子宫内膜癌患者血清CP2、CA125、唾液酸和癌胚抗原检测的临床意义

目的探讨肿瘤标志物CP2、CA125、唾液酸（SA）和癌胚抗原（CEA）检测对子宫内膜癌患者的临床意义。方法选取154例具有肿瘤标志物检测结果的子宫内膜癌患者的临床病理资料进行回顾性分析。结果子宫内膜癌患者血清CP2、SA、CA125和CEA水平升高的百分率分别为23．4％、36．8％、19．0％和30．3％。血清CP2水平升高与手术病理分期、病理分化程度、附件受累、腹腔细胞学检查阳性及盆腔淋巴结转移相关（P值分别为0．002、0．040、0．019、0．019、0．005）;血清SA水平升高与附件受累、腹腔细胞学检查阳性相关（P值分别为0．021、0．000）;血清CA125水平升高与病理分化程度、宫颈受累和盆腔淋巴结转移相关（P值分别为0．014、0．006、0．018）;CEA与各临床病理特征间均无相关性（P均〉0．05）。血清CP2、CA125和CEA水平升高与患者预后相关（P值分别为0．016、0．000、0．016）,其中CA125水平与预后关系最为密切。结论子宫内膜癌缺乏特异性肿瘤标志物,CP2与子宫内膜癌临床病理特征相关性较强,CP2、CA125和CEA对患者预后有提示作用。     

子宫内膜癌深肌层浸润相关因素分析及预测

目的:探讨临床病理特征与子宫内膜癌深肌层浸润的关系,同时建立Logistic回归预测模型以更好预测子宫内膜癌深肌层浸润情况。方法:回顾性收集274例经手术病理确诊的子宫内膜癌患者的术后临床病理资料,运用单因素和多因素Logistic回归分析确定子宫内膜癌深肌层浸润的高危因素并建立预测模型,用受试者工作曲线(ROC)确定截断值。结果:274例子宫内膜癌患者中,共有101例有深肌层浸润。多因素分析结果显示术前CA_(125)血清水平35 U/ml、肿瘤最大直径3 cm、中/低分化是子宫内膜癌深肌层浸润的高危因素,其OR值分别为3.980(95%CI 1.998～7.926)、2.526(95%CI 1.470～4.339)、1.796(95%CI 1.035～3.116)。建立的Logistic回归预测模型为:Logit P=-2.521+1.381×术前血清CA_(125)水平+0.927×肿瘤最大直径+0.585×组织分级。绘制回归模型预测概率的ROC曲线,其AUC为0.702(95%CI 0.636～0.768);取深肌层浸润概率P=0.32为截断值,其灵敏度和特异度分别为57.4%和79.2%。P0.32时,深肌层浸润的可能性大。结论:联合术前血清CA_(125)水平、肿瘤最大直径和组织分级这3个因素,利用Logistic回归预测模型有助于评估子宫内膜癌患者深肌层浸润的可能性。当深肌层浸润概率P0.32时,深肌层浸润的可能性大。     

子宫内膜异位症患者子宫内膜PDGF、LN表达及其与血清CA_(125)水平相关性研究

目的:探讨子宫内膜异位症(EMT)患者子宫内膜血小板衍生生长因子(PDGF)、层粘连蛋白(LN)表达及其与血清糖类抗原-125(CA_(125))水平相关性。方法:选择经手术病理确诊的EMT患者60例,列为观察组,非EMT患者30例,列为对照组,取观察组术前子宫在位内膜、术后异位内膜,对照组子宫内膜,比较两组患者血清CA_(125)水平及内膜PDGF、LN表达,分析血清CA_(125)诊断EMT的灵敏度、特异度,并分析PDGF、LN表达与血清CA_(125)水平相关性。结果:①观察组血清CA_(125)水平明显高于对照组,差异有统计学意义(P0.05),血清CA_(125)诊断EMT的灵敏度、特异度分别为85.00%、93.33%,CA_(125)水平与EMT分期有显著相关性(r=0.788,P0.05)。②观察组在位内膜、异位内膜平均PDGF表达水平明显高于对照组(P0.05);观察组在位内膜、异位内膜平均LN表达水平明显低于对照组(P0.05);随EMT分期增高,异位内膜PDGF表达增高,异位内膜LN表达降低,各期比较差异有统计学意义(P0.05)。③观察组异位内膜PDGF的表达随血清CA_(125)水平增高而增高,两者相关性检验呈正相关(r=0.653,P0.05)。④观察组异位内膜LN水平随血清CA_(125)水平增高而降低,两者相关性检验呈负相关(r=-0.442,P0.05)。结论:血清CA_(125)可作为诊断、评估EMT的客观指标,PDGF、LN的表达与CA_(125)水平有关。     

