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Intraoperative Evaluation of Depth of Myometrial Invasion in Stage I Endometrial Adenocarcinoma

From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; the Gynecologic Oncology Service, Department of Obstetrics and Gynecology, and the Department of Pathology, Walter Reed Army Medical Center, Washington, DC; the Gynecologic Oncology Service, Department of Obstetrics and Gynecology, Naval Hospital, Bethesda, Maryland; and the Gynecologic Oncology Service, Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, Texas

Abstract

In patients with stage I endometrial adenocarcinoma, the incidence of pelvic and para-aortic lymph node metastasis is related to the grade of the tumor and the depth of myometrial invasion. Although the grade of the tumor may be predicted preoperatively by endometrial sampling, the depth of myometrial invasion cannot be determined until after the uterus has been removed. Although complications have been attributed to lymph node sampling, failure to perform the procedure in patients at risk for nodal metastasis may result in underdiagnosis of extrauterine disease, leading to inadequate therapy. Gross visual examination of the cut surface of the tumor at the time of hysterectomy accurately determined the depth of myometrial invasion in 135 of 148 prospectively studied patients (91%) (P<.001). The sensitivity of the test was 0.71, the specificity was 0.96, and the positive predictive value was 0.80. Intraoperative assessment of the depth of myometrial invasion is a simple, inexpensive, and useful technique for selecting those patients with stage I endometrial adenocarcinoma who might benefit from selective para-aortic lymphadenectomy.

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