RISS 검색 - 국내학술지논문 상세보기

다국어 초록 (Multilingual Abstract)

Objective: To evaluate the concordance between preoperative European Society for Medical Oncology (ESMO)-European Society of Gynaecological Oncology (ESGO)-European SocieTy for Radiotherapy and Oncology (ESTRO) risk classification in early-stage endometrial cancer (EC) assessed by biopsy and magnetic resonance imaging (MRI) with this classification based on histology of surgical specimen.
Methods: This bicentric retrospective study included women diagnosed with early-stage EC (≤stage II) who had a complete preoperative assessment and underwent a surgical management from January 2011 to December 2018. Patients were preoperatively classified into 3 degrees of risk of lymph node (LN) involvement based on biopsy and MRI. Based on final histological report, patients were re-classified using the preoperative classification. Concordance between the preoperative assessment and definitive histology was calculated with weighted Cohen's kappa coefficient.
Results: A total of 333 women were included and kappa coefficient of preoperative risk classification was 0.49. The risk was underestimated and overestimated in 37% and 10% of cases, respectively. Twenty-nine percent of patients had an incomplete LN staging according to the degree of risk of re-classification. The observed discordance in the risk classification was attributed to MRI in 75% of cases, to biopsy in 18% and in 7% to both (p<0.001). Kappa coefficient for concordance was 0.25 for MRI and 0.73 for biopsy.
Conclusion: Concordance between preoperative ESMO-ESGO-ESTRO risk classification and final histology is weak. Given that the risk was underestimated in the majority of patients wrongly classified, sentinel LN procedure instead of no LN dissection could be an option offered to preoperative low-risk patients to decrease the indication of second surgery for re- staging and/or to avoid toxicity of adjuvant radiotherapy.

참고문헌 (Reference)

1 Kurman RJ, "WHO classification of tumours of female reproductive organs" International Agency for Research on Cancer 2014

2 Benedetti Panici P, "Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial" 100 : 1707-1716, 2008

3 Kim HS, "Systematic lymphadenectomy for survival in patients with endometrial cancer: a meta-analysis" 42 : 405-412, 2012

4 Todo Y, "Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis" 375 : 1165-1172, 2010

5 Haldorsen IS, "Staging of endometrial carcinomas with MRI using traditional and novel MRI techniques" 67 : 2-12, 2012

6 Kinkel K, "Staging of endometrial cancer with MRI: guidelines of the European Society of Urogenital Imaging" 19 : 1565-1574, 2009

7 Querleu D, "Primary management of endometrial carcinoma. Joint recommendations of the French society of gynecologic oncology (SFOG) and of the French college of obstetricians and gynecologists (CNGOF)" 45 : 715-725, 2017

8 Lavaud P, "Preoperative MR imaging for ESMO-ESGO-ESTRO classification of endometrial cancer" 99 : 387-396, 2018

9 Tuomi T, "Prediction of lymphatic dissemination in endometrioid endometrial cancer: comparison of three risk-stratification models in a single-institution cohort" 144 : 510-514, 2017

10 Groff B, "Pertinence of the preoperative exploration in the evaluation of the risk of lymph node metastasis in endometrial cancer" 42 : 92-96, 2014