子宫内膜癌术前临床分期与手术病理分期的对照研究

目的探讨子宫内膜癌术前临床分期的应用价值。方法汕头大学肿瘤医院1996年1月至2004年6月对68例子宫内膜癌患者行术前超声检测、诊断性刮宫以及血清CA125水平测定后进行临床分期,并与术后手术病理分期进行比较。结果(1)超声诊断子宫内膜癌肌层浸润程度的准确率为868%;(2)诊断性刮宫诊断宫颈管是否受侵的准确率为912%;(3)子宫内膜癌I期血清CA125水平明显低于Ⅱ、Ⅲ、Ⅳ期,且手术病理分期愈晚,血清CA125的水平也愈高;(4)三种方法术前综合判断子宫内膜癌临床分期的准确率为824%。结论超声、诊断性刮宫以及血清CA125水平联合检测可提高子宫内膜癌术前临床分期的准确率,具较好的临床应用价值。     

Ⅰ～Ⅲ期子宫内膜癌淋巴结转移及预后的相关因素分析

目的:探讨国际妇产科联盟(FIGO)Ⅰ～Ⅲ期子宫内膜癌患者的临床病理特征与淋巴结转移及预后的相关因素。方法:选择2009～2020年于安徽医科大学第一附属医院妇科因子宫内膜癌行分期手术的患者1346例为研究对象(其中130例淋巴结阳性),对其临床病理特征行单因素及Logistic、Cox多因素回归模型分析与淋巴结转移及生存期预后的相关因素。结果:(1)单因素分析提示:病理类型、组织学分级、肌层浸润深度、肿瘤直径、子宫颈侵犯、淋巴脉管间隙浸润(LVSI)、术前CA_(125)及卵巢受累与淋巴结转移有关(P0.05)。多因素的Logistic回归分析显示:病理类型为非子宫内膜样癌、子宫颈侵犯、LVSI阳性、术前CA_(125)≥35 U/L、卵巢受累是淋巴结转移的独立危险因素(OR1,P0.05)。(2)单因素分析提示:病理类型、组织学分级、肌层浸润深度、子宫颈侵犯、LVSI、淋巴结转移、卵巢受累及术后辅助治疗与总生存期有关(P0.05)。多因素Cox回归验证及Kaplan-Meier生存曲线显示:非子宫内膜样癌、子宫颈侵犯、LVSI阳性和淋巴结转移是影响总生存期的独立危险因素(HR1,P0.05)。结论:特殊病理类型、子宫颈侵犯、LVSI阳性、术前CA_(125)≥35 U/ml及卵巢受累,对淋巴结转移风险具有独立预测意义。特殊病理类型、子宫颈侵犯、LVSI阳性及淋巴结转移是临床预后不良的有力预测因子。进一步完善子宫内膜癌分期手术和术后病理,为指导患者个体化治疗提供有效帮助。     

