Endometrium kanserinde lenf nodu metastazını öngörmede preoperatif kontrastlı bilgisayarlı tomografinin tanısal performansı: 408 hastalık tek merkezli bir çalışma

Abstract

Amaç: Bu çalı%mada, endometrium kanseri hastalarında preoperatif bilgisayarlı tomografide (BT) kısa aks çapı ≥10 mm olan lenf nodlarının, patolojik lenf nodu metastazını (LNM) öngörmedeki tanısal performansının değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Bu retrospektif tek merkezli çalı%maya, sentinel lenf nodu (SLN) haritalaması ve/veya sistematik lenfadenektomi uygulanan 408 endometrium kanseri hastası dahil edildi. Preoperatif kontrastlı BT incelemelerinde kısa aks çapı ≥10 mm olan lenf nodları pozitif olarak kabul edildi. Patolojik LNM, SLN ve/veya lenfadenektomi örneklerinde metastaz saptanması olarak tanımlandı. Duyarlılık, özgüllük, pozitif öngörü değeri (PPV), negatif öngörü değeri (NPV), doğruluk ve olasılık oranları (OR) hesaplandı. Bulgular: Patolojik LNM 36 hastada (%8.8) saptandı. BT’de 39 hastada lenf nodu pozitif (≥10 mm) izlendi. BT’nin LNM saptamadaki duyarlılığı %50.0, özgüllüğü %94.4 olarak bulundu. PPV %46.2, NPV %95.1 ve genel tanısal doğruluk %90.5 idi. BT pozitifliği ile patolojik LNM arasında anlamlı ili%ki saptandı (OR 16.7, 95% CI: 8.1–34.3, p < 0.001). Ancak LNM saptanan hastaların %50’sinde BT’de büyümü% lenf nodu izlenmedi. Çok deği%kenli analizde, BT pozitifliğinin LVSI ve histolojik tip için düzeltme yapıldıktan sonra da lenf nodu metastazı ile bağımsız olarak ili%kili olduğu gösterildi (düzeltilmi% OR: 2.83, %95 GA: 1.10–7.29, p = 0.031). Sonuç: Kısa aks ≥10 mm kriteri kullanılarak yapılan preoperatif BT değerlendirmesi, EK’de LNM saptamada yüksek özgüllük ve negatif öngörü değerine sahip olmakla birlikte, duyarlılığı sınırlıdır. BT pozitifliği nodal metastaz olasılığını belirgin %ekilde artırsa da, negatif BT mikroskopik metastazı güvenilir biçimde dı%lamamaktadır. Bu nedenle cerrahi nodal değerlendirme stratejileri yalnızca BT bulgularına dayandırılmamalıdır.

Keywords

• Endometrium Neoplazileri
• Lenfatik Metastaz
• Bilgisayarlı Tomografi
• Duyarlılık ve Özgüllük
• Tanısal Görüntüleme

Diagnostic performance of preoperative contrast-enhanced computed tomography in predicting lymph node metastasis in endometrial cancer: a single-center study of 408 patients

Abstract

Aim: To evaluate the diagnostic performance of preoperative computed tomography (CT) using a short-axis diameter threshold of ≥10 mm for predicting lymph node metastasis (LNM) in patients with endometrial cancer. Material and Methods: This retrospective single-center study included 408 patients with endometrial cancer who underwent primary surgical treatment with sentinel lymph node (SLN) mapping and/or systematic lymphadenectomy. Preoperative contrast-enhanced CT scans were reviewed, and lymph nodes with a short-axis diameter ≥10 mm were considered positive. Pathological LNM was defined as metastatic involvement in SLN and/or lymphadenectomy specimens. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and odds ratios (ORs) were calculated. Results: Pathological LNM was identified in 36 patients (8.8%). CT detected lymph node enlargement (≥10 mm) in 39 patients. The sensitivity and specificity of CT for detecting LNM were 50.0% and 94.4%, respectively. PPV was 46.2%, NPV was 95.1%, and overall diagnostic accuracy was 90.5%. CT positivity was significantly associated with pathological LNM (OR 16.7, 95% CI: 8.1–34.3, p < 0.001). However, 18 patients with LNM (50%) had no radiologically enlarged lymph nodes on CT. In multivariable analysis, CT positivity remained independently associated with LNM after adjustment for LVSI and histological type (adjusted OR: 2.83, 95% CI: 1.10–7.29, p = 0.031). Conclusion: Preoperative CT using a ≥10 mm short-axis criterion demonstrates high specificity and negative predictive value but limited sensitivity for detecting lymph node metastasis in endometrial cancer. While CT positivity markedly increases the likelihood of nodal metastasis, a negative CT does not reliably exclude microscopic disease. Therefore, surgical nodal assessment strategies should not rely solely on CT findings.

Keywords

• endometrial neoplasms
• lymphatic metastasis
• computed tomography
• sensitivity and specificity
• diagnostic imaging

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