Stage Endometrial Carcinoma Research Articles

Does change in endometrial carcinoma FIGO staging (2018 to 2023) matters?

Abstract Introduction/Objective Endometrial Carcinoma (EC) is the sixth most common diagnosed cancer in women. Cancer related to corpus uteri are often diagnosed after menopause. TNM classification and FIGO staging system is used for staging of EC. College of American Pathologists (CAP) has been using FIGO staging system 2018 until new FIGO staging 2023 was published on June 20th 2023. We aim to identify if the new 2023 FIGO staging will change the previously assigned staging as per 2018 FIGO staging system of the endometrial carcinoma and if this change will help the physician to reevaluate the patient management. Methods/Case Report This is a retrospective cohort study. Total 205 cases were recruited from June 2022 till October 2023 at Danbury Hospital. All the patients of 18 years and above were selected for the study and were treated with hysterectomy for endometrial carcinoma and were reported to have FIGO staging as per 2018 CAP cancer protocol. Sixty three (63) participants were selected for the study. Exclusion criteria includes the cases diagnosed as endometrial carcinoma on biopsy, curettage, and patients who did not follow up for treatment. The data search was done on variables required to evaluate the FIGO staging for 2018 and 2023. Results (if a Case Study enter NA) Out of 63 patients, 55 cases were reported as per FIGO stage 2018 and eight cases were evaluated on TNM classification only. The staging did not change for forty nine (49/63) cases. However, six cases (6/63) had a change in staging based on the criteria out of which four cases (4/6) had an upstage and two cases (2/6) had a downstage. Conclusion Staging has a critical role in management of the patient. The updated FIGO staging includes multiple variables (including molecular) to improve the patient care who are diagnosed with endometrial carcinoma. Identifying the appropriate updated staging can be beneficial for oncologist to decide the treatment recommendation in the future.

Role of Diffusion and T2-Weighted Magnetic Resonance Imaging in Preoperative Assessment of Myometrial Invasion and Staging of Endometrial Carcinoma

Role of Diffusion and T2-Weighted Magnetic Resonance Imaging in Preoperative Assessment of Myometrial Invasion and Staging of Endometrial Carcinoma

Prognostic performance of FIGO 2023 endometrial carcinoma staging: a comparison to FIGO 2009 staging in the setting of known and unknown molecular classification.

The 2023 FIGO staging criteria for endometrial cancer (EC) introduced marked changes from the 2009 version. The full implication of these changes for patient diagnosis and treatment is unknown. We evaluate the differences in staging and prognostication between the two systems, with and without inclusion of molecular classification. We assigned (1) FIGO 2009, (2) 2023 molecular-agnostic and (3) 2023 molecular-informed stages to 404 fully staged and molecularly classified patients with EC. Disease-specific and progression/relapse-free survival were analysed via the Kaplan-Meier method and compared with log-rank testing; 118 of 252 (47%) FIGO 2009 stage I patients were upstaged based on histopathological findings alone. Stage I/II subgroup survival distribution analysis showed a worse prognosis in FIGO 2023 IIB and IIC patients. In the molecular-informed FIGO 2023 system, three of 15 (20%) POLE-mutated stage I/II cases were downstaged from FIGO 2009 and eight (53%) were downstaged from molecular-agnostic FIGO 2023. Fifty-one of 60 (85%) p53-abnormal tumours were upstaged from the FIGO 2009, whereas 13 of 60 (22%) were upstaged from the 2023 molecular-agnostic stage. Molecular classification improved prognostic stratification for both 2009 and 2023 FIGO systems. Downstaging based on POLE mutation more accurately represents patient outcomes. However, in the absence of known POLE status, applying molecular-agnostic FIGO 2023 criteria for stage I/II disease should be conducted with caution. For aggressive histotypes, additionally reporting FIGO 2009 stage should be considered. Upstaging based on substantial lymphovascular space invasion, aggressive histotype with any myometrial invasion and abnormal p53 improves prognostic discernment. Further subdivisions within stage I/II provide minimal additional prognostic information.