CA125对子宫内膜癌检测及临床意义

目的 探讨血清CA25值对子宫内膜癌早期诊断、监测病情变化和预测预后的价值。方法 用免疫化学法检测55例子宫内膜癌患者和16例良性子宫病变患者血清CA125水平。结果 良性子宫病变和44例手术分期为I期的子宫内膜癌患者血清CA125阳性率分别为19．4％和27．3％，两者相比，P＞0．05，无显著性差异（P＞0．05）。手术分期为I期和10例晚期病人（Ⅲ期＋Ⅳ期）血清CA125的阳性率各为27．3％和70％，两者相比，有显著性差异（P＜0．05）。30例Ia期＋Ib期和14例Ic期病人血清CA1254的阳性率分别为20％和47．8％，两者相比，无显著性差异（P＞0．05）。病理分级中30例G1、20例G2、5例G3血清CA1254的阳性率分别为20％、45％、80％，三者相比，相互之间有显著性差异（P＜0．05）。结论 血清CA125的检测对早期诊断子宫内膜癌缺乏敏感性，对早期内膜癌患者预测手术分期，Ic期无明显的参考价值，但与手术分期和病理分级密切相关，可能对预测预后提供一定的参考价值。     

Rb、CyclinD1在子宫内膜癌中的表达及临床意义

目的 研究 Rb、CyclinD1在子宫内膜癌中的表达及其临床意义。方法 采用免疫组化LSAB法检测42例子宫内膜癌中Rb、CyclinD1的表达。结果42例子宫内膜癌中19例Rb表达阳性,占45.2％,Rb与子宫内膜癌的细胞分级、肌层浸润深度有关(P<0.05);17例子宫内膜癌CyclinD1表达阳性,占40.5％,CyclinD1与子宫内膜癌的细胞分级、临床分期、淋巴结转移有关(P<0.05);Rb、CyclinD1)协同表达15例,均为晚期或低分化癌。结论Rb、CyclinD1作为细胞周期调节因子参与子宫内膜癌的发生、发展,其协同作用促进子宫内膜癌的发展,且预后不良。     

巨噬细胞集落刺激因子水平对子宫内膜癌术前分期的判断

为分析子宫内膜癌患者血中巨噬细胞集落刺激因子(CSF)及CA125水平与肌层浸润深度、病理类型、病理分级及临床分期的关系,以评估单项巨噬细胞CSF或结合CA125在术前判断宫外转移的实用价值,将1986～1989年Duke大学医疗中心首次手术治疗92例子宫内膜癌患者选入本研究。其中61     

肿瘤抑癌蛋白PTEN、P53在子宫内膜癌组织中的表达

目的 研究肿瘤抑癌蛋白PTEN、突变型P53在子宫内膜组织中的分布和表达,探讨其在子宫内膜癌发病中的意义。方法 选择30例子宫内膜癌组织及癌旁组织标本,分别采用Western印迹半定量方法研究PTEN的相对表达量,采用免疫组织化学法进行PTEN、P53蛋白表达研究,并与临床分期、病理分级、淋巴结转移和雌孕激素受体状态的相关性进行分析。结果 Western印迹定量结果显示PTEN蛋白在子宫内膜癌组织中的表达明显高于癌旁正常组织(P<0.01)。免疫组化结果显示PTEN主要分布于细胞浆中,而P53主要分布于细胞核中。17/30例(56.7％)子宫内膜癌中PTEN完全缺失,9/30例(30.0％)部分缺失。PTEN在子宫内膜癌的表达与临床分期有关,其中Ⅱ期的表达缺失率明显高于临床Ⅱ、Ⅲ期,但与病理分级、肌层浸润及淋巴结转移无明显相关性。突变型P53在子宫内膜癌的阳性表达率为36.7％;与病理分级、临床分期有关,而与肌层浸润、淋巴结转移无关。PTEN表达缺失率在雌孕激素受体阳性的癌组织中明显高于雌孕激素受体阴性的癌组织。结论K-PTEN与子宫内膜癌的发生有关,是相对早期的分子事件;P53的突变提示肿瘤预后不良,是相对晚期的分子事件,可能在子宫内膜癌的发展中发挥作用。     

