Utility of computerized tomography in clinical staging and surgical decision making in patients with uterine cancer

IF 1.3 Q3 OBSTETRICS & GYNECOLOGY

Gynecologic Oncology Reports Pub Date : 2025-07-25 DOI:10.1016/j.gore.2025.101812

Andrew Tannous , Alexzandra Adler , Jeanelle Sheeder , Rebecca J. Wolsky , Jill Alldredge

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引用次数: 0

Abstract

Objective

We investigated the utility of pre-operative computerized tomography (CT) abdomen and pelvis on clinical staging and surgical decision making for uterine carcinoma.

Methods

This retrospective cohort study included patients treated surgically for uterine carcinoma between 2010 and 2021 at a single academic center. Data on patient demographics, tumor characteristics, CT imaging results, and surgical procedures were collected. Diagnostic accuracy metrics (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) were analyzed to assess the predictive value of CT for determining extrauterine disease, lymphadenopathy, and omental involvement. The impact of CT imaging on surgical management decisions was also evaluated.

Results

Of 409 patients meeting inclusion criteria, 68.9 % underwent pre-operative CT imaging. CT demonstrated moderate sensitivity (67.0 %, 61/91) and high specificity (87.4 %, 145/166) for detecting extrauterine disease, which was comparable across those with low grade endometrioid, high grade endometrioid, and non-endometrioid histotypes. Patients with abnormal CT findings were significantly more likely to have advanced stage disease (FIGO stage III/IV; p < 0.001), undergo tumor debulking (p < 0.001), and receive pelvic (p = 0.001) and para-aortic lymphadenectomy (p < 0.001). Conversely, patients with normal CT scans more frequently underwent minimally invasive surgery (MIS) and sentinel lymph node (SLN) procedures (p < 0.001).

Conclusions

Preoperative CT shows moderate sensitivity but high specificity for identifying extrauterine disease in uterine carcinoma, supporting continued use for high risk histotypes. Among patients with low-grade histotypes, risk-adaptive use of CT may be valuable in determining eligibility for either MIS or SLN mapping. This is an increasingly relevant consideration as MIS and SLN are becoming more widely adopted.

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计算机断层扫描在子宫癌患者临床分期及手术决策中的应用

目的探讨术前腹部及骨盆CT在子宫癌临床分期及手术决策中的应用价值。方法本回顾性队列研究纳入2010年至2021年在单一学术中心接受手术治疗的子宫癌患者。收集了患者人口统计学、肿瘤特征、CT成像结果和手术程序的数据。分析诊断准确性指标（敏感性、特异性、阳性预测值[PPV]、阴性预测值[NPV]），以评估CT在确定子宫外疾病、淋巴结病和网膜受累方面的预测价值。CT成像对手术管理决策的影响也进行了评估。结果409例符合纳入标准的患者中，68.9%接受了术前CT成像。CT在检测子宫外疾病方面表现出中等敏感性（67.0%,61/91）和高特异性（87.4%,145/166），在低级别子宫内膜样、高级别子宫内膜样和非子宫内膜样组织型中具有可比性。有异常CT表现的患者更有可能是晚期疾病(FIGO III/IV期；p & lt;0.001)，行肿瘤减容术(p <；0.001)，并接受盆腔（p = 0.001）和主动脉旁淋巴结切除术(p <；0.001)。相反，CT扫描正常的患者更频繁地接受微创手术（MIS）和前哨淋巴结（SLN）手术(p <；0.001)。结论术前CT对子宫癌中宫外病变的诊断敏感性中等，但特异性较高，支持对高危组织型继续使用。在低级别组织型患者中，风险适应性CT应用在确定MIS或SLN定位的资格方面可能是有价值的。随着MIS和SLN被越来越广泛地采用，这是一个日益相关的考虑因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gynecologic Oncology Reports OBSTETRICS & GYNECOLOGY-

CiteScore

2.00

自引率

0.00%

发文量

183

审稿时长

41 days

期刊介绍： Gynecologic Oncology Reports is an online-only, open access journal devoted to the rapid publication of narrative review articles, survey articles, case reports, case series, letters to the editor regarding previously published manuscripts and other short communications in the field of gynecologic oncology. The journal will consider papers that concern tumors of the female reproductive tract, with originality, quality, and clarity the chief criteria of acceptance.