title: Accuracy of a nomogram for prediction of lymph-node metastasis detected with conventional histopathology and ultrastaging in endometrial cancer.
abstract: BACKGROUND
  We developed a nomogram based on five clinical and pathological characteristics to predict lymph-node (LN) metastasis with a high concordance probability in endometrial cancer. Sentinel LN (SLN) biopsy has been suggested as a compromise between systematic lymphadenectomy and no dissection in patients with low-risk endometrial cancer.
  
  
  METHODS
  Patients with stage I-II endometrial cancer had pelvic SLN and systematic pelvic-node dissection. All LNs were histopathologically examined, and the SLNs were examined by immunohistochemistry. We compared the accuracy of the nomogram at predicting LN detected with conventional histopathology (macrometastasis) and ultrastaging procedure using SLN (micrometastasis).
  
  
  RESULTS
  Thirty-eight of the 187 patients (20%) had pelvic LN metastases, 20 had macrometastases and 18 had micrometastases. For the prediction of macrometastases, the nomogram showed good discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.76, and was well calibrated (average error =2.1%). For the prediction of micro- and macrometastases, the nomogram showed poorer discrimination, with an AUC of 0.67, and was less well calibrated (average error =10.9%).
  
  
  CONCLUSIONS
  Our nomogram is accurate at predicting LN macrometastases but less accurate at predicting micrometastases. Our results suggest that micrometastases are an 'intermediate state' between disease-free LN and macrometastasis.
authors.affiliation: Department of Obstetrics and Gynaecology, Bichat University Hospital, Paris 75018, France. martin.koskas@bch.aphp.fr
authors.forename: M
authors.initials: M
authors.lastname: Koskas
authors.forename: E
authors.initials: E
authors.lastname: Chereau
authors.forename: M
authors.initials: M
authors.lastname: Ballester
authors.forename: G
authors.initials: G
authors.lastname: Dubernard
authors.forename: F
authors.initials: F
authors.lastname: Lécuru
authors.forename: D
authors.initials: D
authors.lastname: Heitz
authors.forename: P
authors.initials: P
authors.lastname: Mathevet
authors.forename: H
authors.initials: H
authors.lastname: Marret
authors.forename: D
authors.initials: D
authors.lastname: Querleu
authors.forename: F
authors.initials: F
authors.lastname: Golfier
authors.forename: E
authors.initials: E
authors.lastname: Leblanc
authors.forename: D
authors.initials: D
authors.lastname: Luton
authors.forename: R
authors.initials: R
authors.lastname: Rouzier
authors.forename: E
authors.initials: E
authors.lastname: Daraï
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000556:secondary* / Q000601:surgery; D000368:Aged; D019540:Area Under Curve; D002291:Carcinoma, Papillary / Q000556:secondary* / Q000601:surgery; D018284:Cystadenocarcinoma, Serous / Q000556:secondary* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D061206:Neoplasm Micrometastasis; D009367:Neoplasm Staging; D049451:Nomograms; D010386:Pelvic Neoplasms / Q000556:secondary* / Q000601:surgery; D011379:Prognosis; D012372:ROC Curve; D021701:Sentinel Lymph Node Biopsy