雌激素膜受体GPR30在子宫内膜癌的表达及意义

目的:探讨雌激素膜受体GPR30在子宫内膜癌的表达及意义。方法:RT-PCR和免疫组织化学法检测子宫内膜癌组织和正常子宫内膜组织中GPR30mRNA和蛋白的表达,分析GPR30表达与临床病理的联系;免疫细胞化学分析GPR30蛋白在子宫内膜癌细胞系RL95-2(ER+)和KLE(ER-)的表达。结果:子宫内膜癌组织GPR30mRNA的表达水平显著高于正常子宫内膜组织(P<0.05);子宫内膜癌组织GPR30蛋白表达阳性率(21/30,70%)显著高于正常子宫内膜组织(5/17,29.41%)(χ2=7.232,P=0.007);肿瘤组织学分级越高,GPR30表达阳性率越高(P=0.003),GPR30表达与内膜癌分期、肌层浸润深度和腹水转移无关(P>0.05);ERα阳性的子宫内膜癌细胞系RL95-2和ERα阴性的细胞系KLE均表达GPR30。结论:雌激素膜受体GPR30于子宫内膜癌组织和子宫内膜癌细胞系均有表达,与肿瘤组织学高分级相关,提示GPR30可能在子宫内膜癌中发挥重要的作用。     

子宫内膜癌肌层浸润深度的评估

目的　探讨术前B超、术中肉眼观察、术后大体标本测量和血清CA12 5测定 ,对判断子宫内膜癌肌层浸润深度的价值。方法　采用术前B超、术中肉眼观察和术后大体标本测量对 13 3例手术病理分期Ⅰ期子宫内膜癌患者的肌层浸润深度的判断进行评估 ,并分析 91例 (79例为Ⅰ期 ,12例为同期的Ⅱ～Ⅳ期患者 )子宫内膜癌患者血清CA12 5水平与子宫内膜癌的关系。结果　术前B超判断子宫内膜癌肌层浸润和深肌层浸润的敏感性分别为 62 6%和 47 8% ,特异性分别为 67 7%和90 0 % ;术中肉眼观察判断子宫内膜癌肌层浸润和深肌层浸润的敏感性分别为 5 9 6%和 73 9% ,特异性分别为 76 5 %和 94 6% ;术后大体标本测量判断子宫内膜癌肌层浸润和深肌层浸润的敏感性分别为 70 0 %和 94 4% ,特异性分别 92 0 %和 97 7%。子宫内膜癌手术病理分期Ⅰ期患者血清CA12 5水平异常 (≥ 3 5kU/L)的发生率为 8% (6/79) ,Ⅱ～Ⅳ期患者的发生率为 5 8% (7/12 ) ,血清CA12 5水平异常的发生率与手术病理分期的期别有极显著相关性 (P <0 0 0 1) ,而与子宫内膜癌肌层浸润深度无显著相关性 (P >0 0 5 )。结论　术前B超、术中肉眼观察和术后大体标本测量对判断Ⅰ期子宫内膜癌肌层浸润深度有一定帮助 ,其中术后大体标本测量的准确性相对较好。血     

Preoperative Serum CA 125 Level as a Predictor for Metastasis and Survival in Endometrioid Endometrial Cancer

ObjectiveWe wished to determine the relationship between preoperative serum CA 125 levels and the risk of metastatic disease, recurrent disease, and death in women with endometrial cancer.MethodsWe reviewed the records of women with endometrial adenocarcinoma of all stages who underwent primary surgery. We abstracted multiple data variables, including demographic characteristics, serum CA 125 levels, postoperative histopathology results, progression-free survival, and overall survival rates.ResultsThe records of 97 women with endometrial carcinoma were analyzed. With a serum CA 125 cut-off level of 35 kU/L, the likelihood of disease-related death could be predicted with 70% sensitivity and 83% specificity; disease progression could be predicted with 60% sensitivity and 84% specificity; and lymph node metastasis could be predicted with 75% sensitivity and 84% specificity. There was a significant relationship between a serum CA 125 level ≥ 35 kU/L and depth of myometrial invasion, cervical stromal invasion, stage, frequency of recurrence, and disease-related death. Having deep myometrial invasion, cervical stromal involvement, positive peritoneal cytology, lymph node metastasis, disease recurrence, and disease-related death were each associated with significantly higher mean CA 125 levels. In women with serum CA 125 levels < 35 kU/L, fiveyear progression-free survival rates (88%) and overall survival rates (92%) were significantly better than in women with levels ≥ 35 kU/L (57% and 70%, respectively; P = 0.001 for both).ConclusionSerum CA 125 levels and extension of disease are highly correlated in women with endometrioid endometrial cancer, and elevated CA 125 levels predict a higher risk of disease recurrence and death.     

