[Methods for preoperative and intraoperative evaluation of the tumour infiltration and lymph node metastases in endometrial cancer (summarized own and foreign experience)]

Abstract

Aim: The preoperative and intraoperative evaluation of the depth of tumour infiltration into the myometrium and the assessment of the lymph node metastases of pelvic and paraaortal region, is used from many western oncogynaecological clinics to plan the extend of the surgical treatment. In this way is determined the need for surgical staging and the performance of pelvic and paraaortal lymph node dissection. Sometimes this evaluation differs from the final histopathological report. That is why with the present research work done for 22 years period we tried to evaluate the accuracy and efficacy of the preoperative and intraoperative evaluation of the myometrial infiltration in endometrial cancer patients.

Material and methods: We evaluated 460 patients radically operated without lymph node dissection and 460 patients with lymph node dissection for 22 years period. The depth of myometrial infiltration was evaluated by TVS, CT scan, MRI, and in the last 2 years with PET scan. D&C was preoperatively performed. The histological grading was preoperatively and postoperatively assessed. The depth of myometrial infiltration was evaluated (less or more than 50%). Intraoperatively the uterus was cut and gross examined visually measuring the depth of cancer invasion in the myometrium. From the statistical methods - x2, variation analysis, correlation analysis, regression analysis as well as the Wilcoxon and the log-rank test were used.

Results: The histopathological findings showed 346 patients with lymph node dissection-stage IA and 370 patients without lymph node dissection- stage IA. 114 patients had lymph node dissection - stage IB and 90 patients without lymph node dissection - stage IB. In 716 patients the infiltration in myometrium was less than 50% and in 204 patients the infiltration was more than 50%. The ultrasound examination (TVS) had 80% accuracy. The accuracy, sensitivity and specificity of MRI were 85%, 77% and 87% respectively The CT scan examinations were not so convincing, while the PET scan were better and were very useful. In intraoperative cutting of the uterus and its gross examination, if the infiltration of the tumour was more than 50% in the myometrium, and diameter of the tumour more than 2 cm--we performed lymph node dissection. The method was economically efficient, very easy appliciable and with high sensitivity (85%) and specificity (90%) rate. It can be easily applied in gynaecological and oncogynaecological practice. The definition of the preoperative grading was 75%. We observed differences in evaluation of preoperative and post operative grading results in low differentiated endometrial cancers (G3).

Conclusions: Our research work showed that the cutting and gross examination of the tumor intraoperatively could be of benefit for evaluation of the myometrial infiltration of the tumor mostly when it was more than 50%, but also when it was less than 50% of the myometrial depth. In this way we can define the need for surgical staging especially when the infiltration of the tumour into the myometrium was more than 50% of its thickness.