title: Diagnostic Performance of Computed Tomography for Preoperative Staging of Patients with Non-endometrioid Carcinomas of the Uterine Corpus.
abstract: OBJECTIVE
  The aim of this study was to assess the diagnostic performance of computed tomography (CT) for initial staging of non-endometrioid carcinomas of the uterine corpus.
  
  
  METHODS
  Waiving informed consent, the Institutional Review Board approved this Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study of 193 women with uterine papillary serous carcinomas, clear cell carcinomas, and carcinosarcomas, who underwent surgical staging between May 1998 and December 2011 and had preoperative CT within 6 weeks before surgery. Two radiologists (R1, R2) independently reviewed all CT images. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and area under the curve were calculated using operative notes and surgical pathology as the reference standard.
  
  
  RESULTS
  The respective sensitivities and specificities achieved by R1/R2 were 0.79/0.64 and 0.87/0.75 for detecting deep myometrial invasion (MI) on CT; 0.56/0.63 and 0.93/0.79 for detecting cervical stromal invasion; 0.52/0.45 and 0.95/0.93 for detecting pelvic nodal metastases; and 0.45/0.30 and 0.98/0.98 for detecting para-aortic nodal metastases. Although CT had suboptimal sensitivity for the detection of omental disease, it had high PPV for omental seeding at surgical exploration (1.00 for R1 and 0.92 for R2). Inter-observer agreement ranged from moderate in the detection of deep MI (κ = 0.42 ± 0.06) to almost perfect in the detection of para-aortic nodal metastases (κ = 0.88 ± 0.08).
  
  
  CONCLUSIONS
  In patients with uterine non-endometrioid carcinomas, CT is only moderately accurate for initial staging but may provide clinically valuable information by 'ruling-in' isolated para-aortic lymph node metastases and omental dissemination.
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. lakhmany@mskcc.org.
authors: Yulia
authors: Y
authors: Lakhman
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Seth S
authors: SS
authors: Katz
authors: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Debra A
authors: DA
authors: Goldman
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors: Derya
authors: D
authors: Yakar
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Hebert A
authors: HA
authors: Vargas
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Ramon E
authors: RE
authors: Sosa
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Bioimaging and Radiological Science, Catholic University "A. Gemelli" Hospital, Rome, Italy.
authors: Maura
authors: M
authors: Miccò
authors: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Robert A
authors: RA
authors: Soslow
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Hedvig
authors: H
authors: Hricak
authors: Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Nadeem R
authors: NR
authors: Abu-Rustum
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Evis
authors: E
authors: Sala
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002296:Carcinosarcoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D018284:Cystadenocarcinoma, Serous / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery