Diagnostic Performance of Computed Tomography for Preoperative Staging of Patients with Non-endometrioid Carcinomas of the Uterine Corpus

Abstract

Purpose The aim of this study was to assess the diagnostic performance of computed tomography (CT) for initial staging of non-endometrioid carcinomas of the uterine corpus. Materials and Methods Waiving informed consent, the Institutional Review Board approved this Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study of 193 women with uterine papillary serous carcinomas, clear cell carcinomas, and carcinosarcomas, who underwent surgical staging between May 1998 and December 2011 and had preoperative CT within 6 weeks before surgery. Two radiologists (R1, R2) independently reviewed all CT images. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and area under the curve were calculated using operative notes and surgical pathology as the reference standard. Results The respective sensitivities and specificities achieved by R1/R2 were 0.79/0.64 and 0.87/0.75 for detecting deep myometrial invasion (MI) on CT; 0.56/0.63 and 0.93/0.79 for detecting cervical stromal invasion; 0.52/0.45 and 0.95/0.93 for detecting pelvic nodal metastases; and 0.45/0.30 and 0.98/0.98 for detecting para-aortic nodal metastases. Although CT had suboptimal sensitivity for the detection of omental disease, it had high PPV for omental seeding at surgical exploration (1.00 for R1 and 0.92 for R2). Inter-observer agreement ranged from moderate in the detection of deep MI (κ = 0.42 ± 0.06) to almost perfect in the detection of para-aortic nodal metastases (κ = 0.88 ± 0.08). Conclusion In patients with uterine non-endometrioid carcinomas, CT is only moderately accurate for initial staging but may provide clinically valuable information by ‘ruling-in’ isolated para-aortic lymph node metastases and omental dissemination.

Synthesis, Characterization, and Biological Evaluation of Anti-HER2 Indocyanine Green-Encapsulated PEG-Coated PLGA Nanoparticles for Targeted Phototherapy of Breast Cancer Cells

“…Currently, in addition to serving as a fluorophoric agent for use in diagnostic purposes such as NIR image-guided oncologic surgery [14], fluorescence angiography [15], and lymph node detection of cancer [16], ICG has been exploited as a photosensitizer for use in cancerous phototherapy including breast, brain, and skin tumors [17–19] since it enables to produce heat and ROS (i.e., singlet oxygen) upon NIR irradiation. Although ICG is of particular advantage for use in cancer phototherapy, it adversely tends to disintegrate in aqueous medium and such degradation can be markedly accelerated by light irradiation (photodegradation) and/or heating (thermal degradation) [20].…”

The Role of Monoclonal Antibody Targeted Therapy in Uterine Sarcomas

“…Neoplastic pathologies can not benefit from a correct and effective therapeutic attitude in the absence of imaging. Initially, when there is suspicion of a pelvic tumor on the basis of patient's symptoms and bio-humoral investigations, it is recommended to perform a thoraco-abdomino-pelvic computerized tomographic scan with contrast agent to assess the location, size and consistency tumor, relationships with surrounding tissues, or distant extension [14]. Magnetic Resonance and PET-CT are imaging investigations that add extra features to describing neoplasia.…”

Imaging Recommendations for Diagnosis, Staging, and Management of Uterine Cancer

“…In comparative studies of CT with US or MRI for myometrial invasion, the accuracy of CT is reported to be 58% to 61% versus 68% to 69% for US and 88% to 89% for MRI. 21,22 In select cases, CT chest and abdomen is indicated as a part of metastatic workup.…”