Preliminary results of adjuvant image-guided vaginal brachytherapy alone for early stage endometrial carcinoma

ObjectiveThis retrospective study evaluated the preliminary outcomes of image-guided vaginal brachytherapy (IG-VBT) in the adjuvant treatment of high intermediate risk endometrial cancer. Materials and MethodsData were collected from 48 patients who underwent adjuvant IG-VBT between 2019 and 2022 at the Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University. The vaginal cuff clinical target volume (CTV-VC) is composed of a 4-mm-thick band around vaginal cylinder at the upper 3 cm of the vaginal cuff. A total dose of 21 Gy in three fractions was delivered to the CTV-VC, and the dose to the bladder and rectum were evaluated. Treatment details, patient characteristics, and outcomes were analyzed. Descriptive statistics were used for analysis, and Kaplan-Meier method was employed for survival analysis. ResultsThe mean age was 62 years, with mainly endometrioid carcinoma pathology (96 %). All patients were at stage I, with 87.5 % receiving complete surgical staging. Mean total treatment time was 10 days with mean D90 of CTV-VC was 29.7 Gy, and D2cc of bladder, rectum, and sigmoid were 24.6 Gy, 21.0 Gy, and 7.7 Gy, respectively. At a median follow-up of 37 months, 3-year local control, disease-free survival, and overall survival rates were 100 %, 100 %, and 97.9 %. respectively. Two patients (4.2 %) experienced grade 1–2 gastrointestinal toxicity, while no genitourinary toxicity or serious adverse events were observed. ConclusionsThe preliminary results of IG-VBT in endometrial cancer demonstrated favorable outcomes in terms of vaginal control and toxicity. Further studies with larger cohorts and longer follow-up durations are warranted.

The Analysis of in vitro Fertilization Outcomes after Fertility-Preserving Therapy for Endometrial Hyperplasia or Carcinoma.

This study aimed to evaluate the clinical efficacy of fertility-preserving therapy through in vitro fertilization (IVF) procedures in women who were pathologically diagnosed with endometrial hyperplasia or carcinoma. A retrospective cohort study on fertility-preserving therapy was conducted. Participants/Materials, Setting: A total of 82 women were enrolled who had simple endometrial hyperplasia (SH), complex hyperplasia (CH), complex atypical hyperplasia (CAH), and endometrioid endometrial carcinoma stage IA (EC IA) and underwent IVF at Gangnam CHA fertility center between January 2008 and December 2020. The primary endpoints were oncologic outcomes and subsequent reproductive outcomes of patients who underwent fertility-preserving treatments analyzed by χ2 test or Fisher's exact test. Of the 82 patients, 33 had a cumulative clinical pregnancy (40.2%), and 25 had a cumulative live birth (30.5%) through IVF procedures following pathologic confirmation of complete remission or non-progressive status. The cumulative clinical pregnancy rates and live birth rates for SH were 50.0% and 30.0%, for CH were 37.8% and 28.9%, for CAH were 25.0% and 25.0%, and for EC were 38.5% and 38.5%, respectively. There were no significant differences in cumulative clinical pregnancy rates or live birth rates when comparing the four groups. There was a difference in endometrial thickness between medroxyprogesterone acetate (MPA) treatment group and intrauterine device (IUD) group (p = 0.036); however, there were no significant differences in clinical pregnancy rates among MPA, IUD, and MPA+IUD groups. Because of the retrospective nature of the study, many factors relevant to the treatment decision were not strictly controlled. All endometrial hyperplasia and carcinoma groups had competent cumulative live birth rates by IVF procedures. There may be differences in endometrial thickness depending on the treatment methods, but this does not affect clinical pregnancy rates. Therefore, the fertility-preserving treatment for endometrial hyperplasia and carcinoma is a safe and feasible method that results in good IVF outcomes.

Preoperative Ultrasound local Staging of Endometrial Carcinoma in Correlation to Intraoperative and Histopathology Findings

Preoperative Ultrasound local Staging of Endometrial Carcinoma in Correlation to Intraoperative and Histopathology Findings

VNOTES surgical staging for endometrial carcinoma in overweight patients: a case series.

