Diagnostic accuracy and economic impact of three work-up strategies identifying risk groups in endometrial cancer, fully incorporating sentinel lymph node algorithm.
endometrial cancer
lymphadenectomy
risk groups
sentinel lymph node
surgical staging
work-up strategy
Journal
Facts, views & vision in ObGyn
ISSN: 2032-0418
Titre abrégé: Facts Views Vis Obgyn
Pays: Belgium
ID NLM: 101578773
Informations de publication
Date de publication:
08 Oct 2020
08 Oct 2020
Historique:
entrez:
30
10
2020
pubmed:
31
10
2020
medline:
31
10
2020
Statut:
epublish
Résumé
According to the European Society for Medical Oncology/ European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology (ESMO/ESGO/ESTRO) Consensus Conference, the role of preoperative risk groups (RGs) in endometrial cancer (EC) is to direct surgical nodal staging. We compared diagnostic accuracy and economic impact of three work-up strategies to identify RGs. A retrospective multicentre study including patients with early-stage EC. The three different work-up strategies were as follows:-Mondovì Hospital: transvaginal ultrasonography, pelvic magnetic resonance imaging (MRI); frozen section examination of the uterus in case of imaging discordance. High-risk patients underwent abdominal computed tomography.-Gemelli Hospital: transvaginal ultrasonography, MRI, One-Step Nucleic Acid Amplification (OSNA) of sentinel lymph node (SLN); frozen section examination of the uterus in case of imaging discordance.-Negrar Hospital: positron emission tomography (PET), frozen section examination of the uterus and of SLN. For statistical purposes patients were assigned, preoperatively and postoperatively, to two groups: group A (high-risk) and group B (not high-risk). Three hundred eighty-five patients were included (93 Mondovì, 215 Gemelli, 77 Negrar). Endometrial biopsy errors led to 47.3% misclassifications. Test accuracy of Mondovì, Gemelli and Negrar strategies was 0.83 (95%CI 0.734-0.901), 0.95 (95%CI 0.909-0.975) and 0.94 (95%CI 0.866-0.985), respectively. Preoperative work-up mean cost per patient in group A was €514.5 at Mondovì, €868.5 at Gemelli, and €1212.8 at Negrar hospital (p-value < 0.001), while in group B was €378.8 at Mondovì, €941.2 at Gemelli, and €1848.4 at Negrar hospital (p-value < 0.001). In our study, work-up strategies with more relevant economic impact showed a better diagnostic accuracy. Upcoming guidelines should specify recommendations about the gold standard work-up strategy, including the role of SLN.
Sections du résumé
BACKGROUND
BACKGROUND
According to the European Society for Medical Oncology/ European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology (ESMO/ESGO/ESTRO) Consensus Conference, the role of preoperative risk groups (RGs) in endometrial cancer (EC) is to direct surgical nodal staging. We compared diagnostic accuracy and economic impact of three work-up strategies to identify RGs.
METHODS
METHODS
A retrospective multicentre study including patients with early-stage EC. The three different work-up strategies were as follows:-Mondovì Hospital: transvaginal ultrasonography, pelvic magnetic resonance imaging (MRI); frozen section examination of the uterus in case of imaging discordance. High-risk patients underwent abdominal computed tomography.-Gemelli Hospital: transvaginal ultrasonography, MRI, One-Step Nucleic Acid Amplification (OSNA) of sentinel lymph node (SLN); frozen section examination of the uterus in case of imaging discordance.-Negrar Hospital: positron emission tomography (PET), frozen section examination of the uterus and of SLN. For statistical purposes patients were assigned, preoperatively and postoperatively, to two groups: group A (high-risk) and group B (not high-risk).
RESULTS
RESULTS
Three hundred eighty-five patients were included (93 Mondovì, 215 Gemelli, 77 Negrar). Endometrial biopsy errors led to 47.3% misclassifications. Test accuracy of Mondovì, Gemelli and Negrar strategies was 0.83 (95%CI 0.734-0.901), 0.95 (95%CI 0.909-0.975) and 0.94 (95%CI 0.866-0.985), respectively. Preoperative work-up mean cost per patient in group A was €514.5 at Mondovì, €868.5 at Gemelli, and €1212.8 at Negrar hospital (p-value < 0.001), while in group B was €378.8 at Mondovì, €941.2 at Gemelli, and €1848.4 at Negrar hospital (p-value < 0.001).
