Indian Journal of Obstetrics and Gynecology Research


Correlation between tumour size and Lymphatic spread in cases of type I endometrial carcinoma


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Author Details: Amira Mohammed Badawy

Volume : 4

Issue : 4

Online ISSN : 2394-2754

Print ISSN : 2394-2746

Article First Page : 343

Article End Page : 349


Abstract

Introduction and Objectives: Endometrial cancer is the most common malignancy of the female genital tract in the world. The lymphatic spread is the most frequent pathway for spread. It primarily involves the pelvic lymph nodes. It was suggested recently that tumour size (TS) may be a risk factor for lymph node (LN) metastases.
The aim of the present study was to assess the relationship between tumour size and pelvic lymph node metastasis in patients undergoing surgical staging for type-1 (endometrioid) endometrial adenocarcinoma, in order to plan for proper surgical approach.
Patients and Method: A total of 29 patients with type I (endometrioid) endometrial adenocarcinoma, were included. TS was obtained through detailed ultrasound (U/S). It was defined as the largest of the three dimensions of the tumour. All cases were subjected to total hysterectomy with bilateral salpingo-oophorectomy & bilateral pelvic lymphadenectomy. TS was re-assessed pathologically. The main outcome was to assess the relation between TS (by ultrasound and by pathologically) and LN metastasis. Correlation between TS and other prognostic factors such as grade, stage, and lympho-vascular space involvement, were also studied as secondary outcomes.
Results: Tumour sizes by U/S and by gross pathologic examination were significantly related to LN metastasis (p=0.009 and 0.011 respectively). There was agreement between TS measured by U/S and by pathologic examinations, (ICC) = 0.975 (95% CI 0.946-0.988) (F=39.376, p=0.000*)).
The TS measured by U/S was a statistically significant discriminator of LN metastasis (AUC = 0.867 (95% CI 0.689-0.964) (Z=3.810, p=0.0001)), with a cut off value of 4.50 cm (sensitivity=80.00%, specificity=79.17%, PPV=44.4% and NPV=95.0%). Similarly, the TZ measured by pathology was also statistically significant discriminator of LN metastasis (AUC=0.858 (95% CI 0.679-0.959) (Z=3.346, p=0.0008)), with a cut off value of 5.00 cm (sensitivity=80%, specificity=91.67%, PPV=66.7%, NPV=95.7%).
Conclusions: Assessment of TS by U/S and by pathologic examination are comparable in cases of type I (endometrioid) endometrial adenocarcinoma. Both methods are reliable in predicting pelvic LN metastasis with a cut off value of 4.5 cm and 5 cm respectively. Preoperative assessment by U/S is more practical and useful in planning the extent of surgery and the need for pelvic lymphadenectomy.

Keywords:
Endometrial cancer, Endometrioid adenocarcinoma, Pelvic lymph nodes, Lymphadenectomy, Tumour size