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Diagnostic Performance of Computed Tomography for Preoperative Staging of Patients with Non-endometrioid Carcinomas of the Uterine Corpus

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

A Commentary to this article was published on 29 January 2016

An Editor Note to this article was published on 22 January 2016

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.

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Acknowledgment

The authors thank Ada Muellner, MS, for her editorial assistance.

Disclosure

Yulia Lakhman, Seth S. Katz, Debra A. Goldman, Derya Yakar, Hebert A. Vargas, Ramon E. Sosa, Maura Miccò, Robert A. Soslow, Hedvig Hricak, Nadeem R. Abu-Rustum, and Evis Sala have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Yulia Lakhman MD, Seth S. Katz MD, PhD, Derya Yakar MD, PhD, Hebert A. Vargas MD, Ramon E. Sosa BA, Maura Miccò MD, Hedvig Hricak MD, PhD & Evis Sala MD, PhD

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Debra A. Goldman MS

  3. Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

    Derya Yakar MD, PhD

  4. Department of Bioimaging and Radiological Science, Catholic University “A. Gemelli” Hospital, Rome, Italy

    Maura Miccò MD

  5. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Robert A. Soslow MD

  6. Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Nadeem R. Abu-Rustum MD

Authors
  1. Yulia Lakhman MD
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  2. Seth S. Katz MD, PhD
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  8. Robert A. Soslow MD
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  9. Hedvig Hricak MD, PhD
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  11. Evis Sala MD, PhD
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Corresponding author

Correspondence to Yulia Lakhman MD.

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Lakhman, Y., Katz, S.S., Goldman, D.A. et al. Diagnostic Performance of Computed Tomography for Preoperative Staging of Patients with Non-endometrioid Carcinomas of the Uterine Corpus. Ann Surg Oncol 23, 1271–1278 (2016). https://doi.org/10.1245/s10434-015-4410-x

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  • DOI: https://doi.org/10.1245/s10434-015-4410-x

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