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Endometrial cancer: Preoperative and intraoperative assessment of myometrial invasion — Comparison between MRI and intraoperative examination
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Abstracts / Gynecologic Oncology 133 (2014) 2–207
34 - Featured Poster Endometrial cancer: Preoperative and intraoperative assessment of myometrial invasion — Comparison between MRI and intraoperative examination G.F. Cintra, C.E.M.D.C. Andrade, R. Dos Reis, M.A. Vieira, A.T. Tsunoda. Barretos Cancer Hospital, Barretos, Brazil. Objectives: The purpose of this study was to compare the myometrial invasion assessed by preoperative MRI and intraoperative examination in endometrial cancer. Methods: Eighty-seven consecutive endometrial cancer patients from a single institution, evaluated between September 2011 and May 2013, were included. MRI was part of the preoperative routine evaluation. All underwent total hysterectomy and bilateral salpingo-oophorectomy, with the intraoperative assessment of depth of myometrium invasion performed by an experienced pathologist. The final pathology report was used as definitive diagnosis. To calculate the positive predictive value (PPV) and negative predictive value (NPV), the reports were divided in 2 categories: ≤50% and N50% myometrial invasion. Results: All patients underwent perioperative examination, and the MRI report was available in 78 patients. MRI failed to predict the depth of myometrial invasion in the final pathology report in 50% of the cases; the perioperative assessment erred in 23%. The PPV and NPP for the MRI were 64.3% and 68%, respectively. The PPV and NPP for the intraoperative evaluation were 80% and 89.5%, respectively. Final results are shown in Table 1. Table 1. Results. Final Pathology Report Restricted to Invades the Invades ≤50% >50% Endometrium
Myometrium invasion in the MRI
Restricted to the endometrium Invades ≤50% Invades >50% Unspecific myometrium invasion Indeterminate
TOTAL Myometrium invasion in the perioperative evaluation
Restricted to the endometrium Invades ≤50% Invades >50% Indeterminate
TOTAL
TOTAL
1
10
1
12
3 0
20 7
4 18
27 25
1
1
1
3
1 6
6 44
4 28
11 78
3
5
0
8
3 1 0 7
40 3 2 50
5 24 1 30
48 28 3 87
Conclusions: MRI showed poor accuracy in predicting myometrial invasion, although the correlation was better when MRI suggested N50% of myometrial invasion. Perioperative evaluation had a satisfactory accuracy, especially in those who had N50% myometrial invasion. These results indicate that preoperative assessment in endometrial cancer may not be reliable in predicting the extent of the surgery or the final stage.
on the preoperative prediction model versus routine lymphadenectomy for patients undergoing surgery for endometrial cancer. Methods: A modified Markov model was used to estimate the clinical and economic consequences of a newly diagnosed, apparent early-stage endometrial cancer using 2 different strategies: 1) selective lymphadenectomy, in which surgical staging is omitted for patients classified as low risk based on the preoperative prediction model and 2) routine lymphadenectomy, in which all patients undergo complete surgical staging. Published data were used to estimate the rates of adjuvant therapy and survival. The cost of diagnosis and treatment for endometrial cancer was estimated using Korean National Health Insurance database. The rates of lymph node metastasis and lymphedema, the cost of lymphedema treatment, and the performance of the preoperative prediction model were varied for sensitivity analysis. Results: Using selective lymphadenectomy as the baseline, the incremental cost-effectiveness ratio (ICER) of routine lymphadenectomy was $98,295 per year of life saved (YLS). A one-way sensitivity analysis showed that the ICER for routine lymphadenectomy exceeded $50,000/YLS if the prevalence of lymph node metastasis was b16%, the rate of lymphedema was N6%, the cost of lymphedema care was N$9250, or the sensitivity of the preoperative prediction model was N85%. The cost-effectiveness acceptability curve demonstrated that at a willingness-to-pay threshold of $50,000, almost 90% of samples suggested that selective lymphadenectomy is cost-effective. Conclusions: A strategy of selective lymphadenectomy based on the preoperative prediction model was more cost-effective than routine lymphadenectomy for patients with endometrial cancer. The costeffectiveness of selective lymphadenectomy is projected to increase generally when there is a lower rate of lymph node metastasis, a higher rate of lymphedema, a higher cost of lymphedema treatment, and higher test sensitivity.
