Clinical Utility of Preoperative Computed Tomography in Patients With Endometrial Cancer

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

Research output: Contribution to journalArticle

4 Citations (Scopus)

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 patients with G3 endometrioid cancer. In the case of negative para-aortic nodes in the CT scan, 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 : official journal of the International Gynecological Cancer Society
Volume27
Issue number8
DOIs
StatePublished - Oct 1 2017

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Endometrial Neoplasms
Tomography
Incidental Findings
Biopsy
Neoplasm Metastasis
Pelvis
Physical Examination
Hyperplasia
Neoplasms

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Clinical Utility of Preoperative Computed Tomography in Patients With Endometrial Cancer. / Bogani, Giorgio; Gostout, Bobbie S.; Dowdy, Sean Christopher; Multinu, Francesco; Casarin, Jvan; Cliby, William Arthur; Frigerio, Luigi; Kim, Bohyun; Weaver, Amy L.; Glaser, Gretchen E.; Mariani, Andrea.

In: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, Vol. 27, No. 8, 01.10.2017, p. 1685-1693.

Research output: Contribution to journalArticle

Bogani, Giorgio ; Gostout, Bobbie S. ; Dowdy, Sean Christopher ; Multinu, Francesco ; Casarin, Jvan ; Cliby, William Arthur ; Frigerio, Luigi ; Kim, Bohyun ; Weaver, Amy L. ; Glaser, Gretchen E. ; Mariani, Andrea. / Clinical Utility of Preoperative Computed Tomography in Patients With Endometrial Cancer. In: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2017 ; Vol. 27, No. 8. pp. 1685-1693.
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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 patients with G3 endometrioid cancer. In the case of negative para-aortic nodes in the CT scan, 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.",
author = "Giorgio Bogani and Gostout, {Bobbie S.} and Dowdy, {Sean Christopher} and Francesco Multinu and Jvan Casarin and Cliby, {William Arthur} and Luigi Frigerio and Bohyun Kim and Weaver, {Amy L.} and Glaser, {Gretchen E.} and Andrea Mariani",
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T1 - Clinical Utility of Preoperative Computed Tomography in Patients With Endometrial Cancer

AU - Bogani, Giorgio

AU - Gostout, Bobbie S.

AU - Dowdy, Sean Christopher

AU - Multinu, Francesco

AU - Casarin, Jvan

AU - Cliby, William Arthur

AU - Frigerio, Luigi

AU - Kim, Bohyun

AU - Weaver, Amy L.

AU - Glaser, Gretchen E.

AU - Mariani, Andrea

PY - 2017/10/1

Y1 - 2017/10/1

N2 - 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 patients with G3 endometrioid cancer. In the case of negative para-aortic nodes in the CT scan, 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.

AB - 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 patients with G3 endometrioid cancer. In the case of negative para-aortic nodes in the CT scan, 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.

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