Abstract
Objective
To assess the role of routine intravenous pyelography (IVP), rectoscopy and additional imaging techniques like computed tomography (CT) and abdominal ultrasonography (USG) for the evaluation of patients with endometrial cancer.
Materials and methods
A total of 97 women with endometrial cancer (82 endometrioid and 15 non-endometrioid type) of all stages (Stage I = 65, II = 14, III = 13, IV = 5) were included in the study. Of these, 50 women were admitted because of postmenopausal bleeding, 24 with irregular vaginal bleeding and 7 with pain and leucorrhea, whereas the others had no complaints. Only one patient had symptoms related to the gastrointestinal system, but none for the urinary system. Preoperative CT (n = 45), IVP (n = 78), rectoscopy (n = 46), and USG or colonoscopy (n = 37) were performed on our patients. All the women had total abdominal hysterectomy and bilateral salpingo-oophorectomy, with/without pelvic (n = 81) and paraaortic (n = 34) lymphonodectomy, and omentectomy (n = 35).
Results
In 39 of 45 women who had CT, it had no effect on the operation and did not facilitate the operation. In two women there were pathological findings on CT and some interventions (resection and anastomosis) were performed on the gastrointestinal tract in these patients. However, CT had overcome pathological findings related with the gastrointestinal or urinary systems in four women, who needed interventions to these systems during the operation. CT was not performed on six women who needed interventions to the gastrointestinal system during the operations. Three patients had pathological findings (fissure, external compression) in rectoscopy, but only one patient had ileo-transverstomy, in which rectoscopic finding had not predicted the necessity of that procedure. Out of 78 IVP, the only finding was external compression to the bladder in 38 patients, and this finding had no contribution to the operation. Among women who had USG or colonoscopy (n = 37) performed, five had pathological findings that contributed to the extensiveness or the mode of the operations (liver nodules, polyps in the colon).
Conclusions
Routine preoperative computed tomography, intravenous pyelography, rectoscopy or abdominal USG and colonoscopy have little impact on the decision and the prediction of the extensiveness of the operation.
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References
Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer (a Gynecol Oncol Group study). Cancer 60(8):2035–2041. doi:10.1002/1097-0142(19901015)60:8+<2035::AID-CNCR2820601515>3.0.CO;2-8
Ascher SM, Cooper C, Scoutt L, Imaoka I, Hricak H (2005) Diagnostic imaging techniques in gynecologic oncology. In: Hoskins WJ, Perez CA, Young RC (eds) Principles of gynecologic oncology. Williams & Wilkins, Philadelphia, pp 223–268
Anderson B (1986) Diagnosis of endometrial cancer. Clin Obstet Gynaecol 13(4):739–750
Kirby TO, Leath CA 3rd, Kilgore LC (2006) Surgical staging in endometrial cancer. Oncology 20(1):45–50 Williston Park
Shepherd JH (1989) Revised FIGO staging for gynaecological cancer. Br J Obstet Gynaecol 96(8):889–892
Rockall AG, Sohaib SA, Harisinghani MG et al (2005) Diagnostic performance of nanoparticle-enhanced magnetic resonance imaging in the diagnosis of lymph node metastases in patients with endometrial and cervical cancer. J Clin Oncol 23(12):2813–2821. doi:10.1200/JCO.2005.07.166
Zerbe MJ, Bristow R, Grumbine FC, Montz FJ (2000) Inability of preoperative computed tomography scans to accurately predict the extent of myometrial invasion and extracorporal spread in endometrial cancer. Gynecol Oncol 78(1):67–70. doi:10.1006/gyno.2000.5820
Connor JP, Andrews JI, Anderson B, Buller RE (2000) Computed tomography in endometrial carcinoma. Obstet Gynecol 95(5):692–696. doi:10.1016/S0029-7844(99)00626-2
Vorgias G, Katsoulis M, Argyrou K et al (2002) Preoperative imaging of primary intra-abdominal gynaecological malignancies, diagnostic accuracy of CT-scan and MRI. a Greek cohort study. Eur J Gynaecol Oncol 23(2):139–144
Soper JT (2001) Radiographic imaging in gynecologic oncology. Clin Obstet Gynecol 44(3):485–494. doi:10.1097/00003081-200109000-00005
Park JY, Kim EN, Kim DY et al (2008) Comparison of the validity of magnetic resonance imaging and positron emission tomography/computed tomography in the preoperative evaluation of patients with uterine corpus cancer. Gynecol Oncol 108:486–492. doi:10.1016/j.ygyno.2007.11.044
Lai CH, Yen TC, Chang TC (2007) Positron emission tomography imaging for gynecologic malignancy. Curr Opin Obstet Gynecol 19:37–41. doi:10.1097/GCO.0b013e32801195c9
Sironi S, Picchio M, Landoni C et al (2007) Post-therapy surveillance of patients with uterine cancers: value of integrated FDG PET/CT in the detection of recurrence. Eur J Nucl Med Mol Imaging 34:472–479. doi:10.1007/s00259-006-0251-y
Benedetti-Panici P, Maneschi F, Scambia G, Greggi S, Mancuso S (1994) Anatomic abnormalities of the retroperitoneum encountered during aortic and pelvic lymphadenectomy. Am J Obstet Gynecol 170(1 Pt 1):111–116
Chung HH, Kim JW, Park NH, Song YS, Kang SB, Lee HP (2006) Use of preoperative serum CA-125 levels for prediction of lymph node metastasis and prognosis in endometrial cancer. Acta Obstet Gynecol Scand 85:1501–1505
Hsieh CH, ChangChien CC, Lin H et al (2002) Can a preoperative CA 125 level be a criterion for full pelvic lymphadenectomy in surgical staging of endometrial cancer? Gynecol Oncol 86:28–33. doi:10.1006/gyno.2002.6664
Ebina Y, Sakuragi N, Hareyama H et al (2002) Para-aortic lymph node metastasis in relation to serum CA 125 levels and nuclear grade in endometrial carcinoma. Acta Obstet Gynecol Scand 81:458–465. doi:10.1034/j.1600-0412.2002.810514.x
Reddoch JM, Burke TW, Morris M, Tornos C, Levenback C, Gershenson DM (1995) Surveillance for recurrent endometrial carcinoma: development of a follow-up scheme. Gynecol Oncol 59:221–225. doi:10.1006/gyno.1995.0012
Trope CG, Alektiar KM, Sabbatini PJ, Zaino RJ (2005) Corpus: epithelial tumors. In: Hoskins WJ, Perez CA, Young RC (eds) Principles of gynecologic oncology. Williams & Wilkins, Philadelphia, pp 823–872
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Sayın, N.C., Varol, F.G., Yüce, M.A. et al. Do routine preoperative imaging techniques facilitate the operation in endometrial cancer?. Arch Gynecol Obstet 280, 211–215 (2009). https://doi.org/10.1007/s00404-008-0893-z
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DOI: https://doi.org/10.1007/s00404-008-0893-z