子宫内膜癌患者血清及病理分子标志物与其病理特征关系的研究

目的探讨子宫内膜癌组织中癌基因表达及血清学肿瘤标志物水平与其临床病理特点及预后的相关性。方法回顾性分析467例原发性子宫内膜癌患者的临床病理资料。并按照临床预后的高危因素将子宫内膜癌患者分为高危组和低危组。采用免疫组化法检测其组织中雌激素受体（ER）、孕激素受体（PR）、PTEN、p53和Ki-67基因的表达,电化学发光法和酶联免疫法检测血清中CA125、CP2、CA199及唾液酸（SA）等肿瘤标志物,分析各项肿瘤标志物与其临床病理特征的相关性。结果不同临床病理分期ER、PR、PTEN、CA125和CP2表达比较,差异均有统计学意义（P〈0.05）,不同病理分级ER、PR、Ki-67和SA表达比较,差异有统计学意义（P〈0.05）,不同肌层浸润深度PR、CA125和CA199表达比较,差异均有统计学意义（P〈0.01）,有无淋巴结转移ER、PR、CA125和CP2表达比较,差异均有统计学意义（P〈0.01）,有无脉管内癌栓CA125和SA表达比较,差异有统计学意义（P〈0.05）,有无腹水癌细胞CA125表达比较,差异有统计学意义（P〈0.001）。高危组PR表达显著低于低危组（P〈0.05）,高危组Ki-67、CA125、CA199和CP2的表达均显著高于低危组（P〈0.05）,两组中ER、p53、PTEN和SA表达比较,差异均无统计学意义（P〉0.05）。结论 PR、Ki-67、CA125、CA199和CP2与子宫内膜癌的预后密切相关,有助于指导临床治疗。     

Can a preoperative CA 125 level be a criterion for full pelvic lymphadenectomy in surgical staging of endometrial cancer?

OBJECTIVE: The aim of the present study was to evaluate whether a preoperative serum level of CA 125 in patients with endometrial cancer can provide additional information in determining the extent of lymphadenectomy required in the surgical staging and which cutoff value is optimal in this respect. METHODS: CA 125 was measured in 124 patients diagnosed with endometrial carcinoma who underwent surgery at our institution between January 1995 and May 2000. Statistic analysis was performed using the Mann-Whitney U test and Kruskal-Wallis test to evaluate the association of preoperative CA 125 levels with various factors. The chi(2)/Fisher's exact test and a logistic regression model were employed to examine the effects of clinicopathological factors on serum CA 125 levels. Furthermore, a receiver operating characteristic curve was used to determine which cutoff value of the preoperative CA 125 was the optimal one. RESULTS: Univariate analyses showed that elevated CA 125 levels were significantly correlated with an advanced stage, larger tumor size, increasing depth of the myometrial invasion, cervical invasion, positive cytology, and lymph node metastases (P < 0.05). Multivariate analyses using a logistic regression model showed lymph node metastases had the most significant effect on the elevation of CA 125 levels. The ROC curve determined that the best cutoff value was 40 U/ml; the sensitivity and specificity for screening lymph node metastases were found to be 77.8 and 81.0%, respectively. CONCLUSION: Our data provide evidence indicating that a preoperative CA 125 level greater than 40 U/ml can be considered a criterion for full pelvic lymphadenectomy in the surgical staging of endometrial cancer.     