The purpose of this study is to show the feasibility and surgical outcome of vNOTES retroperitoneal dissection and isolation of sentinel lymph nodes in overweight and obese patients with endometrial cancer. Four patients had undergone pelvic lymphadenectomy with a sentinel lymph node. Three patients were overweight, and one was obese with a BMI of 34.6kg/m2. By using NMR mode sentinel lymph node was visualized, excised and marked separately for pathohistological analysis from the rest of the visualized lymph nodes that were then consecutively excised. The mean number of overall excised lymph nodes was 12.5, and the mean number on the right side was 5.75 and 6.25 on the left side. There were no metastases verified in the pathohistological evaluation. vNOTES retroperitoneal isolation of sentinel lymph nodes is good alternative and has its benefits, especially in overweight and obese patients with satisfying low intra- and postoperative complications.

Evaluation of multi-parameter MRI in preoperative staging of endometrial carcinoma

BackgroundEndometrial carcinoma (EC) is a prevalent gynecological malignancy, necessitating accurate preoperative staging for effective treatment planning. This study explores the application value of multi-parameter MRI in diagnosing and staging endometrial cancer. MethodsSeventy-six patients diagnosed with endometrial cancer underwent 3.0 T pelvic MRI within two weeks before surgery. Imaging data were analyzed based on FIGO clinical staging criteria. The study assessed the sensitivity, specificity, positive predictive value, and negative predictive value of MRI for each stage. ResultsPostoperative pathology confirmed 71 cases of endometrial adenocarcinoma, 3 serous adenocarcinoma, and 2 clear cell carcinomas. MRI staging showed a high consistency (Kappa value = 0.786) with postoperative pathology. The overall accuracy of MRI diagnosis was 86.8%. Sensitivity and specificity varied for each stage: IA (91.3%, 96.2%), IB (88.6%, 93.8%), II (97.4%, 89.2%), and III (84.2%, 100%). ConclusionWhile there was a slight misdiagnosis rate, the overall accuracy of preoperative MRI for endometrial cancer was high, aiding in precise diagnosis and clinical staging. MRI effectively identified myometrial infiltration, cervical involvement, paracentral extension, and lymph node metastasis. Further research with larger sample sizes is recommended for enhanced reliability.

Can MRI Accurately Diagnose and Stage Endometrial Adenocarcinoma?

Background and Objectives: Endometrial carcinoma is one of the most common gynecological cancers, and benign lesions such as endometrial hyperplasia, polyps, adenomyosis and leiomyomas should be included in the differential diagnosis. Magnetic resonance imaging has an important role in evaluating endometrial cancer and assessing the depth of myometrial invasion, and it closely correlates with the prognosis of the patient. The purpose of this study is to evaluate the MRI semiology of the endometrial carcinomas that mimic benign lesions, the main factors that may affect the correct diagnosis and the feasibility of magnetic resonance imaging to evaluate the depth of the myometrial invasion of endometrial cancer. Materials and Methods: This is a retrospective analysis of 45 patients that underwent MRI examinations and the lesions were pathologically diagnosed as endometrial carcinoma after surgical resection. This study evaluated the staging accuracy of T2-weighted imaging, diffusion-weighted imaging (DWI), ADC mapping and T1-weighted imaging with fat saturation before and after gadolinium injection. Results: In 36 of the 45 cases, the MRI of the lesion showed the characteristics of endometrial cancer and the diagnosis was certain. Nine lesions (20%) were described as unequivocal and had unspecific MR appearance. In eight of the nine cases (89%), the histopathologic report revealed the presence of leiomyomas and two of these cases (22%) were also associated with adenomyosis. The cause of underestimation in these patients was coexisting lesions exhibiting heterogenous intensity and contrast enhancement, which made it difficult to detect the margins of the lesions. The depth of the myometrial invasion was underestimated in nine cases and overestimated in three cases. The staging accuracy with MRI was 74%. There was a significant correlation between MR imaging and histopathologic finding in the assessment of myometrial invasion (p < 0.001). Cervical extension was noted in eight cases (18%), but was missed on MR imaging in two patients and overstaged in none. Six of them were associated with myometrial invasion in more than 50% of the thickness. There was a significant correlation between MR imaging and histopathologic finding in the assessment of cervical extension (p < 0.001). Conclusions: Our data confirm the high accuracy of MRI in the diagnosis and local staging of endometrial carcinoma. The information provided by MRI has an important role in planning the treatment and the prognosis of the patients.

