Analysis of correlation of pre-therapeutic assessment and the final diagnosis in endometrial cancer: role of tumor volume in the magnetic resonance imaging.

Objective: To evaluate whether the introduction of tumor volume as new parameter in the MRI assessment could improve both concordance between preoperative and postoperative staging, and the identification of histological findings. Methods: A retrospective observational study with 127 patients with endometrial cancer (EC) identified between 2016 and 2021 at the Juan Ramon Jimenez University Hospital, Huelva (Spain) was carried out. Tumor volume was measured in three ways. Analyses of Receiver Operating Characteristic (ROC) curve and the area under the curve (AUC) were performed. Results: Although preoperative MRI had an 89.6% and 66.7% sensitivity for the detection of deep mucosal invasion and cervical stroma infiltration, preoperative assessment had an intraclass correlation coefficient of 0.517, underestimating tumor final stage in 12.6% of cases, with a poor agreement between preoperative MRI and postoperative staging (κ=0.082) and low sensitivity (14.3%) for serosa infiltration. The cut-off values for all three volume parameters had good/excellent AUC (0.73-0.85), with high sensitivity (70-83%) and specificity (64-84%) values for all histopathological variables. Excellent/good agreement was found all volume parameters for the identification of deep myometrial invasion (0.71), cervical stroma infiltration (0.80), serosa infiltration (0.81), and lymph node metastases (0.81). Conclusion: Tumor volume measurements have good predictive capacity to detect histopathological findings that affect final tumor staging and might play a crucial role in the preoperative assessment of patients with endometrial cancer in the future.

Values of tumor volume on magnetic resonance imaging for a surgical approach to endometrial cancer.

OBJECTIVE: To analyze the relationship between tumor volume in Endometrial Cancer (EC) on Magnetic Resonance Imaging (MRI) and lymph node metastasis to establish which patients benefit from omitting the lymphadenectomy. METHODS: A retrospective observational study with 194 patients with EC identified between 2016 and 2021 at the Juan Ramón Jiménez University Hospital, Huelva (Spain) was carried out. Preoperative MRI of 127 patients was assessed. The tumor volume was analyzed on MRI by the ellipsoid formula and another alternative method with a manual ROI in different sections. Risk factors for node metastases were analyzed to understand its relationship and to identify an optimum criterion for the tailored surgery. RESULTS: Univariate analysis showed risk factors for lymph node metastases were histological grade (p = 0.001), tumor with a volume greater than >25 cm3 (p < 0.001), lymphovascular space invaded (p = 0.007), and preoperative Ca 125 serum >28 (p < 0.001). Multivariate analysis indicated that tumor volume index >25 cm3 was an independent risk factor for lymph node metastases. The patients without significant proposed risk factors (volume index >25 cm3  [OR = 0.64], Ca 125 > 28 [OR = 0.32], and high histological grade [OR = 2.6]) did not present lymph node metastases, independent of myometrial invasion. CONCLUSIONS: Lymphadenectomy can be omitted in patients with Endometrioid carcinoma that do not have any of the following risk factors: high-grade tumor, elevated Ca 125 (>28), and tumor volume on MRI greater than 25 cm3 . Tumor volume might predict the state of lymph nodes in EC and it could give information regarding surgical management.

Role of tumor volume in endometrial cancer: An imaging analysis and prognosis significance.

OBJECTIVE: To evaluate the prognostic value of tumor volume on preoperative MRI in endometrial cancer (EC) patients and its association with adverse prognostic factors and survival. METHODS: A retrospective observational study with 127 consecutive patients with endometrioid EC was carried out between 2016 and 2021 at Juan Ramón Jiménez University Hospital, Huelva (Spain). All patients underwent preoperative magnetic resonance imaging (MRI) for local staging. The tumor volume was analyzed on MRI by two different methods: by measuring the three maximum diameters of the tumor according to an ellipse formula and by manual region of interest in different sections; the ratio between tumor volume and uterus volume was also calculated as a third tool. The relationships between volume, prognostic factors, and survival were analyzed. RESULTS: A total of 127 patients with endometroid EC underwent preoperative MRI and were included in the study. Tumor volume was significantly higher for deep myometrial invasion, cervical stromal involvement, infiltrated serosa, lymph node metastases, high-grade EC, and lymphovascular space involvement, advanced FIGO stage, and High Recurrence Risk Group (P < 0.001). ROC curves showed that tumor volume greater than 25 cm3 predicts lymph node metastases. Volume index greater than 17 cm3 was associated with reduced disease-free survival (P < 0.001) and overall survival (P < 0.003). Multivariate analysis showed that the greatest tumor volume had an independent impact on recurrence (odds ratio [OR]1.019, 95% confidence interval [CI] 1.005-1.032) and survival (OR 1.027, 95% CI 1.009-1.046). CONCLUSIONS: This study shows an important correlation between tumor volume on MRI and poor prognostic factors. Preoperative tumor volume on MRI is a valuable biomarker to be considered for management of EC.

