Surgical pathologic spread patterns of endometrial cancer: A gynecologic oncology group study

Creasman, William T.; Morrow, C. Paul; Bundy, Brian N.; Homesley, Howard D.; Graham, James E.; Heller, Paul B.

doi:10.1002/1097-0142(19901015)60:8+<2035::aid-cncr2820601515>3.0.co;2-8

Cited by 1,883 publications

(1,238 citation statements)

References 3 publications

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“…Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of both 3.0 T and 1.5 T imaging were calculated for diagnosis of myometrial invasion, cervical invasion, and lymph node metastases. For the analyses, only two classifications were used for depth of myometrial invasion: absent or less than 50% and 50% or more, because patients with 50% or greater myometrial invasion are at much greater risk for pelvic and lumboaortic lymph node metastases (3). These values were determined by using confidence scores of 4 or 5 indicating a positive diagnosis.…”

Section: Resultsmentioning

confidence: 99%

MR imaging of endometrial carcinoma for preoperative staging at 3.0 T: Comparison with imaging at 1.5 T

Hori

Kim

Murakami

et al. 2009

Magnetic Resonance Imaging

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Purpose:To prospectively compare magnetic resonance imaging (MRI) at 3.0 T and 1.5 T in the same patients for preoperative evaluation of endometrial carcinoma. Materials and Methods:Thirty consecutive patients with endometrial carcinoma underwent MRI at both 3.0 T and 1.5 T as well as surgery. Quantitative and qualitative analyses were performed. Two radiologists independently evaluated images. MR findings were compared with surgicopathologic findings.Results: Image homogeneity of T2-weighted images at 3.0 T was significantly inferior to that at 1.5 T (P ϭ 0.007). The scores of image homogeneity and susceptibility artifacts were not significantly different between 3.0 T gadoliniumenhanced imaging and 1.5 T imaging (P ϭ 0.09 and 0.36). Kappa statistics showed good interobserver agreement between the two radiologists for local-regional staging on T2-weighted images ( Ͼ0.6). The area under the receiver operating characteristic curve (Az) values for T2-weighted imaging in terms of myometrial invasion, cervical invasion, and lymph node metastases were 0.88 (3.0 T) versus 0.91 (1.5 T), 0.84 versus 0.83, and 0.94 versus 0.95 for reader 1, respectively. There were no significant differences between imaging at 3.0 T and at 1.5 T in Az values for either reader (P Ͼ 0.35).Conclusion: 3.0 T MRI is an equivalent imaging modality to 1.5 T imaging for presurgical evaluation of endometrial carcinoma, although not significantly superior to 1.5 T imaging.

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Section: Resultsmentioning

confidence: 99%

MR imaging of endometrial carcinoma for preoperative staging at 3.0 T: Comparison with imaging at 1.5 T

Hori

Kim

Murakami

et al. 2009

Magnetic Resonance Imaging

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“…Other prognostic factors that may impact survival include complete surgical staging and extent of lymph node dissection (Creasman et al, 1987;Chan et al, 2003;Huh et al, 2003). All patients in this study underwent surgical staging based on FIGO criteria and the majority of patients with early stage disease had a lymph node assessment.…”

Section: Discussionmentioning

confidence: 99%

“…Uterine papillary serous carcinoma and CC histologies have also been identified as distinct variants of endometrial cancer with a propensity for extrauterine spread and poor prognosis (Clement and Young, 2004). Furthermore, previous studies have shown that women with G3EC have a significant risk for nodal metastases at 28% (Creasman et al, 1987). However, other authors have not been able to show a survival difference between UPSC and CC compared to G3EC (Alektiar et al, 2002;Creasman et al, 2004).…”