Integration of the Molecular Classification of Endometrial Carcinoma to Select Patients for Fertility Sparing Strategies.

Fertility-sparing treatment (FST) for endometrial carcinoma (EC) is an option for a subgroup of young women with low-risk disease. The low-risk group comprises patients with endometrioid EC stage IA, grade 1, with or without focal lymphovascular invasion. In the era of molecular subtyping, treatment de-escalation for some EC subtypes is recommended. Recommendations for fertility-preserving treatments were developed regardless of the molecular classification of EC. However, few studies have focused on this topic. In this review, we summarize the actual data available in the literature and discuss the impact of some molecular subtypes of FST.

Registry-derived stage (RD-Stage) for capturing cancer stage at diagnosis for endometrial cancer

BackgroundCapture of cancer stage at diagnosis is important yet poorly reported by health services to population-based cancer registries. In this paper we describe current completeness of stage information for endometrial cancer available in Australian cancer registries; and develop and validate a set of rules to enable cancer registry medical coders to calculate stage using data available to them (registry-derived stage or ‘RD-Stage’).MethodologyRules for deriving RD-stage (Endometrial carcinoma) were developed using the American Joint Commission on Cancer (AJCC) TNM (tumour, nodes, metastasis) Staging System (8th Edition). An expert working group comprising cancer specialists responsible for delivering cancer care, epidemiologists and medical coders reviewed and endorsed the rules. Baseline completeness of data fields required to calculate RD-Stage, and calculation of the proportion of cases for whom an RD stage could be assigned, was assessed across each Australian jurisdiction. RD-Stage (Endometrial cancer) was calculated by Victorian Cancer Registry (VCR) medical coders and compared with clinical stage recorded by the patient’s treating clinician and captured in the National Gynae-Oncology Registry (NGOR).ResultsThe necessary data completeness level for calculating RD-Stage (Endometrial carcinoma) across various Australian jurisdictions varied from 0 to 89%. Three jurisdictions captured degree of spread of cancer, rendering RD-Stage unable to be calculated. RD-Stage (Endometrial carcinoma) could not be derived for 64/485 (13%) cases and was not captured for 44/485 (9%) cases in NGOR. At stage category level (I, II, III, IV), there was concordance between RD-Stage and NGOR captured stage in 393/410 (96%) of cases (95.8%, Kendall’s coefficient = 0.95).ConclusionA lack of consistency in data captured by, and data sources reporting to, population-based cancer registries meant that it was not possible to provide national endometrial carcinoma stage data at diagnosis. In a sample of Victorian cases, where surgical pathology was available, there was very good concordance between RD-Stage (Endometrial carcinoma) and clinician-recorded stage data available from NGOR. RD-Stage offers promise in capturing endometrial cancer stage at diagnosis for population epidemiological purposes when it is not provided by health services, but requires more extensive validation.

Expression Analysis of COPB2 and Bcl-2 in Early Stages of Endometrial Carcinoma

Expression Analysis of COPB2 and Bcl-2 in Early Stages of Endometrial Carcinoma

Elevated preoperative hemoglobin A1c is associated with higher stage and grade of endometrial carcinoma

Introduction: The incidence of endometrial cancer (EC) and diabetes mellitus has been linked in many studies. EC patients had more severely impaired glucose tolerance than individuals with other malignancies. An indicator that determines glycemic index control is hemoglobin A1c (HbA1c). This study aimed to assess whether the preoperative level of HbA1c in diabetes mellitus patients is related to the stage and grade of endometrial carcinoma. Methods: This cross-sectional study uses a retrospective observational analytic design. Diabetes mellitus patients diagnosed with EC and measured for HbA1c levels in Dr. Kariadi General Hospital Semarang from January 2018 to December 2021 were involved as the subjects of this study. The data was analyzed using correlation analysis and linear regression analysis. A value of p&lt;0.05 was used to determine the statistical significance. Results: This study involved 27 EC patients who had preoperative HbA1c data. The overall average HbA1c was 7.88±1.35 in the early-stage group and 10.85±1.15 in the advanced-stage group, significantly different between groups (p&lt;0.001). There was also a significant difference between HbA1c in low-grade and high-grade tumors (p&lt;0.001). With an increase of HbA1c in one unit value, the endometrial carcinoma stage also increases by 0.323 units or 32.3%, while the grade of endometrial carcinoma also increases by 0.275 units or 27.5%. Conclusion: HbA1c level significantly correlates with both the stage and grade of EC. This study also found a linear relationship between increased HbA1c levels and higher stage and grade of EC, indicating that HbA1c levels influence the stage and grade of endometrial carcinoma.

