The Accuracy of Surgical Assessment of Gross Myometrial Invasion as a Predictor of Lymphatic Metastases in Women with Endometrial Carcinoma

Abstract

Objective: The objective of this study was to determine if the surgeon can accurately predict the depth of myometrial tumor invasion in women with endometrial cancer, and if tumor invasion will correlate with node metastases. Methods: We identified 1,943 women with endometrial carcinoma who underwent hysterectomy. Of these, 295 underwent comprehensive surgical staging including lymph node analysis. All subjects also underwent gross examination of the uterine specimen by their surgeon where the depth of myometrial invasion was recorded. Patients with grade III tumors or papillary serous and clear cell histology were excluded. The presence or absence of myometrial invasion was then correlated with the incidence of nodal involvement to determine if this system can be used to predict tumor spread at the time of hysterectomy. Results: The ability of the surgeon to accurately predict the depth of myometrial invasion was 82%, sensitivity was 57%, specificity 89%, positive predictive value 62% and the negative predictive value was 88%. If this system was used as the indication for nodal evaluation the authors would have missed 3% of women with nodal metastases who had less than 50% myometrial invasion. Conclusions: Gross evaluation of the hysterectomy specimen can accurately predict depth of myometrial invasion. However, in our analysis 3% of women with less than 50% invasion had node involvement. If the surgeon had used the absence of myometrial invasion to omit nodal assessment, these lesions would have been missed. Therefore, we feel that nodal assessment should be considered in the majority of cases.