doi:10.1016/j.ygyno.2014.03.055
doi:10.1016/j.ygyno.2014.03.054
35 - Featured Poster Cost-effectiveness of selective lymphadenectomy based on a preoperative prediction model in patients with endometrial cancer J.Y. Lee1, J.W. Kim1, Y.W. Jeon2, K. Kim3, S. Kang4, S.M. Park1. 1Seoul National University, Seoul, South Korea, 2Korean Health Promotion Foundation, Seoul, South Korea, 3Seoul National University Bundang Hospital, SeoungNam, South Korea, 4National Cancer Center, Ilsan, South Korea. Objectives: In 2012, the Korean Gynecologic Oncology Group proposed a preoperative prediction model for lymph node metastasis using CA125 concentrations and MRI parameters. The aim of this study was to determine the cost-effectiveness of selective lymphadenectomy based
36 - Featured Poster The impact of body mass index on radiotherapy technique in patients with early-stage endometrial cancer: A single-center dosimetric study G. Yavas1, C. Yavas2, O.S. Kerimoglu1, C. Celik1. 1Selcuk University, Konya, Turkey, 2Konya Training and Research Hospital, Konya, Turkey. Objectives: Obesity is a well-known risk factor for endometrial carcinoma. In obese patients, the depth to the tumor is greater compared to normal-weight patients, which can result in unwanted radiation “hot spots” and excess doses to organs at risk (OAR), making pelvic radiotherapy (RT) planning more difficult. We sought to evaluate the impact of body mass index (BMI) on RT technique in patients with early-stage endometrial cancer.
Abstracts / Gynecologic Oncology 133 (2014) 2–207
34 - Featured Poster Endometrial cancer: Preoperative and intraoperative assessment of myometrial invasion — Comparison between MRI and intraoperative examination G.F. Cintra, C.E.M.D.C. Andrade, R. Dos Reis, M.A. Vieira, A.T. Tsunoda. Barretos Cancer Hospital, Barretos, Brazil. Objectives: The purpose of this study was to compare the myometrial invasion assessed by preoperative MRI and intraoperative examination in endometrial cancer. Methods: Eighty-seven consecutive endometrial cancer patients from a single institution, evaluated between September 2011 and May 2013, were included. MRI was part of the preoperative routine evaluation. All underwent total hysterectomy and bilateral salpingo-oophorectomy, with the intraoperative assessment of depth of myometrium invasion performed by an experienced pathologist. The final pathology report was used as definitive diagnosis. To calculate the positive predictive value (PPV) and negative predictive value (NPV), the reports were divided in 2 categories: ≤50% and N50% myometrial invasion. Results: All patients underwent perioperative examination, and the MRI report was available in 78 patients. MRI failed to predict the depth of myometrial invasion in the final pathology report in 50% of the cases; the perioperative assessment erred in 23%. The PPV and NPP for the MRI were 64.3% and 68%, respectively. The PPV and NPP for the intraoperative evaluation were 80% and 89.5%, respectively. Final results are shown in Table 1. Table 1. Results. Final Pathology Report Restricted to Invades the Invades ≤50% >50% Endometrium
Myometrium invasion in the MRI
Restricted to the endometrium Invades ≤50% Invades >50% Unspecific myometrium invasion Indeterminate
TOTAL Myometrium invasion in the perioperative evaluation
Restricted to the endometrium Invades ≤50% Invades >50% Indeterminate
TOTAL
TOTAL
1
10
1
12
3 0
20 7
4 18
27 25
1
1
1
3
1 6
6 44
4 28
11 78
3
5
0
8
3 1 0 7
40 3 2 50
5 24 1 30
48 28 3 87
Conclusions: MRI showed poor accuracy in predicting myometrial invasion, although the correlation was better when MRI suggested N50% of myometrial invasion. Perioperative evaluation had a satisfactory accuracy, especially in those who had N50% myometrial invasion. These results indicate that preoperative assessment in endometrial cancer may not be reliable in predicting the extent of the surgery or the final stage.