Laparoscopic Sentinel Lymph Node Mapping Using NIR Fluorescence with ICG in Early Endometrial Cancer: Experience at a Tertiary Care Oncology Centre

Objective: To determine the detection rates and location of sentinel nodes as well as to determine intraoperative and postoperative surgico-pathological outcomes in endometrial cancer patients who underwent laparoscopic staging with sentinel node biopsy using ICG dye. Materials and Methods: This retrospective study was conducted in a tertiary care oncology centre, Amrita Institute of medical sciences, Kochi from April 2021 to March 2023. All cases of biopsy proven early stage endometrial carcinoma that underwent laparoscopic staging with SLN mapping using the ICG dye were included. All histological types were included, as long as the disease was confined to the uterus, clinically and on MRI. Results: A total of 80 patients were found eligible for the study. Only the patients with apparent uterine confined disease on preoperative MRI were selected for sentinel mapping, 80 % of whom had IA disease on MRI, and 20 % had IB, 13.5 % were high grade histology.The overall SLN detection rate was 93.75%, and bilateral detection rate was 92.5 %. Most common location was external iliac in 40.8% cases. Only 1 patient was found to harbour nodal micro metastasis on ultrastaging. Final histopathology identified stage IA in 63 (78.75%) patients, IB in 14 (17.5%), Stage II in 2 (2.5%) and Stage IIIC1 in 1 (1.25%) patient. Conclusion: Laparoscopic staging with SLNB using ICG is a practicable approach for uterine limited disease on preoperative evaluation. It extends the benefits of minimally invasive surgery to these patients, while overcoming the limitations of prohibitive cost or availability of expensive robotic equipment.

Practice patterns of adjuvant radiotherapy in women with stage I to II endometrial carcinoma: a real-world multi-institutional analysis in China

BackgroundThis study aimed to report clinical practice patterns of postoperative radiotherapy for stage I to II endometrial carcinoma (EC) patients treated in 13 Chinese medical centers.MethodsWe included early stage EC patients treated by hysterectomy and adjuvant RT between 2003 and 2017 from 13 institutions. Patients were classified into 4 risk groups based on ESMO-ESGO-ESTRO recommendations (2014).ResultsA total of 1,227 cases were analyzed. Along the 15 years of the study, an increasing tendency was found towards administration for vaginal brachytherapy (VBT) alone, while the proportion of external beam pelvic radiotherapy (EBRT) alone remained stable in the corresponding period. When radiation modalities were stratified by risk groups, proportion of VBT alone significantly increased in all risk groups. The higher the risk, the later VBT became the main adjuvant treatment modality. However, EBRT alone or with VBT remained the main adjuvant method for high-risk patients.There were 13 dose-fractionation schemes for VBT alone with the scheme of 30 Gy in 6 fractions prescribed at 0.5cm under the vaginal mucosa accounting for most. There were 17 schemes for VBT boost and the most common schedule was 10 Gy in 2 fractions. The upper 3–5cm part of vagina was the most frequent target. 89.6% of the practitioners performed two-dimensional VBT technique. The median dose for EBRT was 50 Gy. From 2003 to 2017, conventional radiotherapy was gradually replaced by three-dimensional conformal radiotherapy modality and intensity modulated radiotherapy.ConclusionWe report a significant shift from EBRT to VBT alone for high-intermediate-risk, intermediate-risk and low-risk EC patients from 2003 to 2017 while EBRT remained the main radiation modality for high-risk early stage patients. There has been remarkable heterogeneity among VBT dose fractionation schedules across China.Trial registrationThe clinical trial ID was ChiCTR-PRC-17010712. It was authorized by the Institutional Review Board of Peking Union Medical College Hospital (N0. S-K139).

Preoperative staging of uterine cancer: can transvaginal ultrasonography play a role?

