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Prediction of Para-aortic Spread by Gross Pelvic Lymph Node Findings in Patients With Endometrial Carcinoma

Luomaranta, Anna MD*; Lohi, Jouko MD; Bützow, Ralf MD; Leminen, Arto MD*; Loukovaara, Mikko MD*

International Journal of Gynecological Cancer: May 2014 - Volume 24 - Issue 4 - p 697–702
doi: 10.1097/IGC.0000000000000113
Uterine Cancer

Objective Isolated para-aortic lymph node metastases are rare in patients with endometrial carcinoma. We wanted to determine the reliability of macroscopic pelvic lymph node findings at surgery in predicting para-aortic space involvement in these patients.

Methods We identified all women with surgically treated endometrial carcinoma at our institution between January 2008 and February 2013 (n = 854). One hundred seventeen patients received pelvic-aortic lymphadenectomy. Lymph nodes were considered grossly positive based on size and morphology.

Results In patients who underwent comprehensive lymphadenectomy, grossly positive pelvic nodes predicted para-aortic metastasis with a sensitivity of 52.4% and specificity of 93.8%. The positive and negative likelihood ratios were 8.4 and 0.51, respectively. The predictive power of grossly positive pelvic nodes remained significant (odds ratio, 18; 95% confidence interval, 4.1–78; P < 0.0001) after correcting for deep myometrial invasion, poor tumor differentiation, and nonendometrioid histology as confounders. The whole sample of 854 patients was used for Bayesian calculations. The cutoff for a clinically useful test was set at the negative predictive value of 98.0%. The negative predictive value of the test (ie, grossly positive pelvic nodes at surgery in predicting the likelihood of para-aortic metastasis) was 99.7% for patients with superficial grade 1 to 2 endometrioid carcinomas and 98.0% for patients with deeply invasive grade 1 to 2 endometrioid carcinomas. For patients with grade 3 endometrioid and nonendometrioid carcinomas, the negative predictive values were 97.3% and 92.2%, respectively. For the whole study population, the value was 98.4%.

Conclusions When uterine factors are used for risk stratification of endometrial carcinomas, selective para-aortic lymphadenectomy, based on gross findings of pelvic nodes, is feasible for patients with grade 1 to 2 endometrioid carcinomas, regardless of the depth of myometrial invasion. Similarly, gross findings of pelvic nodes can be used to evaluate the need for para-aortic lymphadenectomy in the strategy of routine pelvic lymphadenectomy.

Departments of *Obstetrics and Gynecology and †Pathology, Helsinki University Central Hospital, Helsinki, Finland.

Address correspondence and reprint requests to Anna Luomaranta, MD, Department of Obstetrics and Gynecology, Helsinki University Central Hospital, PO Box 140, FIN-00029 HUS, Helsinki, Finland. E-mail:

The authors declare no conflicts of interest.

Received August 21, 2013

Accepted January 21, 2014

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.