PROGNOSTIC-SIGNIFICANCE OF GROSS MYOMETRIAL INVASION WITH ENDOMETRIALCANCER

Objective: To determine if intraoperative estimation of gross myometri al invasion is sufficiently precise to guide surgical aggressiveness i n staging patients with endometrial cancer. Methods: Between September 1987 and September 1995, 236 women with endometrial cancer had visual estimation of gross myometrial invasion during surgical staging, whic h included pelvic and para-aortic lymphadenectomy. Results: In 213 pat ients (90.3%), the depth of gross myometrial invasion correctly predic ted the microscopic depth of invasion on permanent histopathologic sec tions. Statistically significant associations were found between gross depth of myometrial invasion and tumor grade (P < .001 histopathology (P = .014), cervical metastases (P <.001), adnexal metastases (P < .0 01), omental metastases (P < .001), malignant pelvic cytology (P < .00 1), pelvic lymph node metastases (P <.001, para-aortic lymph node meta stases (P = .001), and surgical stage (P < .001). Patients with more t han 50% gross myometrial invasion were more likely to have poorly diff erentiated malignancies; nonendometrial histologies; malignant pelvic cytology higher surgical stage; and cervical, adnexal, omental, pelvic lymph node, and para-aortic lymph node metastases. Patients with more than 50% gross myometria invasion had a 6.4-fold higher pre valence o f pelvic lymph node metastases, a 6.9-fold higher prevalence of para-a ortic lymph node metastases, and a 6.7-fold higher pre-valence of adva nced surgical stage than patients with less than 50% myometrial invasi on. Conclusion: Patients with endometrial cancer and more than 50% myo metrial invasion on gross visual intraoperative estimation are at mark ed risk for extrauterine metastases, including pelvic and para-aortic lymph node metastases. Such patients should he considered for more agg ressive surgical staging, including pelvic and para-aortic lymphadenec tomy.