Absolute depth of myometrial invasion in endometrial cancer is superior to the currently used cut-off value of 50%

Geels, Yvette P.; Pijnenborg, Johanna M.A.; Erp, S.H.M. van den Berg-van; Snijders, Marc P.L.M.; Bulten, Johan; Massuger, Leon F.A.G.

doi:10.1016/j.ygyno.2013.02.013

Cited by 28 publications

(37 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Reproducibility of TFD was calculated for all three previously reported cutoff values: ≤1.75 or >1.75 mm (including no invasion), ≤7 or >7 mm (including no invasion), and ≤10 or >10 mm (including no invasion) [6, 7, 9, 10]. Only one earlier study described a cutoff for DOI, which was categorized as <4 mm (including no invasion) or ≥4 mm [9]. …”

Section: Methodsmentioning

confidence: 99%

“…A study comparing TFD and DOI and another study comparing %MI, TFD, and DOI concluded that TFD is superior in predicting disease extension as well as outcome [6, 7]. Two comparable studies, on the other hand, have shown that DOI is superior in predicting nodal involvement, recurrent disease, and disease-related mortality [8, 9]. One study comparing TFD and DOI concluded that DOI is a stronger predictor of outcome, but TFD is easier to measure, but kappa statistics were not reported [10].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reproducibility of measurement of myometrial invasion in endometrial carcinoma

et al. 2016

View full text Add to dashboard Cite

Myometrial invasion (MI) as a percentage (%MI), categorized into <50 or ≥50 %, is an important predictor of prognosis in endometrial carcinoma. Recent studies suggest that tumor-free distance (TFD) to serosa and the absolute depth of invasion (DOI) might be stronger predictors of prognosis. Although reproducibility is important in clinical practice for patient prognostication and treatment, reproducibility of these methods for the measurement of MI is largely unknown. One or two slides from 50 patients with FIGO stage I endometrioid endometrial carcinoma were viewed by seven gynecological pathologists, who were requested to measure %MI, TFD, and DOI. We categorized %MI as <50 % (including no MI) or ≥50 %, TFD as ≤1.75 or >1.75 mm (including no MI), ≤7 or >7 mm (including no MI), and ≤10 or >10 mm (including no MI) and DOI as <4 mm (including no MI) or ≥4 mm. Light’s kappa for multi-rater agreement was calculated. The %MI, TFD, and DOI could be measured in 88, 83, and 79 % of cases, respectively. Kappa was 0.75 for %MI, 0.77, 0.73, and 0.69 respectively for TFD with cutoffs of 1.75, 7, and 10 mm, and 0.59 for DOI. Pathologists reach substantial agreement when measuring %MI and TFD and moderate agreement when measuring DOI. The %MI can be measured in more cases than TFD and DOI. This supports the use of %MI in daily clinical practice, but future studies should compare %MI and TFD more extensively, including inter-observer variability.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reproducibility of measurement of myometrial invasion in endometrial carcinoma

et al. 2016

View full text Add to dashboard Cite

show abstract

“…To our knowledge, this is the first study demonstrating the superiority of MI compared to TFD and DMI in predicting EC outcomes. This can be explained by the reduced number of patients included in this study compared with other study (11,14). Besides, the lack of equitable distribution of histological types with a large predominance of endometroid carcinoma seems to influence the results of the study.…”

Section: Discussionmentioning

confidence: 83%

“…It is associated with recurrence, overall survival, and lymph node involvement (11). In this study, the ability of 50% MI, DMI and TFD to predict recurrence and death from disease was investigated.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, authors showed that depth of MI can predict nodal involvement independently when compared with TFD. On the other hand, several studies have shown that TFD is superior than DMI and 50% MI in predicting disease extension as well as outcome (11,13). Chattopadhyay et al (10) demonstrated that TFD is an independent predictor of disease specific survival, recurrence and pelvic lymph node involvement.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of tumor‑free distance and depth of myometrial invasion as prognostic factors in endometrial cancer

et al. 2018

View full text Add to dashboard Cite

Abstract. The aim of the study was to investigate whether the tumor free distance (TFD), which is the distance in millimeters between the deepest point of invasion and the serosal surface, and absolute depth of invasion (DMI), the distance in millimeters between the endomyometrial junction and the deepest point of myometrial invasion, are useful in surgical staging and in predicting prognosis. The present study retrospectively analyzed 62 cases of endometrial carcinoma with complete surgical staging, carried out over a 4 and half-year period (January 2003 to June 2007). All surgicopathological findings including surgical stages, histological type and grade, myometrial invasion, lymphovascular space invasion, cervical and adnexal involvement, and lymph node metastasis were abstracted from medical records and pathological reports. Univariate and multivariate analyses were performed comparing TFD, DMI and the percentage of mypmetrial invasion (MI) with established prognostic factors. A total of 62 patients were included in the study. A total of 52 (84%) had endometrioid carcinomas and 31 patients (60%) had grade 1 cancer. The deepest MI was <50% in 32 patients (52%). Median DMI was 2.7 mm (range 0-15 mm). Median TFD was 3 mm (range 0-19 mm). There was lymphovascular space invasion (LVSI) in 11 patients (17.5%), cervical involvement in 11 patients (17.5%), extra-uterine extension in 9 cases (14%) and lymph node metastasis in 12 patients (22%). It was demonstrated that 50% MI was significantly associated with prognostic factors (cervical involvement, type 2 carcinomas and LVSI, and was a significant predictor of the 5-year overall survival rate and recurrence-free survival (P=0.05, P=0.01). No significant association was observed between DMI and TFD with clinicopathological parameters and survival rates. The importance of DMI in predicting recurrence of disease was observed to be highest in terms of sensitivity and specificity. The cut-off value with the highest sensitivity and specificity crossing the receive operating characteristic curve was calculated to be 3 mm for DMI and 2.5 mm for TFD. The results indicate that DMI is a superior predictive factor of recurrence of the disease compared with TFD. However, further studies are required in order to prove the prognostic usefulness of these parameters and then to improve management of endometrial cancer. IntroductionEndometrial carcinoma is the most common of all the gynecologic malignancies and its incidence is rising (1,2). Surgical staging is an important determinant of adjuvant therapy. Whilst most patients with early stage disease have a good prognosis, the prognosis for patients with recurrent or advanced disease at presentation, i.e., advanced stage, incurable by surgery or radiotherapy, is poor. The most important parameter to elaborate the surgical stage is the depth of myometrial invasion (3,4). The percentage of myometrial invasion (%MI) is routinely determined in hysterectomy specimens and categorized as greater than or less than 50% and it is one of the ...

show abstract