Yulia Lakhman1, Seth S Katz2, Debra A Goldman3, Derya Yakar2,4, Hebert A Vargas2, Ramon E Sosa2, Maura Miccò2,5, Robert A Soslow6, Hedvig Hricak2, Nadeem R Abu-Rustum7, Evis Sala2. 1. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. lakhmany@mskcc.org. 2. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 4. Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. 5. Department of Bioimaging and Radiological Science, Catholic University "A. Gemelli" Hospital, Rome, Italy. 6. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 7. Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Abstract
PURPOSE: The aim of this study was to assess the diagnostic performance of computed tomography (CT) for initial staging of non-endometrioid carcinomas of the uterine corpus. MATERIALS AND METHODS: Waiving informed consent, the Institutional Review Board approved this Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study of 193 women with uterine papillary serous carcinomas, clear cell carcinomas, and carcinosarcomas, who underwent surgical staging between May 1998 and December 2011 and had preoperative CT within 6 weeks before surgery. Two radiologists (R1, R2) independently reviewed all CT images. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and area under the curve were calculated using operative notes and surgical pathology as the reference standard. RESULTS: The respective sensitivities and specificities achieved by R1/R2 were 0.79/0.64 and 0.87/0.75 for detecting deep myometrial invasion (MI) on CT; 0.56/0.63 and 0.93/0.79 for detecting cervical stromal invasion; 0.52/0.45 and 0.95/0.93 for detecting pelvic nodal metastases; and 0.45/0.30 and 0.98/0.98 for detecting para-aortic nodal metastases. Although CT had suboptimal sensitivity for the detection of omental disease, it had high PPV for omental seeding at surgical exploration (1.00 for R1 and 0.92 for R2). Inter-observer agreement ranged from moderate in the detection of deep MI (κ = 0.42 ± 0.06) to almost perfect in the detection of para-aortic nodal metastases (κ = 0.88 ± 0.08). CONCLUSION: In patients with uterine non-endometrioid carcinomas, CT is only moderately accurate for initial staging but may provide clinically valuable information by 'ruling-in' isolated para-aortic lymph node metastases and omental dissemination.
PURPOSE: The aim of this study was to assess the diagnostic performance of computed tomography (CT) for initial staging of non-endometrioid carcinomas of the uterine corpus. MATERIALS AND METHODS: Waiving informed consent, the Institutional Review Board approved this Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study of 193 women with uterine papillary serous carcinomas, clear cell carcinomas, and carcinosarcomas, who underwent surgical staging between May 1998 and December 2011 and had preoperative CT within 6 weeks before surgery. Two radiologists (R1, R2) independently reviewed all CT images. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and area under the curve were calculated using operative notes and surgical pathology as the reference standard. RESULTS: The respective sensitivities and specificities achieved by R1/R2 were 0.79/0.64 and 0.87/0.75 for detecting deep myometrial invasion (MI) on CT; 0.56/0.63 and 0.93/0.79 for detecting cervical stromal invasion; 0.52/0.45 and 0.95/0.93 for detecting pelvic nodal metastases; and 0.45/0.30 and 0.98/0.98 for detecting para-aortic nodal metastases. Although CT had suboptimal sensitivity for the detection of omental disease, it had high PPV for omental seeding at surgical exploration (1.00 for R1 and 0.92 for R2). Inter-observer agreement ranged from moderate in the detection of deep MI (κ = 0.42 ± 0.06) to almost perfect in the detection of para-aortic nodal metastases (κ = 0.88 ± 0.08). CONCLUSION: In patients with uterine non-endometrioid carcinomas, CT is only moderately accurate for initial staging but may provide clinically valuable information by 'ruling-in' isolated para-aortic lymph node metastases and omental dissemination.
Authors: R Suzuki; E Miyagi; N Takahashi; A Sukegawa; A Suzuki; I Koike; K Sugiura; N Okamoto; T Inoue; F Hirahara Journal: Int J Gynecol Cancer Date: 2007-03-02 Impact factor: 3.437
Authors: Frederic Amant; Philippe Moerman; Patrick Neven; Dirk Timmerman; Erik Van Limbergen; Ignace Vergote Journal: Lancet Date: 2005 Aug 6-12 Impact factor: 79.321
Authors: Neil S Horowitz; Farrokh Dehdashti; Thomas J Herzog; Janet S Rader; Matthew A Powell; Randal K Gibb; Perry W Grigsby; Barry A Siegel; David G Mutch Journal: Gynecol Oncol Date: 2004-12 Impact factor: 5.482
Authors: Nisha Bansal; Thomas J Herzog; Adrian Brunner-Brown; Stephanie L Wethington; Carmel J Cohen; William M Burke; Jason D Wright Journal: Gynecol Oncol Date: 2008-09-11 Impact factor: 5.482