Surgical Staging of Endometrial Cancer: Evolution, Evaluation, and Responsible Challenge—A Personal Perspective

Boronow, Richard C.

doi:10.1006/gyno.1997.4732

Cited by 53 publications

(36 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…If the myometrium is not invaded, nodal metastases are rare, irrespective of histologic grade. 13 We demonstrated 14 (11.7%) patients with no myometrial invasion, but in only 3 of them preoperative ultrasonographic evaluation was in agreement with definitive histologic examination. For superficial myometrial invasion, the risk is substantial only for grade 3; for deep myometrial invasion, all grades of tumor present substantial risk.…”

Section: Discussionmentioning

confidence: 65%

High frequency transvaginal ultrasonography in preoperative assessment of myometrial invasion in endometrial cancer.

Arko¹,

Takač²

2000

Journal of Ultrasound in Medicine

View full text Add to dashboard Cite

The aim of the study was to assess the depth of myometrial invasion by endometrial cancer using preoperative 5‐9 MHz, high frequency transvaginal ultrasonography as compared with postoperative assessment using histopathologic examination. The study included 120 patients with histologically proven cancers of the endometrium. All patients underwent transvaginal sonography before surgery. The depth of myometrial invasion was classified as none, inner half of uterine wall, and outer half of uterine wall. Of 106 (88.3%) patients with proven myometrial invasion, 98 cases (92.5%) were revealed by sonography. In 109 cases (90.8%) invasion was believed to be present on transvaginal sonography. Histologically proven invasion that correlated with sonography was shown in 88 patients (73.3%). In 32 patients (26.7%) ultrasonography could not correctly predict the depth of myometrial invasion. The depth of invasion was underestimated in 10 (8.3%) cases and overestimated in 22 (18.3%) cases. Preoperative assessment of invasion of the uterine wall by transvaginal ultrasonography had an accuracy of 73% if correlated with the definitive histopathologic examination. The role of high frequency transvaginal ultrasonography in preoperative assessment of the depth of myometrial invasion in patients with endometrial cancer is limited.

show abstract

Section: Discussionmentioning

confidence: 65%

High frequency transvaginal ultrasonography in preoperative assessment of myometrial invasion in endometrial cancer.

Arko¹,

Takač²

2000

Journal of Ultrasound in Medicine

View full text Add to dashboard Cite

show abstract

“…[1][2][3] Since cancer staging is essentially a categorization of patients based on the extent of a tumor's anatomic spread from its primary site, it should also categorize patients into prognostically distinct groups, in which those patients in a given stage are more comparable to other patients in that stage than they are to patients from the other stages with respect to clinical outcome. 1,3 In cancers of the endometrium, as with most malignant tumors of most organs, stage is the most powerful prognostic parameter.…”

mentioning

confidence: 99%

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

et al. 2005

View full text Add to dashboard Cite

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.

show abstract

“…Some surgeons have argued that the morbidity of lymphadenectomy precludes its use as a prognostic tool in clinical practice [6,12].…”

Section: Prognostic and Therapeutic Informationmentioning

confidence: 99%

“…Complications associated with pelvic lymphadenectomy include vascular and nerve injuries, lymphocyst and lymphedema formation, febrile morbidity, and an increased transfusion rate [6,8,11,31,32]. Despite these risks, many surgeons favor widespread incorporation of lymphadenectomy in endometrial cancer staging and management [14,29••,33].…”

Section: Prognostic and Therapeutic Informationmentioning

confidence: 99%

“…In 1988, the International Federation of Gynecology and Obstetrics changed to a surgical staging classification for endometrial cancer that included assessment of the pelvic and para-aortic lymph nodes [6]. Previously, endometrial cancer had been clinically staged, but studies by the Gynecologic Oncology Group demonstrated that clinical staging failed to identify clinically significant microscopic spread [7].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Endometrial carcinoma

Huh

Straughn

Kelly

et al. 2001

Curr. Treat. Options in Oncol.

View full text Add to dashboard Cite

Endometrial cancer is a common tumor of the female genital tract. The majority of women diagnosed with endometrial cancer present with early-stage disease. Although the optimal treatment for these patients requires hysterectomy, the use of lymphadenectomy is controversial. Growing scientific data support the use of lymphadenectomy in all patients diagnosed with endometrial cancer. When performed by an experienced surgeon, pelvic and para-aortic lymphadenectomy is a safe and potentially therapeutic procedure that provides prognostic information to the patient and physician. This information allows appropriate, cost-effective treatment strategies to be created for all women with endometrial cancer.

show abstract

Surgical Staging of Endometrial Cancer: Evolution, Evaluation, and Responsible Challenge—A Personal Perspective

Cited by 53 publications

References 29 publications

High frequency transvaginal ultrasonography in preoperative assessment of myometrial invasion in endometrial cancer.

High frequency transvaginal ultrasonography in preoperative assessment of myometrial invasion in endometrial cancer.

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

Endometrial carcinoma

Contact Info

Product

Resources

About