Accuracy of a nomogram for prediction of lymph-node metastasis detected with conventional histopathology and ultrastaging in endometrial cancer

Abstract

Background:We developed a nomogram based on five clinical and pathological characteristics to predict lymph-node (LN) metastasis with a high concordance probability in endometrial cancer. Sentinel LN (SLN) biopsy has been suggested as a compromise between systematic lymphadenectomy and no dissection in patients with low-risk endometrial cancer.Methods:Patients with stage I–II endometrial cancer had pelvic SLN and systematic pelvic-node dissection. All LNs were histopathologically examined, and the SLNs were examined by immunohistochemistry. We compared the accuracy of the nomogram at predicting LN detected with conventional histopathology (macrometastasis) and ultrastaging procedure using SLN (micrometastasis).Results:Thirty-eight of the 187 patients (20%) had pelvic LN metastases, 20 had macrometastases and 18 had micrometastases. For the prediction of macrometastases, the nomogram showed good discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.76, and was well calibrated (average error =2.1%). For the prediction of micro- and macrometastases, the nomogram showed poorer discrimination, with an AUC of 0.67, and was less well calibrated (average error =10.9%).Conclusion:Our nomogram is accurate at predicting LN macrometastases but less accurate at predicting micrometastases. Our results suggest that micrometastases are an ‘intermediate state' between disease-free LN and macrometastasis.

Sentinel lymph node procedure in endometrial cancer: A systematic review and proposal for standardization of future research

“…Eleven studies were excluded because of subsequent more comprehensive publications on the same database. One exception was Koskas et al [21], which included patients from the landmark SENTI-ENDO paper [22]. We chose to exclude the more recent and larger study because the outcome measures of interest in our review were more comprehensively reported in SENTI-ENDO.…”

Prognostic value of 18F-FDG PET/CT for identifying high- and low-risk endometrial cancer patients

“…The low sensitivity of PET/CT for determining lymph-node metastasis in endometrial cancer patients is the main shortcoming of this test as a diagnostic tool [15]. Omitting patients who need lymphadenectomy carries a risk of inadequate staging, leading to secondary lymphadenectomy or systematic adjuvant radiotherapy [18]. Discrepancy rates have been stated as up to 33% in some studies [19].…”

“…All patients fasted for at least 6 hours before the PET/CT imaging. 18 F-FDG (3.7 MBq/kg body weight) was administered antecubitally. After a 60-90-minute uptake period, whole-body PET/CT was performed.…”

“…Given the invasive nature of the staging process, surgeons tend to rely on a detailed preoperative imaging evaluation to determine appropriate therapeutic management [5]. 18 F-Fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) is an imaging method that can be used to obtain anatomic and metabolic data on cancer cells in various malignancies [6][7][8]. Several studies have examined the usefulness of 18 F-FDG PET/CT for determining the presence, stage, and aggressiveness of endometrial cancer [9,10].…”

Staging for endometrial cancer: The controversy around lymphadenectomy – Can this be resolved?

“…The frequency of such "low-volume, ultrastage-detected LN metastases" has been reported to be around 5% and interestingly, in such patients, the rate of micrometastases and isolated tumor cells does not seem to be correlated with myometrial invasion 99 and primary tumoral aggressiveness 100 . However, the oncologic significance of "low volume LN metastases" has not been reported yet.…”