Clinical utility of preoperative computed tomography in patients with endometrial cancer

Giorgio Bogani, Bobbie S. Gostout, Sean C. Dowdy, Francesco Multinu, Jvan Casarin, William A. Cliby, Luigi Frigerio, Bohyun Kim, Amy L. Weaver, Gretchen E. Glaser, Andrea Mariani

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Objective: The aim of this study was to determine the clinical utility of routine preoperative pelvic and abdominal computed tomography (CT) examinations in patients with endometrial cancer (EC). Methods: We retrospectively reviewed records from patients with EC who underwent a preoperative endometrial biopsy and had surgery at our institution from January 1999 through December 2008. In the subset with an abdominal CT scan obtained within 3 months before surgery, we evaluated the clinical utility of the CT scan. Results: Overall, 224 patients (18%) had a preoperative endometrial biopsy and an available CT scan. Gross intra-abdominal disease was observed in 10% and 20% of patients with preoperative diagnosis of endometrioid G3 and type II EC, respectively, whereas less than 5% of patients had a preoperative diagnosis of hyperplasia or low-grade EC. When examining retroperitoneal findings, we observed that a negative CT scan of the pelvis did not exclude the presence of pelvic node metastasis. Alternately, a negative CT scan in the para-aortic area generally reduced the probability of finding para-aortic dissemination but with an overall low sensitivity (42%). However, the sensitivity for para-aortic dissemination was as high as 67% in patientswithG3endometrioid cancer. In the case of negative para-aortic nodes in theCTscan, the risk of para-aortic node metastases decreased from 18.8% to 7.5% in patients with endometrioid G3 EC. Up to 15% of patients with endometrioid G3 cancer had clinically relevant incidental findings that necessitated medical or surgical intervention. Conclusions: In patients with endometrioid G3 and type II EC diagnosed by the preoperative biopsy, CT scans may help guide the operative plan by facilitating preoperative identification of gross intra-abdominal disease and enlarged positive para-aortic nodes that are not detectable during physical examinations. In addition, CT may reveal other clinically relevant incidental findings.

Original languageEnglish (US)
Pages (from-to)1685-1693
Number of pages9
JournalInternational Journal of Gynecological Cancer
Volume27
Issue number8
DOIs
StatePublished - Jan 1 2017

Keywords

  • Computed tomography
  • Costs
  • Endometrial cancer
  • Minimally invasive surgery
  • Staging

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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    Bogani, G., Gostout, B. S., Dowdy, S. C., Multinu, F., Casarin, J., Cliby, W. A., Frigerio, L., Kim, B., Weaver, A. L., Glaser, G. E., & Mariani, A. (2017). Clinical utility of preoperative computed tomography in patients with endometrial cancer. International Journal of Gynecological Cancer, 27(8), 1685-1693. https://doi.org/10.1097/IGC.0000000000001076