Determination of a Normal Level of Serum CA125 in Postmenopausal Women as a Tool for Preoperative Evaluation and Postoperative Surveillance of Endometrial Carcinoma

In an attempt to determine a normal level of CA125 in postmenopausal women, CA125 levels of normal postmenopausal women (n= 36, 58.2 ± 8.1 years) and postmenopausal women undergoing hormone replacement therapy (HRT) (n= 111, 56.8 ± 6.1 years) were studied. A mean CA125 concentration of 10.0 ± 3.8 U/ml was found in postmenopausal women without HRT and was significantly lower than that of postmenopausal women undergoing HRT (12.8 ± 3.8 U/ml), indicating that the cutoff level of CA125 in postmenopausal women or women without reproductive organs should be estimated at a level lower than that conventionally accepted. A receiver operating characteristic (ROC) curve for a preoperative evaluation of myometrial invasion was analyzed in postmenopausal women with endometrial cancer (n= 110). A novel cutoff level of 20 U/ml of CA125 could detect myometrial invasion to more than one-half of the myometrium with sensitivity of 69.0%, specificity of 74.1%, positive predictive value of 58.8%, and negative predictive value of 81.6%. In addition, the distribution of CA125 levels was analyzed in patients who had undergone an operation for endometrial cancer more than 2 years earlier and as yet had no clinical evidence of recurrence of the disease. Ninety-six point two percent of 619 measurement values were lower than 20 U/ml. These results suggest that the novel CA125 level of 20 U/ml is clinically useful for preoperative evaluation and postoperative surveillance of endometrial carcinoma.     

Preoperative CA-125 levels predict poor prognostic pathologic features in early stage, FIGO grade 1 and 2 endometrial adenocarcinoma

Preoperative CA-125 levels were studied in patients with favorable histology and early clinical stage endometrial adenocarcinoma to determine its ability to predict the presence of poor pathologic prognostic features on final pathology. One hundred and one patients with clinical stage I ( N = 65) or II ( N = 19) or diagnosed by endometrial curettage (EMC) only ( N -17) with grade 1 or 2 endometrial adenocarcinoma without gross cervical involvement underwent preoperative CA-125 levels. Final pathology was reviewed for five poor prognostic pathologic features: FIGO grade 3 histology, unfavorable histologic type (sarcoma, clear cell, or papillary serous), invasion into the outer third of the myometrium, extension to the cervix, and extra-uterine metastases. Fifteen patients (14.9%) had CA-125 levels greater than 30 IU ml⁻¹. Of these 15 patients, 12 had one or more of the five poor prognostic pathologic features (positive predictive value 80.0%, specificity 95.8%, P < 0.0001). However, since 30 of the 101 patients were found to have one or more of these poor prognostic pathologic features the sensitivity was only 40.0%. When clinical stage I patients were analyzed separately three patients (4.6%) had CA-125 levels greater than 30 IU ml ⁻¹ (positive predictive value 100%, specificity of 100%, sensitivity of 21.4%, P = 0.008). For patients with clinical stage II carcinoma, CA-125 was not predictive of pathologic findings except as a negative predictor of disease in a subgroup of patients whose endocervical curettage (ECC) demonstrated carcinoma unattached to endocervical tissue. In patients diagnosed by EMC only, an elevated CA-125 level was associated with poor prognostic pathologic features ( P = 0.001). An elevated preoperative CA-125 reliably predicts advanced disease even in patients with apparently favorable histology and clinical stage, however the sensitivity of this method remains low.     

