title: Diagnostic usefulness of intraoperative ultrasonography in avoiding unnecessary para-aortic lymphadenectomy in women with endometrial carcinoma.
abstract: OBJECTIVE
  To evaluate the usefulness of intraoperative ultrasonography (IU) in reducing the number of unnecessary para-aortic lymphadenectomy in women with endometrial carcinoma.
  
  
  METHODS
  Computed tomography (CT) and IU were used to assess whether para-aortic lymph nodes were enlarged in 91 women with endometrial carcinoma. All women underwent hysterectomy and systematic pelvic and para-aortic lymphadenectomy. On the basis of the intrauterine pathological findings (IPF) of the removed uterus, the women were classified into low- and high-risk groups. It was assumed that para-aortic lymphadenectomy would be performed only when enlarged nodes were detected by CT or IU or only when women were classified into the high-risk group. The numbers of women who would have had missed metastases and who could have avoided para-aortic lymphadenectomy were calculated.
  
  
  RESULTS
  Eighteen women had pathological para-aortic node metastases. Theoretically, the number of women who would have had missed metastases on the basis of CT, IU, and IPF were 11, 2, and 2, respectively; more metastases were missed with CT than with the other 2 methods. The number of women who could have avoided para-aortic lymphadenectomy on the basis of CT, IU, and IPF were 84, 59, and 29, respectively; compared to IPF, IU helped avoid para-aortic lymphadenectomy in more women.
  
  
  CONCLUSIONS
  Intraoperative ultrasonography is the most efficient method for avoiding both unnecessary para-aortic lymphadenectomy and missed para-aortic node metastases in women with endometrial carcinoma.
authors.affiliation: Department of Obstetrics and Gynecology, Teikyo University, and Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan. yonchi@med.teikyo-u.ac.jp
authors.forename: Eiji
authors.initials: E
authors.lastname: Ryo
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yasugi
authors.forename: Katsumi
authors.initials: K
authors.lastname: Mizutani
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Kita
authors.forename: Shigeki
authors.initials: S
authors.lastname: Takeshita
authors.forename: Takuya
authors.initials: T
authors.lastname: Ayabe
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D008954:Models, Biological; D016343:Monitoring, Intraoperative / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D014463:Ultrasonography / Q000379:methods / Q000706:statistics & numerical data; D019564:Unnecessary Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*