hysterectomy and bilateral salpingo-oophorectomy. The two groups were compared for demographic characteristics, perioperative factors, and complications. [Results] A total of 62 patients were enrolled. Demographic and clinicopathological factors showed no differences between the extraperitoneal group (n = 34) and the historical control group (n = 28). The median number of pelvic (30 vs. 28) and para-aortic (14 vs. 17) nodes dissected was also similar. However, median intraoperative blood loss was significantly smaller in the extraperitoneal group than the control group (220 vs. 573 g). Median operating time (265 vs. 323.5 min), median laparotomy time (60 vs. 295 min), and median initial flatus time (8 vs. 32 hours) were all significantly shorter in the extraperitoneal group, while complications and severe postoperative pain were significantly less frequent. [Conclusions] Our new technique was feasible, safe, and less invasive than standard laparotomy. It is an alternative to laparoscope-assisted or robotic procedures.
Collapse
Affiliation(s)
| | - Chiaki Takeya
- Department of Gynecology, Toho University Ohashi Medical Center
| | - Rena Takahashi
- Department of Gynecology, Toho University Ohashi Medical Center
| | - Sumito Nagasaki
- Department of Gynecology, Toho University Ohashi Medical Center
| | | |
Collapse
|
5
|
To what extent is risk grouping method successful in deciding surgical staging in endometrial cancer? TUMORI JOURNAL 2016; 102:422-5. [PMID: 27032702 DOI: 10.5301/tj.5000497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE The aim of this investigation was to evaluate the success rate of risk grouping method for staging surgery by exploring the rate of lymph node metastasis (LNM) in patients with endometrial cancer (EC) according to low-risk (LR) and high-risk (HR) groups. METHODS Patient files were reviewed retrospectively and the data of 268 patients were included in the study who underwent lymph node dissection (LND) for EC. Nodal status, histopathologic type, myometrial invasion (MI), tumor size (TS), and grade (G) were evaluated. In the LR group, all the criteria were required (G 1-2, <1/2 MI, type 1 histology, <2 cm TS), but in the HR group, one of them was enough (G 3 or ≥1/2 MI or type 2 histology or ≥2 cm TS). RESULTS A total of 84 (31.3%) and 184 (68.7%) patients were grouped LR and HR, respectively. In total, 23 patients had LNM (8.5%) out of 268 surgically staged EC patients. Lymph node metastasis was significantly (p = 0.001) more common in the HR group of patients (2.4%, 2/84 LR vs 11.4%, 21/184 HR). Cancer-specific survival (CSS) rates in groups were 96.8% and 88.6%, respectively (p = 0.009). CONCLUSIONS In patients with EC, there is a significant difference between LR and HR groups for LNM and CSS rates. But this method of stratification is not adequate to separate them for deciding whether surgical staging is mandatory. Moreover, even most of the HR patients (163/184, 88.6%) are exposed to unnecessary LND. Perhaps they are not really HR and the HR definition needs to be revised.
Collapse
|
6
|
Body N, de Kerdaniel O, Lavoué V, Leblanc M, Henno S, Levêque J. [Early-stage endometrial cancer: Sentinel node or lymphadenectomy?]. ACTA ACUST UNITED AC 2016; 44:239-43. [PMID: 27053036 DOI: 10.1016/j.gyobfe.2016.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/25/2016] [Indexed: 11/30/2022]
Abstract
The endometrial cancers are mainly discovered at an early stage justifying a less aggressive treatment. The therapeutic choices are today based on preoperative classifications themselves based on histo-prognostic factors of the tumor and its extension measured in MRI: consequently, lymph node dissection in case of low and intermediate risk cancer is not systematically achieved. But a number of patients have lymph node involvement finally, probably justifying an adapted surgical and adjuvant treatment. The technique of sentinel node would compensate the weaknesses of preoperative prognostic evaluation. This new operative technique needs to be precised and evaluated: the topics subject to discussion are the technical implementation, the definition of its quality standards and the management of its histological results especially in cases of low volume lymph node metastasis.
Collapse
Affiliation(s)
- N Body
- Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90 203, 35203 Rennes cedex 2, Breizh, France
| | - O de Kerdaniel
- Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90 203, 35203 Rennes cedex 2, Breizh, France; Service de gynécologie obstétrique, centre hospitalier de Vannes, 56000 Vannes, France
| | - V Lavoué
- Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90 203, 35203 Rennes cedex 2, Breizh, France
| | - M Leblanc
- Service de gynécologie obstétrique, centre hospitalier de Vannes, 56000 Vannes, France
| | - S Henno
- Service d'anatomie et cytologie pathologiques, CHU Pontchaillou, 35000 Rennes, France
| | - J Levêque
- Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90 203, 35203 Rennes cedex 2, Breizh, France.
| |
Collapse
|