Preoperative staging of uterine cancer has recently been implied as an important contribution to an accurate selection of low-risk cases, ultimately avoiding unnecessary lymph node debulking. The aim of this study was to evaluate the validity of transvaginal ultrasonography (TVS) in preoperative staging of uterine cancer in comparison to pelvic magnetic resonance imaging (MRI) and permanent section. We conducted a prospective longitudinal multicenter trial between 2017 and 2018. Inclusion criteria comprised cases of endometrial neoplasia histologically confirmed or strong imaging suspicion, candidates for elective surgery as primary treatment. Proportions of Agreement (PA), kappa statistic (K), sensitivity, specificity and accuracy were calculated with 95% confidence intervals (95%CI). Eighty-two patients were eligible for the study, presenting a mean age of 68 years (standard deviation 11). In what concerns the TVS evaluation of myometrial invasion, the subjective and objective methods of Gordon and Karlsson presented a sensitivity of 79%, 79% and 67% [95%CI 63-91; 63-91; 50-81], a specificity of 65%, 58% and 79% [95%CI 49-79; 42-73; 64-89] and an overall accuracy of 72%, 68% and 73% [95%CI 61-81; 57-78; 63-82]. MRI presented respectively a sensitivity, specificity and overall accuracy of 92%, 70% and 82% [95%CI 77-98; 52-85; 71-90]. Regarding cervical involvement, the sensitivity was respectively 31%, 50% and 67% [95%CI 9-61; 21-79; 35-90] for the subjective method, objective TVS and MRI, and the specificity was 98%, 90% and 100% [95%CI 92-100; 77-97; 94;100]. Agreement between TVS and MRI was superior in the assessment of cervical invasion, with PA ranging from 0.82 to 0.93 and K from 0.45 to 0.58, in comparison to myometrial invasion with PA ranging from 0.68 to 0.73 and K from 0.31 to 0.50. Considering the assessment of cervical involvement, as MRI showed a specificity of 100% it is not possible to increase the specificity. However, it was possible to increase the sensitivity, considering the combination of TVS with objective approach and MRI. TVS may have a promising role as a tool for preoperative staging of endometrial carcinoma, presenting a performance that approximates to MRI, with a higher agreement in the assessment of cervical invasion.

Self-reported lower extremity lymphedema and quality of life after surgical staging of endometrial carcinoma: A population based cross-sectional study

ObjectivesSentinel lymph node biopsy (SLN) has replaced lymphadenectomy in staging of endometrial carcinoma. The aims of the study were to explore the prevalence of self-reported lymphedema (LEL), identify factors associated with LEL, compare quality of life (QoL) scores using thresholds of clinical importance, and assess correlation between different questionnaires. MethodsWomen who underwent staging for endometrial carcinoma from 2006 to 2021 were invited to complete the Lower Extremity Lymphedema Screening Questionnaire (LELSQ), EORTC QLQ-C30, QLQ-EN24 and EQ-5D-5L. ResultsOf 2156 invited survivors, 61% participated in the study, whereof 1127 were evaluable by LELSQ. The LEL prevalence was 51%, 36% and 40% after lymphadenectomy, SLN and hysterectomy, respectively (p < 0.001). Higher BMI, undergoing lymphadenectomy and receiving adjuvant chemotherapy were associated with LEL; odds ratios 1.07 (95% CI 1.05–1.09), 1.42 (95% CI 1.03–1.97) and 1.43 (95% CI 1.08–1.89) respectively. QoL was lower for women with LEL compared to those without. In women with musculoskeletal complaints the prevalence of LEL was 59%, 50% and 53% after lymphadenectomy, SLN and hysterectomy (p = 0.115), respectively, compared to 39%, 17% and 18% (p < 0.001) in women without musculoskeletal complaints. Spearman's correlation was moderate to strong between the questionnaires. ConclusionSLN implementation is not associated with increased LEL prevalence compared to hysterectomy alone, but is associated with a significantly lower prevalence compared to lymphadenectomy. LEL is associated with lower QoL. Our study demonstrates moderate to strong correlation between self-reported LEL and QoL scores. Available questionnaires may not distinguish between symptoms caused by LEL and musculoskeletal disease.

