Role of preoperative magnetic resonance imaging and histological assessment in identifying patients with a low risk of endometrial cancer: a Korean Gynecologic Oncology Group ancillary study
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Jung-Yun Lee1, Yun Hwan Kim2, Jong-Min Lee3, Kidong Kim4, Sokbom Kang5, Myong Cheol Lim5, Beob-Jong Kim6, Bang Hyun Lee7 and Jae Weon Kim8
1Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
2Department of Obstetrics and Gynecology, Ehwa University College of Medicine, Seoul, Korea
3Department of Obstetrics and Gynecology, Kyung Hee University College of Medicine, Seoul, Korea
4Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
5Gynecologic Oncology Research Branch, Research Institute and Hospital, and Department of Cancer Control and Public Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
6Department of Obstetrics and Gynecology, Korea Cancer Hospital, Korea Cancer Institute of Radiological and Medical Sciences, Seoul, Korea
7Department of Obstetrics and Gynecology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
8Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
Jong-Min Lee, email: email@example.com
Keywords: endometrial cancer; guideline; low risk; lymphadenectomy; magnetic resonance imaging
Received: July 04, 2017 Accepted: October 30, 2017 Published: November 20, 2017
Preoperative identification of individuals at low risk of lymph node metastasis is key to the proper management of endometrial cancer. This study evaluated the role of preoperative assessment based on magnetic resonance imaging (MRI) and histological analysis in identifying a group having a low risk of lymph node metastasis. Data of 529 patients with endometrial cancer were obtained from a prospective multicenter database, between January 2012 and December 2014. Clinical staging, based on MRI and histological analysis, was compared with final pathology results after the surgical staging procedure. The preoperative low-risk criteria, based on current guidelines from Korea, France, and Canada, and criteria used for fertility-sparing therapies, were applied to our multicenter cohort and the accuracy of each set of criteria for identifying group at low risk of lymph node metastasis was evaluated. When considering grades or MR stages separately, the overall agreement between preoperative and postoperative findings was poor (Kappa 0.45 for grades; 0.41 for stages). However, when combining these two parameters, the low-risk group, as defined by any of the guidelines, had an acceptable rate of lymph node metastasis (below 3%). The French guidelines identified 249 patients (47.1%) as being in the low-risk group. Criteria used to define fertility-sparing therapy candidates identified 48 patients (9.1%) among the study population, only one of whom had extra-uterine disease. This study shows that the current guidelines, using preoperative assessment based on MRI and histological analysis, can identify low-risk patients, who may be candidates for omitting lymphadenectomy.
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