Diagnostic Performance and Agreement of Preoperative,
Intraoperative Evaluations, and Final Pathology for
Lymphadenectomy and Lymph Node Involvement
in Endometrial Cancer
Nungrutai Saeaib MD*, Sathana Boonyapipat MD*, Tippawan Liabsuetrakul MD, PhD**, Saibua Chicharoen MD*,
Virach Wootipoom MD*, Rakchai Buhachat MD*, Jitti Hanprasertpong MD*, Yuthasak Suphasynth MD*
Affiliation :
* Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
** Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Objective : To determine the accuracy of clinical parameters examined by preoperative and intraoperative evaluations
compared with final histological results in patients with endometrial cancer, and to evaluate the application of preoperative
investigations, intraoperative evaluations, and final histological results in predicting lymph node involvement.
Material and Method: The medical records of the patients diagnosed with endometrial cancer who had surgical staging
between January 1, 2006 and December 31, 2012 at Songklanagarind Hospital were retrospectively reviewed. The agreement
of clinical parameters identified through preoperative investigations and intraoperative evaluations with the final histology
findings were calculated using kappa statistics. The diagnostic performance of preoperative investigations, intraoperative
evaluations, and final histological results to predict lymph node involvement were calculated in terms of sensitivity, specificity,
positive predictive value, and negative predictive value.
Results : Preoperative investigations showed a slight to fair agreement whereas intraoperative evaluations had a fair to
moderate agreement in detecting clinical parameters compared with the final histological results. Endocervical curettage
and endometrial biopsy exhibited the highest sensitivity, pelvic ultrasonography the highest specificity, and intraoperative
evaluations had a high-level sensitivity and specificity.
Conclusion : Preoperative investigations have role as an adjunctive evaluation, whereas intraoperative gross assessment
remains the most accurate and useful method of detecting patients for lymphadenectomy.
Keywords : Accuracy, Endometrial cancer, Intraoperative evaluations, Lymphadenectomy, Lymph node involvement,
Preoperative investigation
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