The Medical journal of Malaysia · 2025
The accuracy of intraoperative assessment of myometrial invasion in early-stage endometrial cancer and its association with lymph nodes metastasis.
Оценочное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Jaafar J D, Omar J, Mohd Abas M N
Аннотация
INTRODUCTION: Assessment of the depth of myometrial invasion is important for optimal surgical strategies and treatments. This study aims to assess the accuracy of intraoperative evaluation of myometrial invasion in FIGO early-stage endometrial cancer and its association with lymph node metastasis, impacting treatment decisions and patient outcomes.
MATERIALS AND METHODS: This is a retrospective study analysis of 150 patients diagnosed preoperatively with earlystage endometrial cancer who underwent surgical staging in Institut Kanser Negara (IKN), Putrajaya from January 2018 until December 2022. After the hysterectomy procedure, all uterine specimens will be opened for intraoperative assessment of the depth of myometrial invasion by a gynae oncology surgeon. According to FIGO classification, the depth was assessed to be either greater or less than 50% of myometrial thickness. Gross estimation during operation will be compared with the final histopathological result. This study aims to evaluate the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of intraoperative myometrial invasion compared to the final histology. Secondly, this research aims to explore the association between depth of myometrial invasion and lymph nodes involvement.
RESULTS: A total of 150 patients were recruited, the sensitivity and specificity of intraoperative assessment in detecting depth of myometrial invasion were 42% and 94%, respectively and the PPV and NPV were 78% and 76%. The overall accuracy was 77%. The sensitivity of only 42% in this study suggested that intraoperative myometrial assessment missed as many as 58% of patients who had deep myometrial invasion. A total of 9 (6%) patients were found to have lymph nodes involvement with 5 of them showing deeper myometrial invasion. Although there was a higher number of lymph node involvement observed in cases with deeper myometrial invasion, the difference was not statistically significant (p > 0.05).
CONCLUSION: We conclude that intraoperative assessment of myometrial invasion is still reliable and inexpensive method to practice. Accuracy of assessment can be improved in integrate MRI.
MATERIALS AND METHODS: This is a retrospective study analysis of 150 patients diagnosed preoperatively with earlystage endometrial cancer who underwent surgical staging in Institut Kanser Negara (IKN), Putrajaya from January 2018 until December 2022. After the hysterectomy procedure, all uterine specimens will be opened for intraoperative assessment of the depth of myometrial invasion by a gynae oncology surgeon. According to FIGO classification, the depth was assessed to be either greater or less than 50% of myometrial thickness. Gross estimation during operation will be compared with the final histopathological result. This study aims to evaluate the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of intraoperative myometrial invasion compared to the final histology. Secondly, this research aims to explore the association between depth of myometrial invasion and lymph nodes involvement.
RESULTS: A total of 150 patients were recruited, the sensitivity and specificity of intraoperative assessment in detecting depth of myometrial invasion were 42% and 94%, respectively and the PPV and NPV were 78% and 76%. The overall accuracy was 77%. The sensitivity of only 42% in this study suggested that intraoperative myometrial assessment missed as many as 58% of patients who had deep myometrial invasion. A total of 9 (6%) patients were found to have lymph nodes involvement with 5 of them showing deeper myometrial invasion. Although there was a higher number of lymph node involvement observed in cases with deeper myometrial invasion, the difference was not statistically significant (p > 0.05).
CONCLUSION: We conclude that intraoperative assessment of myometrial invasion is still reliable and inexpensive method to practice. Accuracy of assessment can be improved in integrate MRI.