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Updates Surg. 2017 Mar;69(1):75-82. doi: 10.1007/s13304-017-0418-z. Epub 2017 Jan 20.

Preoperative work-up for definition of lymph node risk involvement in early stage endometrial cancer: 5-year follow-up.

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Unit of Obstetrics and Gynecology, "San Camillo de Lellis" Hospital, Viale Kennedy 1, 02100, Rieti, Italy.
Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
Department of Surgery, Vittorio Emanuele Hospital, University of Catania, Via Plebiscito 628, 95124, Catania, Italy.
Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Via Santa Sofia 78, 95124, Catania, Italy.
Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00198, Rome, Italy.


This prospective cohort study aimed to analyze the accuracy of magnetic resonance imaging (MRI) and hysteroscopic excisional biopsy (HEB) for predicting the low- and high-risk patients with endometrial carcinoma for nodal involvement at preoperative evaluation. From January 2005 to December 2006, all patients with a diagnosis of endometrial carcinoma were prospectively included in the study and underwent pelvic MRI and HEB. The pelvic MRI (without contrast) was aimed to evaluate the extent of myometrial invasion (MI < 50%, MI ≥ 50%), the possible involvement of cervical stroma, the ovarian, and lymph nodes status. HEB was performed under general anesthesia, retrieving multiple biopsies through a 5-mm, monopolar, loop electrode. According to our data analysis, the integration of MRI and HEB showed an elevated accuracy and high rates of sensitivity (85.0%), specificity (88.5%), negative predictive value (91.9%) and positive predictive value (79.0%) in identifying low-risk patients who do not need comprehensive surgical staging.


Endometrial carcinoma; Gynaecological oncology; Hysteroscopic biopsy; Lymphadenectomy; Magnetic resonance imaging; Surgical staging

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