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Diagnostic value of intraoperative ultrasonography to assess para‐aortic lymph nodes in women with ovarian and uterine corpus malignancy
Author(s) -
Ryo E.
Publication year - 2008
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.5366
Subject(s) - medicine , palpation , malignancy , radiology , metastasis , lymphadenectomy , lymph node , lymph , ultrasonography , pathology , cancer
Objectives To examine the ability of intraoperative ultrasonography to detect enlarged para‐aortic lymph nodes, and to assess its potential use in reducing the number of unnecessary para‐aortic lymphadenectomies performed in women with ovarian and uterine corpus malignancies. Methods Computed tomography (CT), palpation during surgery, and intraoperative ultrasonography were used to assess whether para‐aortic lymph nodes were enlarged in 163 women with ovarian and uterine corpus malignancy. All the women underwent para‐aortic lymphadenectomy, and nodes were assessed for metastasis. Results Thirty‐five women had pathological para‐aortic node metastasis. The sensitivity, specificity, and positive and negative predictive values of CT for the diagnosis of metastasis were 42.9, 96.1, 75.0 and 86.0%, respectively. These values were 60.0, 82.0, 47.7 and 88.2% for palpation, and 91.4, 69.5, 45.1 and 96.7% for intraoperative ultrasonography, respectively. If para‐aortic lymphadenectomy had been performed only when enlarged lymph nodes were detected on CT then the number performed would have been reduced from 163 to 20 (12.3%); however, node metastasis would have been missed in 20 out of 35 women. On the same basis, the number of lymphadenectomies performed would have been 44 (27.0%) and metastasis would have been missed in 14 women on palpation during surgery, and 71 lymphadenectomies (43.6%) would have been performed and metastasis would have been missed in three women on intraoperative ultrasonography. Conclusions Intraoperative ultrasonography is a highly sensitive tool with which to diagnose lymph node metastasis. Its high negative predictive value allows avoidance of unnecessary para‐aortic lymphadenectomy in women with ovarian and uterine corpus malignancy. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.