CONCLUSIONS
CONCLUSIONS
In our study, work-up strategies with more relevant economic impact showed a better diagnostic accuracy. Upcoming guidelines should specify recommendations about the gold standard work-up strategy, including the role of SLN.
Types de publication
Journal Article
Langues
eng
Pagination
169-177Informations de copyright
Copyright © 2020 Facts, Views & Vision.
Déclaration de conflit d'intérêts
Conflict of Interest statement: none of the authors declare conflicts of interest.
Références
Gynecol Oncol. 2018 Aug;150(2):261-266
pubmed: 29887483
Lancet. 2009 Jan 10;373(9658):125-36
pubmed: 19070889
Gynecol Oncol. 2020 Jan;156(1):62-69
pubmed: 31776037
Eur J Cancer. 2011 Jul;47(10):1504-10
pubmed: 21530238
Int J Gynecol Cancer. 2013 Jun;23(5):964-70
pubmed: 23694985
Ultrasound Obstet Gynecol. 2014 May;43(5):575-85
pubmed: 24281994
Eur J Surg Oncol. 2018 Oct;44(10):1562-1567
pubmed: 30077521
Arch Gynecol Obstet. 2019 May;299(5):1391-1398
pubmed: 30719553
Gynecol Oncol. 2014 Jun;133(3):499-505
pubmed: 24699308
Obstet Gynecol. 2000 May;95(5):692-6
pubmed: 10775731
Int J Obes (Lond). 2013 May;37(5):634-9
pubmed: 22710929
Gynecol Oncol. 2018 Nov;151(2):235-242
pubmed: 30177461
Lancet. 2010 Apr 3;375(9721):1165-72
pubmed: 20188410
Gynecol Oncol. 2014 Jan;132(1):38-43
pubmed: 24120926
Ultrasound Obstet Gynecol. 2010 Jan;35(1):103-12
pubmed: 20014360
EJNMMI Res. 2018 Aug 22;8(1):86
pubmed: 30136163
Gynecol Oncol Rep. 2016 Apr 19;17:69-71
pubmed: 27453926
Gynecol Oncol. 2017 Aug;146(2):234-239
pubmed: 28528918
Lancet Oncol. 2011 May;12(5):469-76
pubmed: 21489874
Obstet Gynecol. 2014 Aug;124(2 Pt 1):307-15
pubmed: 25004343
Gynecol Oncol. 2012 Oct;127(1):5-10
pubmed: 22771890
J Natl Cancer Inst. 2008 Dec 3;100(23):1707-16
pubmed: 19033573
Ann Oncol. 2016 Jan;27(1):16-41
pubmed: 26634381
Ann Oncol. 2017 Jul 1;28(suppl_4):iv153-iv156
pubmed: 28881926
Eur J Surg Oncol. 2016 Sep;42(9):1367-71
pubmed: 27052799
Lancet Oncol. 2017 Mar;18(3):384-392
pubmed: 28159465
Gynecol Oncol. 2017 Aug;146(2):405-415
pubmed: 28566221
Cancer. 2019 Oct 1;125(19):3347-3353
pubmed: 31225906
Int J Gynecol Cancer. 2019 Jan;29(1):60-67
pubmed: 30640685
Int J Gynecol Pathol. 2019 Jan;38 Suppl 1:S64-S74
pubmed: 30550484
Gynecol Oncol. 2008 Apr;109(1):11-8
pubmed: 18304622
Gynecol Oncol. 2017 Dec;147(3):549-553
pubmed: 28942993
PLoS One. 2018 Apr 26;13(4):e0195877
pubmed: 29698418
J Surg Oncol. 2019 Mar;119(3):361-369
pubmed: 30508294
J Gynecol Oncol. 2017 Nov;28(6):e86
pubmed: 29027404
J Natl Compr Canc Netw. 2014 Feb;12(2):288-97
pubmed: 24586087
J Obstet Gynaecol Res. 2014 Feb;40(2):301-11
pubmed: 24472047
Clin Nucl Med. 2015 Oct;40(10):780-5
pubmed: 26053711