on the preoperative prediction model versus routine lymphadenectomy for patients undergoing surgery for endometrial cancer. Methods: A modified Markov model was used to estimate the clinical and economic consequences of a newly diagnosed, apparent early-stage endometrial cancer using 2 different strategies: 1) selective lymphadenectomy, in which surgical staging is omitted for patients classified as low risk based on the preoperative prediction model and 2) routine lymphadenectomy, in which all patients undergo complete surgical staging. Published data were used to estimate the rates of adjuvant therapy and survival. The cost of diagnosis and treatment for endometrial cancer was estimated using Korean National Health Insurance database. The rates of lymph node metastasis and lymphedema, the cost of lymphedema treatment, and the performance of the preoperative prediction model were varied for sensitivity analysis. Results: Using selective lymphadenectomy as the baseline, the incremental cost-effectiveness ratio (ICER) of routine lymphadenectomy was $98,295 per year of life saved (YLS). A one-way sensitivity analysis showed that the ICER for routine lymphadenectomy exceeded $50,000/YLS if the prevalence of lymph node metastasis was b16%, the rate of lymphedema was N6%, the cost of lymphedema care was N$9250, or the sensitivity of the preoperative prediction model was N85%. The cost-effectiveness acceptability curve demonstrated that at a willingness-to-pay threshold of $50,000, almost 90% of samples suggested that selective lymphadenectomy is cost-effective. Conclusions: A strategy of selective lymphadenectomy based on the preoperative prediction model was more cost-effective than routine lymphadenectomy for patients with endometrial cancer. The costeffectiveness of selective lymphadenectomy is projected to increase generally when there is a lower rate of lymph node metastasis, a higher rate of lymphedema, a higher cost of lymphedema treatment, and higher test sensitivity.
doi:10.1016/j.ygyno.2014.03.055
doi:10.1016/j.ygyno.2014.03.054
35 - Featured Poster Cost-effectiveness of selective lymphadenectomy based on a preoperative prediction model in patients with endometrial cancer J.Y. Lee1, J.W. Kim1, Y.W. Jeon2, K. Kim3, S. Kang4, S.M. Park1. 1Seoul National University, Seoul, South Korea, 2Korean Health Promotion Foundation, Seoul, South Korea, 3Seoul National University Bundang Hospital, SeoungNam, South Korea, 4National Cancer Center, Ilsan, South Korea. Objectives: In 2012, the Korean Gynecologic Oncology Group proposed a preoperative prediction model for lymph node metastasis using CA125 concentrations and MRI parameters. The aim of this study was to determine the cost-effectiveness of selective lymphadenectomy based
36 - Featured Poster The impact of body mass index on radiotherapy technique in patients with early-stage endometrial cancer: A single-center dosimetric study G. Yavas1, C. Yavas2, O.S. Kerimoglu1, C. Celik1. 1Selcuk University, Konya, Turkey, 2Konya Training and Research Hospital, Konya, Turkey. Objectives: Obesity is a well-known risk factor for endometrial carcinoma. In obese patients, the depth to the tumor is greater compared to normal-weight patients, which can result in unwanted radiation “hot spots” and excess doses to organs at risk (OAR), making pelvic radiotherapy (RT) planning more difficult. We sought to evaluate the impact of body mass index (BMI) on RT technique in patients with early-stage endometrial cancer.