Assessment of different pre- and intra-operative strategies to predict the actual ESMO risk group and to establish the appropriate indication of lymphadenectomy in endometrial cancer

Purpose of investigation: The objective of this study was to evaluate the best pre- and intra-operative strategy to determine the European Society for Medical Oncology (ESMO) risk group. Materials and Methods: Twelve algorithms, integrating endometrial biopsy for histological type and tumour grade, and ultrasound and/or magnetic resonance imaging (MRI) ± intraoperative examination for determination of myometrial invasion, were built. The diagnostic values of each algorithm to predict high- and low-risk group were calculated. Results: For the prediction of high-risk group, the best algorithm was endometrial biopsy and ultrasound, combined with MRI in case of myometrial invasion < 50% ± intra operative examination in case of myometrial invasion < 50% on MRI. For the prediction of low-risk group, the two best algorithms were endometrial biopsy and ultrasound or MRI, combined with MRI or ultrasound in case of myometrial invasion < 50% and intra-operative examination in case of discrepancy between both exams. Conclusion: The present study suggests that the best strategy to predict actual ESMO risk group is endometrial biopsy and transvaginal ultrasound ± MRI and intra-operative examination in case of myometrial invasion < 50% on ultrasound.

Endometrial cancer; Lymphadenectomy; Ultrasound; MRI; Intra-operative examination.

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