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confidence: 99%

Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers

Cheung²,

et al. 2006

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To compare the survival of women with uterine papillary serous carcinoma (UPSC) and clear cell carcinoma (CC) to those with grade 3 endometrioid uterine carcinoma (G3EC). Demographic, pathologic, treatment, and survival information were obtained from the Surveillance, Epidemiology, and End Results Program from 1988 to 2001. Data were analysed using Kaplan -Meier and Cox proportional hazards regression methods. Of 4180 women, 1473 had UPSC, 391 had CC, and 2316 had G3EC cancers. Uterine papillary serous carcinoma and CC patients were older (median age: 70 years and 68 vs 66 years, respectively; Po0.0001) and more likely to be black compared to G3EC (15 and 12% vs 7%; Po0.0001). A higher proportion of UPSC and CC patients had stage III -IV disease compared to G3EC patients (52 and 36% vs 29%; Po0.0001). Uterine papillary serous carcinoma, CC and G3EC patients represent 10, 3, and 15% of endometrial cancers but account for 39, 8, and 27% of cancer deaths, respectively. The 5-year disease-specific survivals for women with UPSC, CC and G3EC were 55, 68, and 77%, respectively (Po0.0001). The survival differences between UPSC, CC and G3EC persist after controlling for stage I -II (74, 82, and 86%; Po0.0001) and stage III -IV disease (33, 40, and 54; Po0.0001). On multivariate analysis, more favourable histology (G3EC), younger age, and earlier stage were independent predictors of improved survival. Women with UPSC and CC of the uterus have a significantly poorer prognosis compared to those with G3EC. These findings should be considered in the counselling, treating and designing of future trials for these high-risk patients.

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“…9 However, several studies published subsequently showed that clinical staging had an unacceptably high inaccuracy rate, failing to detect extra-uterine spread of disease in at least 15-20% of cases. [10][11][12][13][14][15][16] Additionally, one of the main reasons for clinical staging, the administration of preoperative radiotherapy, fell into disfavor among gynecologists in the mid-1980s. Thus, following the tri-annual meeting of the oncology committee of FIGO in 1988, it was recommended that all endometrial cancers be surgically staged if the patient has an acceptable risk-to-benefit ratio for surgery.…”

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confidence: 99%

Upstaging based solely on positive peritoneal washing does not affect outcome in endometrial cancer

et al. 2005

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Surgical staging of endometrial carcinoma includes the collection of peritoneal washings in the abdomen and pelvis. A positive finding upstages patients to International Federation of Gynecology and Obstetrics stage IIIA. However, the prognostic significance of such an upstaging, and thus the justification for the routine performance of this procedure, is unclear. This 5-year retrospective study was conducted to determine the frequency and prognostic significance of upstaging of endometrial carcinoma based solely on positive washings. The cohort for the study was collected by review of pathology reports of all washings that were performed prior to hysterectomies for suspected endometrial carcinomas over a 5-year period (01/1995-12/ 1999). Cases with positive cytology were selected if there was no grossly apparent intraperitoneal disease, no histologic evidence of extra-uterine tumor and the cases would otherwise have been considered stage I or II (case group). An age-matched control group was selected of stage I and II patients with the same histologic subtypes and negative washings (n ¼ 19). Of 220 endometrial carcinomas, peritoneal washing cytology was abnormal in 19 (8.6%) and was solely responsible for upstaging only 10 patients (4.5% of all cases, eightendometrioid, one-serous, one-mixed; nine stage IA or IB and one stage IIB). Adjuvant therapy was administered in 90% of the case group and 74% of the control group. After a median follow-up of 51 months (case group) and 63 months (control group), we found only a single patient with progression of disease (recurrence, metastases or death) in the control group. It is concluded that abnormal cytology without other evidence of extrauterine disease leads to upstaging of a minority of endometrial carcinoma patients (4.5%), but does not appear to affect their overall outcome. Although this is a small single site study, it raises questions about the value of this procedure in patients with endometrial cancer.

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Surgical pathologic spread patterns of endometrial cancer: A gynecologic oncology group study

Cited by 1,883 publications

References 3 publications

MR imaging of endometrial carcinoma for preoperative staging at 3.0 T: Comparison with imaging at 1.5 T

MR imaging of endometrial carcinoma for preoperative staging at 3.0 T: Comparison with imaging at 1.5 T

Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers

Upstaging based solely on positive peritoneal washing does not affect outcome in endometrial cancer

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