Preoperative Pelvic MRI and Serum Cancer Antigen-125: Selecting Women With Grade 1 Endometrial Cancer for Lymphadenectomy.
OBJECTIVE
The objective of our study was to determine the predictive value of preoperative pelvic MRI and serum cancer antigen-125 (CA-125) evaluation in selecting women with grade 1 endometrial cancer for lymphadenectomy as part of the cancer staging operation.


METHODS
A new preoperative clinical protocol including MRI and CA-125 evaluation was adopted at our institution in patients with grade 1 endometrioid adenocarcinoma. Lymphadenectomy was considered as part of the surgical staging operation if there was an elevated CA-125 value or a positive MRI finding (≥ 50% myometrial invasion, cervical invasion, abnormal lymph nodes, extrauterine disease, or tumor index ≥ 36 cm). From January 2012 through May 2013, a retrospective analysis was performed of 100 women who underwent preoperative MRI and CA-125 evaluation; we refer to this cohort as the "preoperative study cohort." The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using final surgical pathology and CA-125 results as the reference standard. The rate of metastatic lymph nodes in the preoperative study cohort was determined. From May 2009 through January 2011, a retrospective analysis of a cohort who did not undergo preoperative MRI and CA-125 evaluation was undertaken to compare lymphadenectomy and lymph node metastasis rates before and after implementation of the new protocol; we refer to this cohort as the "historical cohort."


RESULTS
The new clinical protocol had sensitivity of 94%, specificity of 91%, PPV of 84%, and NPV of 97%. When histologic grade alone was considered, positive lymph node rates in the preoperative study cohort was 4.0% versus 4.2% in the historical cohort. In the preoperative study cohort, the lymph node metastasis rate increased to 11.1% with a positive MRI finding or elevated CA-125 value.


CONCLUSIONS
Preoperative MRI and CA-125 evaluation identified women for lymphadenectomy with a high NPV.
1 Department of Radiology, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, 600 Highland Ave, E3, Madison, WI 53792-3252.|2 Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Elizabeth A
EA
Sadowski
1 Department of Radiology, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, 600 Highland Ave, E3, Madison, WI 53792-3252.
Jessica B
JB
Robbins
1 Department of Radiology, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, 600 Highland Ave, E3, Madison, WI 53792-3252.
Kristie
K
Guite
1 Department of Radiology, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, 600 Highland Ave, E3, Madison, WI 53792-3252.
Krupa
K
Patel-Lippmann
1 Department of Radiology, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, 600 Highland Ave, E3, Madison, WI 53792-3252.
Alejandro
A
Munoz del Rio
2 Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
David M
DM
Kushner
2 Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Ahmed
A
Al-Niaimi
D000230:Adenocarcinoma / Q000097:blood* / Q000473:pathology*; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D018394:CA-125 Antigen / Q000097:blood*; D002985:Clinical Protocols; D016889:Endometrial Neoplasms / Q000097:blood* / Q000473:pathology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D014408:Biomarkers, Tumor; D018394:CA-125 Antigen
DWI; MRI; endometrial cancer