title: Prospective validation of an intraoperative algorithm to guide surgical staging in early endometrial cancer.
abstract: OBJECTIVE
  Prospectively validate an intraoperative surgical staging algorithm to stratify patients with early endometrial cancer by risk of lymph node metastasis.
  
  
  METHODS
  Subjects with endometrial cancer clinically confined to the uterus were prospectively enrolled at an academic cancer center between Jan 2012 and Jun 2015. Study participants were stratified intraoperatively into two groups based on risk of nodal involvement using cell type, tumor grade, myometrial invasion, and tumor size in accordance with an established protocol from the Mayo Clinic. Low risk (LR) subjects received extrafascial hysterectomy with bilateral salpingo-oophorectomy; high risk (HR) patients received complete surgical staging including bilateral pelvic and para-aortic lymphadenectomy.
  
  
  RESULTS
  Of the 200 subjects enrolled, 194 were eligible for analysis. The algorithm identified 132 (68%) HR and 62 (32%) LR cancers. Of the HR subjects, 126 had lymphadenectomy performed with 14 (11%) positive for nodal metastases. Five HR subjects experienced disease recurrence. Of the 62 LR cancers, two patients developed disease recurrence. Ten LR cancers were upgraded to HR on final pathology due to lesion size (6) and grade (4). None of these patients experienced disease recurrence. The algorithm demonstrated 90% sensitivity (18/20) and 36% specificity (62/174) as determined by positive lymph nodes and/or disease recurrence.
  
  
  CONCLUSIONS
  Intraoperative assessment of early endometrial cancer can be used to determine the extent of surgical staging. The studied algorithm has low specificity and modifications are necessary to better match the surgical procedure to the risk of metastatic cancer.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Markey Cancer Center, Lexington, KY, United States. Electronic address: jlefringhouse@gmail.com.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Lefringhouse
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Markey Cancer Center, Lexington, KY, United States.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Elder
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Markey Cancer Center, Lexington, KY, United States.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Baldwin
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Markey Cancer Center, Lexington, KY, United States.
authors.forename: Rachel W
authors.initials: RW
authors.lastname: Miller
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Markey Cancer Center, Lexington, KY, United States.
authors.forename: Chris P
authors.initials: CP
authors.lastname: DeSimone
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Markey Cancer Center, Lexington, KY, United States.
authors.forename: John R
authors.initials: JR
authors.lastname: van Nagell
authors.affiliation: Department of Pathology, University of Kentucky, Markey Cancer Center, Lexington, KY, United States.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Samoyoa
authors.affiliation: Department of Pathology, University of Kentucky, Markey Cancer Center, Lexington, KY, United States.
authors.forename: Dava S
authors.initials: DS
authors.lastname: West
authors.affiliation: Division of Cancer Biostatistics, University of Kentucky, Markey Cancer Center, Lexington, KY, United States.
authors.forename: Emily V
authors.initials: EV
authors.lastname: Dressler
authors.affiliation: Division of Cancer Biostatistics, University of Kentucky, Markey Cancer Center, Lexington, KY, United States.
authors.forename: Meng
authors.initials: M
authors.lastname: Liu
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Markey Cancer Center, Lexington, KY, United States.
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Ueland
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000465:Algorithms; D001011:Aorta; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007430:Intraoperative Care; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy / Q000379:methods*; D010388:Pelvis; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D058994:Salpingectomy / Q000379:methods*; D047368:Tumor Burden
keywords: Endometrial cancer; Intraoperative; Lymph node; Mayo Clinic algorithm, prospective; Surgical staging