A cost-effectiveness analysis of three approaches for lymph node assessment in patients with low- and intermediate-risk endometrial cancer

Burg, L; Vermeulen, R.; Bekkers, Ruud L.M.; Wijn, Stan R W; Rovers, Maroeska M.; Govers, Tim M.; Zusterzeel, Petra L.M.

doi:10.1016/j.ygyno.2021.01.035

Cited by 13 publications

(12 citation statements)

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“…Based on information in this analysis the total calculated saving of algorithm D compared to SLND in all women could be 705 Euros per cancer patient and overall lymphedema risk could be reduced (appendix C). Another cost-effectiveness study on grade 1À2 endometrioid tumors included, cost of lymphedema treatment for 10 years [27]. The calculated savings by selection of SLND based on algorithm D were comparable in the two studies [26,27].…”

Section: Discussionmentioning

confidence: 99%

“…Another cost-effectiveness study on grade 1À2 endometrioid tumors included, cost of lymphedema treatment for 10 years [27]. The calculated savings by selection of SLND based on algorithm D were comparable in the two studies [26,27]. Price and lymphedema reduction depends on many factors, but in settings with limited resources, this low-cost simple but effective setup to identify high-risk women is advantageous.…”

Section: Discussionmentioning

confidence: 99%

“…In total, selection of SLND based on algorithm D generated a calculated savings of at least 705 Euros per patient and reduction of lymphedema from 7% to 5% compared to the alternative of a SLND procedure in all patients. Table C3 Appendix C include patients with grade 1À2 endometrioid tumors and calculations are based on a Dutch costeffective study including lymphedema treatment for ten years [27]. The calculated savings were comparable in the two studies [26,27].…”

Section: Cost Effectiveness Of Algorithm Dmentioning

confidence: 99%

“…Table C3 Appendix C include patients with grade 1À2 endometrioid tumors and calculations are based on a Dutch costeffective study including lymphedema treatment for ten years [27]. The calculated savings were comparable in the two studies [26,27].…”

Section: Cost Effectiveness Of Algorithm Dmentioning

confidence: 99%

“…Reported rate of lymphedema after LND vary from 3 to 38% and was calculated to be 20 % after LND [26]. Rate of lymphedema after SLND was calculated to be 5% after sentinel lymph node dissection (SLND) [26,27]. A few studies have reported lower lymphedema rates after SLND [15,19].…”

Section: Cost Effectiveness Of Algorithm Dmentioning

confidence: 99%

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Preoperative prediction of high-risk endometrial cancer by expert and non-expert transvaginal ultrasonography, magnetic resonance imaging, and endometrial histology

Dueholm

Hjorth

Dahl

et al. 2021

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective: To identify women with high-risk endometrial cancers using expert and non-expert transvaginal ultrasonography (TVS) and MRI. Study design: Myometrial involvement was prospectively evaluated in patients with atypical hyperplasia or endometrial cancer on ultrasound by non-experts at first visit (non-expert-TVS: n = 266) and experts (expert-TVS: n = 188) at second visit. MRI (n = 175) was performed when high-risk cancer was suspected on non-expert-TVS. Preoperatively, high-risk cancer was defined as myometrial involvement !50 %, or preoperative unfavorable tumor histology (grade 3 endometrioid, non-endometrioid tumors, or tumor in cervical biopsies) obtained by endometrial sampling or hysteroscopic biopsies. Preoperative evaluations were compared with final histopathology obtained at surgery, high-risk cancer being defined as unfavorable tumor histology or patients with FIGO stage !1b. Results: Preoperative unfavorable tumor histology was seen in 64 women and correctly identified 63 of 128 high-risk cancers. Preoperative diagnosis of unfavorable tumor histology or myometrial involvement !50 %, i.e. judged high-risk, had an area under the curve (AUC), sensitivity, and specificity of 79.5 %, 93.8 %, 65.2 % on non-expert-TVS; 85.5 %, 84.4 %, 86.5 % on expert-TVS, and 85.4 %, 89.6 %, 81.2 % on MRI. AUC values were not significantly different between MRI and expert-TVS, but lower on non-expert-TVS (p < 0.02). However, sensitivity was highest on non-expert-TVS, where a low cutpoint for myometrial involvement was used (included potentially deep and difficult evaluations) in contrast to an exact cutpoint of myometrial involvement !50 % used on expert-TVS and MRI.The highest AUC, 88.6 %, was seen when MRI was performed in patients with myometrial involvement !50 %, determined on non-expert TVS. Sensitivity was reduced to 85.9 %, while specificity increased to 91.3 %. Thus, MRI was needed for risk classification in only 104 (39 %) patients. Conclusion: Diagnostically, expert-TVS and MRI were comparable and superior to non-expert-TVS. However, non-expert-TVS classified all patients with unclear myometrial involvement !50 %, and thereby only misdiagnosed 6.2 % of high-risk cases. Non-expert-TVS combined with MRI when myometrial involvement was !50 % on non-expert-TVS was a simple and effective method comparable with expert imaging to identify low-and high-risk cancer and select patients for SLND. Addition of MRI to the diagnostic regimen was needed in only 39 % of our patients.

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Section: Discussionmentioning

confidence: 99%