Assessing the Significance of Lymphadenectomy in Older Patients with Stage I Endometrial Cancer: A Single-Center, Retrospective Cohort Study.

Advantages of lymphadenectomy for early stage endometrial cancer remain controversial. Lymphadenectomy had been routinely omitted for patients aged ≥ 70 years at our institute if lymph node metastasis was unsuspected due to an increased risk of peri- and postsurgical complications. Since 2013, with the introduction of minimally invasive surgery and considering the heterogeneous medical conditions, we started performing lymphadenectomy in patients who were considered well-tolerated. We retrospectively investigated our clinical database to assess the effect of lymphadenectomy in older patients with early stage endometrial carcinoma. Patients aged ≥ 70 years, preoperatively diagnosed with stage I endometrial carcinoma, and who underwent lymphadenectomy between 2013 and 2021 at Tohoku University Hospital were included in the lymphadenectomy group (n = 33), whereas patients who underwent surgery without lymphadenectomy before the end of 2012 were included in the no-lymphadenectomy group (n = 49). Clinical parameters and patient outcomes, such as disease-free survival (DFS) and disease-specific survival (DSS), were compared. The median age was significantly higher and fewer patients received adjuvant chemotherapy in the no-lymphadenectomy group. Neither DSS nor DFS differed significantly between the two groups. Five-year-DFS rates were 77.2% and 82.5% and 5-year-DSS rates were 89.7% and 97.8% for the lymphadenectomy and no-lymphadenectomy groups, respectively. No significant differences were observed in the subsequent survival analysis by substage, histological subtype, or risk of recurrence. Our results suggest that the indications for lymphadenectomy in older patients should be individually optimized according to the risk of recurrence and postoperative complications.

The Accuracy of MRI in the Local Staging of Endometrial Cancer: An Experience From a Tertiary Care Oncology Institute in Pakistan.

Objective Our objective is to assess the diagnostic accuracy of contrast-enhanced magnetic resonance imaging (MRI) in identifying the depth of myometrial invasion and cervical stromal involvement in endometrial carcinoma (EC) along with nodal status and its correlation with surgical and histopathological (HP) findings. Materials and methods We performed a retrospective study on female patients at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Patients with endometrial carcinoma (CA) were searched from the electronic record system, and a total of 188 patients fulfilling the study criteria were selected. All the patients were evaluated using a 1.5T MRI and underwent a hysterectomy. The outcome of preoperative MRI was correlated withhistopathology results, keeping pathologyas the gold standard. Results A total of 188 patients were included in the study, with a mean age of 56.67 ± 12.47 years. Of the patients, 72 (38.3%)were diagnosed with stage 1a. The second common stage was1b, seen in 43 (22.9%) patients. It was found that the staging of endometrial CA on MRI and HP were significantly correlated for myometrial invasion (stage 1a and 1b), cervical stromal involvement (stage 2b), serosal and adnexal (stage 3a), vaginal(stage 3b), and nodal (stage 3c) involvement as shown by their p-values of <0.01. However, in cases of parametrial invasion (stage 3b), bladderinvolvement, and rectal involvement (stage 4), MRI showed decreased sensitivity as shown by their p-values of 0.833, 0.87, and 0.9, respectively. Conclusion Preoperative MRI can predict local disease and low-risk patients accurately, thereby helping in proper surgical planning and avoiding more extensive surgery such as lymphadenectomy in these patients.

Practical MRI of Endometrial Neoplasms, Part 2: MRI and FIGO Staging

MRI is the method of choice for the evaluation of endometrial carcinomas (ECs), from detection to evaluation of recurrent disease. Although the staging of ECs is done surgically using the system of the International Federation of Gynecology and Obstetrics (FIGO), preoperative assessment based on MRI findings helps in risk stratification and decision-making. The main parameters evaluated include the degree and depth of myometrial invasion, parametrial extent, and cervical stromal infiltration. The combination of T2-weighted imaging, dynamic contrast-enhanced MRI, and diffusion-weighted imaging increases the accuracy of EC diagnosis and staging. A proposed step-by-step guide was developed to help the radiologist formulate hypotheses and guide clinical reasoning from the approach of the patient to the preparation of the final report. A structured report is also proposed with the objective of improving report quality and facilitating communication with the treating physicians.