Computed tomography in endometrial carcinoma

Objective: To determine the value of computed tomography (CT) scans for pre operatively detecting extrauterine-nodal disease and postoperative recurren t disease in patients with endometrial cancer. Methods: We reviewed records of 702 women with primary endometrial carcinom a that was diagnosed between 1979 and 1993. Preoperative CT findings were c ompared with pathologic findings to assess nodal disease. The yield of post operative CT was reviewed in clinically suspicious and routine settings. Results: Among 492 women eligible for analysis, 178 (36%) had a total 326 C T scans. Among 56 women who had preoperative CT scans and lymph node sampli ngs, positive and negative predictive values for nodal involvement were 50% and 94%, respectively, and sensitivity and specificity were 57% and 92%, r espectively. Preoperative CT findings altered treatment plans in only six p atients (8%). Forty-five asymptomatic women had 73 routine CT scans, and re currence was diagnosed by CT in only two (4.4%). Thirty-seven women had CT scans for suspicion of recurrence, which was confirmed in 17 (46%). Kaplan- Meyer analysis showed no survival advantage in women with subclinical recur rences diagnosed by CT scan. Conclusion: Routine preoperative CT scanning rarely alters treatment and is a poor predictor of nodal disease. Computed tomography in the postoperativ e period might be helpful for detection and follow-up of recurrent disease, but there was no difference in survival when subclinical recurrence was fo und by CT. Thus, CT scanning of any woman with endometrial cancer should be discouraged unless it is to evaluate symptoms. (Obstet Gynecol 2000;95:692 -6. (C) 2000 by The American College of Obstetricians and Gynecologists.).