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Preoperative assessment of lymph node metastasis in endometrial cancer: A Korean Gynecologic Oncology Group study

 Sokbom Kang  ;  Joo-Hyun Nam  ;  Duk-Soo Bae  ;  Jae-Weon Kim  ;  Moon-Hong Kim  ;  Xiaojun Chen  ;  Jae-Hong No  ;  Jong-Min Lee  ;  Jae-Hoon Kim  ;  Hidemich Watari  ;  Seok Mo Kim  ;  Sung Hoon Kim  ;  Seok Ju Seong  ;  Ki Tae Kim  ;  Seung Cheol Kim  ;  Jong-Hyeok Kim  ;  Myung-Cheol Lim  ;  Jung-Yun Lee  ;  Sang-Young Ryu  ;  Bingyi Yang  ;  Byoung-Gie Kim 
 CANCER, Vol.123(2) : 263-272, 2017 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; CA-125 Antigen/blood ; Endometrial Neoplasms/blood ; Endometrial Neoplasms/pathology* ; Female ; Humans ; Lymph Node Excision/methods ; Lymph Nodes/pathology* ; Lymphatic Metastasis/pathology* ; Magnetic Resonance Imaging/methods ; Middle Aged ; Pelvis/pathology ; Preoperative Period ; Prospective Studies ; Sensitivity and Specificity ; Uterus/pathology
cancer antigen 125 (CA 125) ; endometrial cancer ; lymph node ; lymphadenectomy ; magnetic resonance imaging ; metastasis ; prediction ; risk factor ; surgical staging
BACKGROUND: Previously proposed criteria for preoperatively identifying endometrial cancer patients at low risk for lymph node metastasis remain to be verified. For this purpose, a prospective, multicenter observational study was performed. METHODS: Eligible patients with histologically confirmed endometrial cancer underwent magnetic resonance imaging (MRI) and serum cancer antigen 125 (CA 125) testing before surgery. The following criteria were used to identify low-risk patients: 1) endometrioid-type cancer, 2) no evidence of deep myometrial invasion on MRI, 3) no enlarged lymph nodes on MRI, 4) no suspicious metastasis out of the uterine corpus, and 5) serum CA 125 levels less than 35 U/mL. Systematic pelvic and/or para-aortic lymphadenectomy was performed for all patients. The primary endpoint was estimation of the negative predictive value (NPV). RESULTS: From January 2012 to December 2014, 529 patients from 20 hospitals in 3 Asian countries were consecutively enrolled. According to our criteria, 272 patients (51.4%) were categorized into the low-risk group. Fifty-three of the 529 patients (10.0%) had lymph node metastases; these patients included 8 (2.9%) falsely categorized as low-risk. The sensitivity and specificity of the criteria were 84.9% and 55.5%, respectively. The NPV of 97.1% was higher than the predefined target endpoint of 96%. CONCLUSIONS: The low-risk criteria based on preoperative tests were confirmed to be reliable and accurate for identifying patients at low risk for lymph node metastasis. These criteria may facilitate patient counseling and surgical decision making. Cancer 2017;123:263-272. © 2016 American Cancer Society.
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1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sung Hoon(김성훈) ORCID logo https://orcid.org/0000-0002-1645-7473
Kim, Jae Hoon(김재훈) ORCID logo https://orcid.org/0000-0001-6599-7065
Lee, Jung-Yun(이정윤) ORCID logo https://orcid.org/0000-0001-7948-1350
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