Factores predictores de recurrencia del cáncer de endometrio / Predictors of the endometrium cancer recurrence

Resumen OBJETIVO: Determinar qué factores favorecen la predicción de recurrencia de cáncer de endometrio en diferentes estadios de la enfermedad. MATERIALES Y MÉTODOS: Estudio retrospectivo efectuado en un grupo de pacientes con cáncer de endometrio atendidas entre el 2017 y 2020 en el Hospital Juan Ramón Jiménez de Huelva, España. Variables de análisis: edad, grado de diferenciación tumoral, invasión miometrial, estadio posquirúrgico e infiltración al espacio linfovascular, en todas las pacientes con recidiva. El análisis estadístico se procesó en el programa SPSS v23. Habiéndose realizado un análisis de Kolmogorov- Smirnov y tras haber obtenido un resultado no normal, se utilizó la prueba de χ2 para los datos categóricos paramétricos, e independientemente se aplicó la prueba U de Mann Whitney para los datos no paramétricos. Los valores de p < 0.01 se consideraron estadísticamente significativos. RESULTADOS: Se reunieron 9 pacientes con recidiva tumoral y seguimiento de 5 años luego del diagnóstico primario. Conforme al análisis estadístico no se encontró una relación de dependencia entre las variables recidiva e invasión miometrial (χ2 = 4.780; p = 0.092), recidiva y grado tumoral (χ2 = 7.765; p = 0.051) y recidiva y el estadio posquirúrgico (χ2 = 10.200, p = 0.070). Por el contrario, se observó relación de dependencia entre las variables afectación ganglionar e infiltración al espacio linfovascular positiva (χ2 = 9.954, Cc = 0.235, p < 0.01). En todas las pacientes se evaluó la infiltración al espacio linfovascular. Ésta fue negativa en 141 casos y 4 de estos casos tuvieron recurrencia de la enfermedad. 5 de 9 pacientes con recurrencia de la enfermedad tenían infiltración al espacio linfovascular positiva. CONCLUSIONES: Lo aquí encontrado muestra que más de la mitad de las pacientes con recurrencia de la enfermedad tuvieron infiltración al espacio linfovascular. Cuando ésta fue negativa hubo una reducción del riesgo de 2.8% de padecer una recurrencia.

Abstract OBJECTIVE: To determine which factors favor the prediction of endometrial cancer recurrence at different stages of the disease. MATERIALS AND METHODS: Retrospective study performed in a group of patients with endometrial cancer attended between 2017 and 2020 at the Juan Ramón Jiménez Hospital in Huelva, Spain. Analysis variables: age, degree of tumor differentiation, myometrial invasion, post-surgical stage and infiltration to the lymphovascular space, in all patients with recurrence. The statistical analysis was processed in SPSS v23. Having performed a Kolmogorov-Smirnov analysis and having obtained a non-normal result, a 2 test was used for parametric categorical data, and independently the Mann Whitney U test was used for non-parametric data. Values of p < 0.01 were considered statistically significant. RESULTS: Nine patients with tumor recurrence and 5-year follow-up after primary diagnosis were collected. According to the statistical analysis, no dependency relationship was found between the variables recurrence and myometrial invasion (χ2 = 4.780; p = 0.092), recurrence and tumor grade (χ2 = 7.765; p = 0.051) and recurrence and post-surgical stage (χ2 = 10.200, p = 0.070). In contrast, a dependency relationship was observed between the variables nodal involvement and positive lymphovascular space infiltration (χ2 = 9.954, Cc = 0.235, p < 0.01). The existence of infiltration of the lymphovascular space was evaluated in all patients. This was negative in 141 cases and 4 of these cases had disease recurrence. 5 of 9 patients with disease recurrence had positive lymphovascular space infiltration. CONCLUSIONS: The findings here show that more than half of the patients with disease recurrence have infiltration to the lymphovascular space and, in addition, if the infiltration to the lymphovascular space is negative, there is a 2.8% reduced risk of recurrence.

Metástasis ovárica de melanoma nodular cutáneo / Ovarian metastases from nodular cutaneous melanoma

La metástasis del melanoma cutáneo en ovario es una variedad muy poco frecuente. Presentamos un caso que tuvo lugar en el 2006 en el área hospitalaria Juan Ramón Jiménez, Huelva, España (AU)

Ovarian metastases from melanoma are very infrequent. We report a case of this entity, treated in the Juan Ramon Jimenez Hospital in 2006 in Huelva, Spain (AU)