Accuracy of lymph node palpation to determine need for lymphadenectomy in gynecologic malignancies

Objective: To assess the accuracy of intraoperative lymph node palpation fo r identifying lymph node metastasis in gynecologic malignancies. Methods: We prospectively evaluated 126 women who had lymphadenectomies for staging of various gynecologic malignancies from August 1995 to June 1997. Surgeries were done by obstetrician-gynecologists with subspecialty certif ication in gynecologic oncology from the American Board of Obstetrics and G ynecology, who had practiced gynecologic oncology for at least 5 years. Dat a were collected on gynecologic oncologists' opinions of lymph node status by palpation. Nodes believed to be positive were sent separately. We record ed operating time for lymphadenectomies, and intraoperative and postoperati ve complications. Results: Mean (range) patient age was 55 (18-83) years. Mean (range) operat ing time was 188 (85-435) minutes. The mean (range) lymphadenectomy time wa s 46 (5-150) minutes. The total number of lymph nodes dissected was 2138. O ne hundred seven of 2138 (5%) nodes were positive for malignancy. Thirty-ei ght of 107 (36%) positive lymph nodes were missed by palpation. Fifty-six o f 2031 (3%) negative lymph nodes were selected as positive. Sixty-nine of 1 07 (64%) positive lymph nodes were identified correctly. Sensitivity and sp ecificity of palpation were 72% and 81%, respectively. The positive and neg ative predictive values of lymph node palpation were 56% and 89%, respectiv ely. Conclusion: Intraoperative lymph node palpation has low sensitivity and pos itive predictive value even when done by experienced board-certified gyneco logic oncologists. (C) 2000 by The American College of Obstetricians and Gy necologists.