| Objective:This study analyzes the risk factors of lymph node metastasis in endometrial carcinoma,and discusses the value of preoperative segmentation scraping pathological results,pelvic MRI data and rapid intraoperative pathological examination to predict lymph node metastasis in EC patients,which can help clinicians predict lymph node metastasis before surgery and determine the surgical plan and scope.Methods:Clinical data of 211 patients with EC who underwent staged surgical treatment and had a definite pathological diagnosis in the Second Hospital of Shanxi Medical University from September 2017 to September 2022 were collected,and the data were analyzed using SPSS 25.0.Classification variables were expressed by frequency and percentage.Univariate analysis was performed usingx~2test or Fisher’s exact probability method.The above significant clinicopathological features were included in binary Logistic multivariate analysis.The independent risk factors for patients with endometrial cancer and lymph node metastasis were further explored(P<0.05 was considered statistically significant).With postoperative paraffin pathology as the gold standard,Kappa test was used to evaluate the consistency of preoperative segwise scraping,pelvic MRI,intraoperative rapid freezing disease detection and postoperative pathological results:Kappa value<0.4 was generally consistent,0.4≤Kappa value<0.7 was good consistent,and 0.7≤Kappa value<1 was good consistent.Results:1.Among the 211 EC patients included in this study,total hysterectomy,bilateral adneectomy and pelvic lymphadenectomy were performed in the Second Hospital of Shanxi Medical University,among which 165 EC patients underwent para-aortic lymphadenectomy.Postoperative pathology showed positive lymph node metastasis in 24patients(11.37%).The incidence of positive pelvic lymph node metastasis,positive para-aortic lymph node metastasis and positive pelvic lymph node with para-aortic lymph node metastasis were 5.69%(12/211),1.90%(4/211)and 3.79%(8/211),respectively.2.Univariate analysis of lymph node metastasis showed that low differentiation,specific pathologic type EC,depth of muscular layer infiltration≥1/2,cervical interstitial involvement,invasion of serous layer,accessory metastasis,paruterine or vaginal involvement and lympho-vasculature space infiltration were associated with lymph node metastasis(P<0.05).Age of onset,obesity,blood type,smoking,age of sterilization,age of menarche,menopause,hypertension,diabetes,infertility,family history of malignancy,tumor size,cytological examination of abdominal flushing fluid,and microsatellite stability were not correlated with lymph node metastasis(P>0.05).3.Multivariate analysis of lymph node metastasis showed that the depth of muscle invasion≥(P=0.049,OR=3.080),invasion of serous layer(P=0.033,OR=18.953),LVSI(P<0.001,OR=19.175)were independent risk factors for lymph node metastasis in patients with EC.4.The pathological type evaluated by segmented curettage before surgery(Kappa value=0.614,P<0.001)was consistent with the postoperative pathological results.Histological grading(Kappa=0.817,P<0.001)was in good agreement with postoperative pathological results.5.Preoperative pelvic MRI evaluation of muscle infiltration depth(Kappa=0.798,P<0.001)was in good agreement with postoperative pathological results;Preoperative pelvic MRI evaluation of cervical involvement(Kappa=0.570,P<0.001),attachment metastasis(Kappa=0.640,P<0.001),pelvic lymph node metastasis(Kappa=0.586,P<0.001)and postoperative pathological results were in good agreement.6.Adnexal metastasis(Kappa value=0.381,P<0.001)was generally consistent with postoperative paraffin pathology.Intraoperative rapid cryopathology was consistent with postoperative pathological results in the assessment of pathological type(Kappa value=0.652,P<0.001)and identification of cervical infiltration(Kappa value=0.693,P<0.001).The histological grading(Kappa value=0.740,P<0.001)and the depth of muscle infiltration(Kappa value=0.765,P<0.001)were well consistent with the postoperative pathological results.Conclusion:1.The size of the tumor was not associated with lymph node metastasis2.Low differentiation,special pathologic type EC,muscular layer infiltration depth≥1/2,cervical interstitial involvement,invasion of serous layer,adrenal metastasis,paruterine or vaginal involvement,lymphatic and vasculature space infiltration were associated with lymph node metastasis.3.Preoperative pelvic MRI combined with segmental curettage test results and rapid intraoperative pathological examination can predict lymph node metastasis. |
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