Elizabeth Maddox1, Ashley Cahoon2, Jessica Robbins2, Krupa Patel-Lippmann, David Kushner3, Ahmed Al-Niaimi3, and Elizabeth Sadowski2
1Radiology, University of Wisconsin, madison, WI, United States, 2Radiology, University of Wisconsin, WI, 3OBGYN, University of Wisconsin, WI
Synopsis
MRI
can exclude myometrial invasion (MI) and cervical invasion (CI) with high
accuracy in endometrial carcinoma. Women with small tumors, no MI, no CI and no
evidence of extra-uterine spread have a very low risk of lymph node metastasis,
and lymphadenectomy can be avoided. The
goal of our study was to demonstrate how using preoperative MRI to prevent
unnecessary lymphadenectomy can affect operating room time (OR) and
post-operative complications. We
performed an IRB approved retrospective study evaluating MRI results,
lymphadenectomy status, operative times, and post-operative complications. This demonstrated a statistically significant
decrease in OR times and post-operative complications.
Purpose
MRI
can assess tumor size and exclude myometrial invasion (MI), cervical invasion
(CI), and extra-uterine tumor extension with high accuracy in patients with endometrial
carcinoma.1,2,3 Women with small
tumors and no MI, CI, or extra-uterine spread have a very low risk of lymph
node metastasis, and lymphadenectomy can be avoided.1 The goal of our study was to demonstrate how using
preoperative MRI to prevent unnecessary lymphadenectomy can affect operating
room time (OR) and post-operative complications.Methods
IRB
approved retrospective review of 200
women with biopsy proven grade 1 endometrial cancer. Each patient underwent a preoperative MRI to
determine tumor size, MI, CI, and extra-uterine spread. Women determined to be
low risk for lymph node metastasis by MRI did not undergo lymphadenectomy. OR times and post-operative complications
were recorded. Post-operative
complications were evaluated and classified using the 5 point CTCAE scale.4
Mean, standard deviation, and p-value
were calculated for these variables.Results
Of
200 women, 86 underwent lymphadenectomy and 114 did not, based on pre-operative
MRI results. Differences in OR times
between the two groups was significant; OR times without lymphadenectomy = 206
minutes (+/- 54.0 minutes) versus with lymphadenectomy = 277 minutes (+/- 55.0
minutes, p-value <0.0001). Differences in post-operative complication rates
between the groups was statistically significant; without lymphadenectomy = 0.4
(+/- 0.9) versus with lymphadenectomy 0.7 (+/-1.3, p-value = 0.02).Discussion
In
women with grade 1 endometrial cancer, small tumors with no MI, CI, or obvious
extrauterine spread have a very low risk of lymph node metastasis. Using
pre-operative MRI to determine which patients should undergo lymphadenectomy can
help with surgical planning and decreases OR times. Furthermore, avoiding
lymphadenectomy can potentially spare the patient unnecessary complications. In
the current push towards value-added medical care, MRI can play an important
role in reducing the potential cost associated with longer OR times and can
improve patient outcomes by avoiding unnecessary complications.Conclusion
Utilizing
pre-operative MRI to determine the need for lymphadenectomy in patients with
grade 1 endometrial cancer decreases operating room times and complication rates.
In the era of value-added medicine, MRI may help resource allocation planning
(OR time) and improve patient outcomes by avoiding post-operative complications.Acknowledgements
No acknowledgement found.References
1. Sadowksi E, Robbins J, Guite K, et al. Preoperative Pelvic MRI and Serum Cancer
Antigen-125: Selecting Women with Grade I Endometrial Cancer for
Lymphadenectomy. AJR 2015; 205: 556-564.
2. Beddy
P, O’Neill AC, Yamamoto AK, et al. FIGO
staging system for endometrial cancer: added benefits of MR imaging. RadioGraphics 2012; 32:241-54.
3.
Sala E, Rockall AG, Freeman SJ, et al.
The added role of MR imaging in treatment stratification of patients
with gynecologic malignancies: what the radiologist needs to know. Radiology 2013; 266: 717-740.
4.
Common Terminology Criteria for Adverse Events (CTCAE) Version 4.02.
U.S.DEPARTMENT OF HEALTH AND HUMAN SERVICES.
May 28, 2009.