Magnetic resonance (MR) in endometrial carcinoma preoperative evaluation

BACKGROUND: Myometrial invasion of endometrial carcinoma is an important prognostic factor because the degree of myometrial invasion is correlated with the rate of lymphnode metastases and of recurrences. The aim of the study was a preoperative evaluation of endometrial carcinoma by Magnetic Resonance (MR). METHODS: The authors present a prospective study performed on 54 cases of endometrial carcinoma collected at the Department of Gynecology and Obstetrics of the University of Trieste (Italy). All the patients were considered as Stage I after hysteroscopy and endocervical curettage. Prior to surgery all the patients underwent MR at the Department of Radiology of the University of Trieste (Italy) in order to evaluate the depth of myometrial invasion. The surgical procedure included total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic and lomboaortic lymphadenectomy in high risk cases. Statistical evaluation was performed by Fischer's exact test. RESULTS: Statistically significant positive correlation was found (p<0.001) between MR staging and surgical staging. The sensitivity reported in our series for distinguishing between superficial disease (Stage IA and IB) and deep myometrial invasion (Stage IC) was 92%. CONCLUSIONS: Preoperative MR is helpful in selecting patients at high risk of nodal involvement and it is suggested that, although MR is considered an expensive examination, its use should be always considered before surgical treatment of patients with high surgical risk.     

Magnetic resonance imaging in the preoperative staging of endometrial carcinoma

PURPOSE OF INVESTIGATION: Magnetic resonance imaging (MRI) has emerged as an important imaging modality in the evaluation of the extension of endometrial carcinoma which is essential in planning treatment and predicting prognosis. This study aimed to assess the value of MRI in the preoperative staging of endometrial carcinoma. METHODS: We included in this study 162 patients with a histological diagnosis of endometrial carcinoma who underwent MRI pelvic imaging and surgical staging. MRI images were compared with pathological findings to measure MRI's sensitivity, specificity, positive and negative predictive values and diagnostic accuracy in what concerns myometrial, cervical and lymph node invasion. RESULTS: MRI differentiation of deep myometrial invasion from superficial disease agreed with pathological findings in 77% of cases, with a sensitivity of 83%, a specificity of 72% and a diagnostic accuracy of 77%. Concerning cervical invasion, MRI had a sensitivity, specificity and diagnostic accuracy of 42%, 92%, 81% respectively. In assessing lymph node invasion, MRI presented a sensitivity of just 17%, a specificity of 99% and a diagnostic accuracy of 89%. CONCLUSION: Our study confirmed the high accuracy of MRI imaging in assessing myometrial and cervical invasion in endometrial carcinoma. When evaluating lymph node invasion, micrometastases are responsible for the low sensitivy of MRI.     

Endometrial carcinoma: the relevance of cervical cytology

In patients with endometrial carcinoma, preoperative identification of poor prognostic factors is helpful in planning therapy. Extended surgical staging, including pelvic and periaortic node dissection, is indicated in patients with deep myometrial invasion or high-grade tumor, or when other risk factors for extrauterine spread are present. In this study, cervical cytology was reviewed in 86 patients with endometrial carcinoma, all of whom underwent surgical staging, to correlate the cytologic results with surgical and pathologic findings. Cervical cytology was normal in 20 patients (23%), whereas suspicious or malignant endometrial cells were present in 23 and 43 cases (27 and 50%), respectively. Suspicious or malignant cervical cytology was associated with deeper myometrial invasion (P = .011), higher postoperative tumor grade (P = .006), positive peritoneal washings (P = .012), and more advanced stage by International Federation of Gynecology and Obstetrics criteria (P = .024). When compared with patients with normal cervical cytology, those who had malignant endometrial cells had over twice the risk of deep myometrial invasion (67 versus 30%), twice the risk of grade 2 or 3 tumor (60 versus 30%), and three times the risk of positive peritoneal washings (33 versus 10%). Seventy-four percent of patients with malignant cervical cytology were stage IC or more. In contrast, 70% of patients with normal cervical cytology were stage IA or IB. Patients with endometrial carcinoma who have malignant endometrial cells detected by cervical cytology are at increased risk of having a deeply invasive, high-grade, advanced-stage tumor, and therefore are more likely to require extended surgical staging.