Assessing Tumor Size by MRI and Pathology in Type I Endometrial Carcinoma to Predict Lymph Node Metastasis.

Abstract

IntroductionLymphatic spread is the most common route of spread of endometrial carcinoma, and the most frequently involved lymph nodes are those of the external iliac group. MRI is one of the best imaging tools for the preoperative evaluation of patients with endometrial carcinoma. The objective of the current study is to analyze the relationship between tumor size and lymph node metastasis in patients with type I endometrial carcinoma.MethodsThis is a prospective observational study performed in the Department of Obstetrics and Gynaecology at Liaquat National Hospital, Karachi, Pakistan. The duration of the study was from January 2020 to January 2021. During this period, 86 patients with biopsy-proven type I endometrial carcinoma were selected. Tumor size was measured by MRI. All participants underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy. Histopathological evaluation was performed according to the College of American Pathologists (CAP) protocols, and staging was performed using the 2009 International Federation of Gynecology and Obstetrics (FIGO) staging system. Lymph nodes were considered positive or negative, irrespective of their number.ResultOf the 86 patients, 25 (29.1%) had positive lymph node metastasis. The mean tumor size with positive lymph node metastasis by MRI and histopathology was 7.86 cm and 10.21 cm, respectively. Tumor size determined by MRI and histopathology was significantly associated with lymph node metastasis (p < 0.01 and p < 0.01, respectively). Tumor size was positively correlated with lymph node metastasis (r = 0.715). The cutoff value of >6.5 cm by MRI was established as the statistically significant differentiator of lymph node metastasis. The calculated sensitivity and specificity were 88% and 90.16%, respectively, with an area under the curve (AUC) of 0.920. The cutoff value of >8 cm by histopathology was established as the statistically significant differentiator of lymph node metastasis. The calculated sensitivity and specificity were 80% and 88.52%, respectively, with an AUC of 0.907.ConclusionOur results showed that lymph node metastasis in patients with type I endometrial carcinoma can be predicted by tumor size. This may help incorporate adequate surgical skills and management plans in the treatment course of type I endometrial carcinoma.