title: Patterns and utility of routine surveillance in high grade endometrial cancer.
abstract: OBJECTIVE
  To evaluate surveillance methods and their utility in detecting recurrence of disease in a high grade endometrial cancer population.
  
  
  METHODS
  We performed a multi-institutional retrospective chart review of women diagnosed with high grade endometrial cancer between the years 2000 and 2011. Surveillance data was abstracted and analyzed. Surveillance method leading to detection of recurrence was identified and compared by stage of disease and site of recurrence.
  
  
  RESULTS
  Two hundred and fifty-four patients met the criteria for inclusion. Vaginal cytology was performed in the majority of early stage patients, but was utilized less in advanced stage patients. CA-125 and CT imaging were used more frequently in advanced stage patients compared to early stage. Thirty-six percent of patients experienced a recurrence and the majority of initial recurrences (76%) had a distant component. Modalities that detected cancer recurrences were: symptoms (56%), physical exam (18%), surveillance CT (15%), CA-125 (10%), and vaginal cytology (1%). All local recurrences were detected by symptoms or physical exam findings. While the majority of loco-regional and distant recurrences (68%) were detected by symptoms or physical exam, 28% were detected by surveillance CT scan or CA 125. One loco-regional recurrence was identified by vaginal cytology but no recurrences with a distant component detected by this modality.
  
  
  CONCLUSIONS
  Symptoms and physical examination identify the majority of high grade endometrial cancer recurrences, while vaginal cytology is the least likely surveillance modality to identify a recurrence. The role of CT and CA-125 surveillance outside of a clinical trial needs to be further reviewed.
authors.affiliation: Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Hunn
authors.affiliation: Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA.
authors.forename: Meaghan E
authors.initials: ME
authors.lastname: Tenney
authors.affiliation: Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Tergas
authors.affiliation: University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: Erin A
authors.initials: EA
authors.lastname: Bishop
authors.affiliation: University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Moore
authors.affiliation: Department of Pathology, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: William
authors.initials: W
authors.lastname: Watkin
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Kirschner
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Hurteau
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Gustavo C
authors.initials: GC
authors.lastname: Rodriguez
authors.affiliation: Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA.
authors.forename: Ernst
authors.initials: E
authors.lastname: Lengyel
authors.affiliation: Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA.
authors.forename: Nita K
authors.initials: NK
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA. Electronic address: sdyamada@uchicago.edu.
authors.forename: S Diane
authors.initials: SD
authors.lastname: Yamada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D011159:Population Surveillance / Q000379:methods; D012189:Retrospective Studies
keywords: Endometrial cancer; High grade; Recurrence; Surveillance; Survival
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