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Bell S, Smith K, Kim H, Orellana T, Harinath L, Rush S, Olawaiye A, Lesnock J. Hysterectomy with sentinel lymph node dissection in the setting of preoperative endometrial intraepithelial neoplasia and an endometrial stripe ≥20 mm: a cost-effectiveness analysis . Int J Gynecol Cancer 2024:ijgc-2024-005658. [PMID: 39107049 DOI: 10.1136/ijgc-2024-005658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVES Routine lymph node assessment in patients with endometrial intraepithelial neoplasia is institution and surgeon-dependent without clear guidelines. We sought to determine if routine sentinel lymph node (SLN) dissection at the time of laparoscopic hysterectomy for patients with a preoperative diagnosis of endometrial intraepithelial neoplasia and a preoperative ultrasound with endometrial stripe ≥20 mm is cost-effective. METHODS A decision model was created to perform two cost-effectiveness analyses: (1) hysterectomy with frozen section versus hysterectomy with SLN dissection in patients with a preoperative diagnosis of endometrial intraepithelial neoplasia and an endometrial stripe of 20 mm or greater, and (2) the same options in all patients with a preoperative diagnosis of endometrial intraepithelial neoplasia. Costs obtained from Centers for Medicare and Medicaid Services and event probabilities and quality of life utility values were obtained through literature review. RESULTS In the case of preoperative endometrial stripe ≥20 mm, hysterectomy with SLN dissection cost $2469 more than hysterectomy with frozen section and gained 0.010 quality adjusted life years, or $44,997/quality-adjusted life years gained. In one-way sensitivity analyses, SLN dissection remained the favored strategy at a willingness to pay threshold of $100,000/quality-adjusted life years unless chronic lower extremity lymphedema after full lymphadenectomy had a likelihood <13.1% (base case value 18.1%); otherwise, SLN dissection was favored with individual variation of all other parameters over plausible ranges. When considering all patients with endometrial intraepithelial neoplasia, hysterectomy with frozen section was favored, with results most sensitive to variation of lymphedema risk after full lymphadenectomy. CONCLUSION Hysterectomy with SLN dissection in patients with a preoperative endometrial stripe ≥20mm on ultrasound is cost-effective when compared with hysterectomy with frozen section.
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Affiliation(s)
- Sarah Bell
- Gynecologic Oncology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Kenneth Smith
- General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Haeyon Kim
- Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Taylor Orellana
- Gynecologic Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lakshmi Harinath
- Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shannon Rush
- Gynecologic Oncology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Alexander Olawaiye
- Gynecologic Oncology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Jamie Lesnock
- Gynecologic Oncology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
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Auclair MH, Yong PJ, Salvador S, Thurston J, Colgan T(TJ, Sebastianelli A. Guideline No. 390-Classification and Management of Endometrial Hyperplasia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1789-1800. [DOI: 10.1016/j.jogc.2019.03.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Directive clinique N° 390-Classification et prise en charge de l'hyperplasie de l'endomètre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1801-1813. [DOI: 10.1016/j.jogc.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Parkash V, Fadare O. Endometrial Carcinoma: Grossing, Frozen Section Evaluation, Staging, and Sentinel Lymph Node Evaluation. Surg Pathol Clin 2019; 12:329-342. [PMID: 31097107 DOI: 10.1016/j.path.2019.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article gives an overview of the pathologic assessment of resection specimens removed for uterine carcinoma. Areas of controversy and recent developments in pathologic staging are addressed. This includes assessment of myometrial invasion in the setting of adenomyosis, fallopian tube involvement, and vascular invasion. An overview of the role and evaluation of sentinel node assessments in the staging of endometrial carcinoma is provided.
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Affiliation(s)
- Vinita Parkash
- Department of Pathology and Obstetrics and Gynecology, Yale School of Medicine, PO Box 208070, New Haven, CT 06510, USA.
| | - Oluwole Fadare
- Department of Pathology, Anatomic Pathology Division, University of California San Diego Health, 9300 Campus Point Drive, Suite 1-200, MC 7723, La Jolla, CA 92037, USA
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Travaglino A, Raffone A, Saccone G, Mollo A, De Placido G, Insabato L, Zullo F. Endometrial hyperplasia and the risk of coexistent cancer: WHO versus EIN criteria. Histopathology 2019; 74:676-687. [PMID: 30347477 DOI: 10.1111/his.13776] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/17/2018] [Indexed: 12/20/2022]
Abstract
Endometrial hyperplasia (EH) is classified into benign and precancerous according to two different histomorphological systems: the World Health Organisation (WHO) system (based on the subjective evaluation of cytological atypia) and the endometrial intraepithelial neoplasia (EIN) system (based on a combination of several parameters that are assessable subjectively, or objectively through computerised analysis). The American College of Obstetricians and Gynecologists recommends use of the EIN system. Nonetheless, a higher prognostic value for EIN criteria was demonstrated only with the objective assessment, which is not routinely applicable. The aim of this study was to evaluate which of the subjective classifications of EH (WHO or EIN) has better prognostic value, by assessing the risk of coexistent cancer. Electronic databases were searched for relevant articles from the inception of the databases to July 2018. All studies assessing the presence of cancer on hysterectomy specimens after a preoperative histological diagnosis of EH were included. Odds ratios (ORs), sensitivity and specificity were calculated with 95% confidence intervals (CIs). Sixteen cohort studies and three case-control studies, assessing 2582 EHs, were included. The WHO criteria showed an OR of 11.15 (95% CI 7.65-16.24), a sensitivity of 0.86 (95% CI 0.82-0.90) and a specificity of 0.67 (95% CI 0.64-0.70) for coexistent cancer. The subjective EIN system showed a similar OR (11.85, 95% CI 4.91-28.62; P = 0.90), higher sensitivity (0.98, 95% CI 0.94-0.99), and lower specificity (0.29, 95% CI 0.24-0.34). The WHO system and the subjective EIN system have similar prognostic values. However, the EIN criteria appear to be more sensitive and thus more suitable for selecting women who need to be treated, whereas the WHO criteria, based on cytological atypia, seem to be more specific for lesions at higher risk of cancer. Therefore, integration of the EIN system with cytological atypia should be considered.
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Affiliation(s)
- Antonio Travaglino
- Anatomical Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Gynaecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gabriele Saccone
- Gynaecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Mollo
- Gynaecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe De Placido
- Gynaecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Insabato
- Anatomical Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Fulvio Zullo
- Gynaecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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