Reitsema, T. (Thalia) (2016) Diagnostiek bij laaggradige endometriumcarcinomen : De klinische relevantie van een preoperatieve X-thorax bij patiënten met een laaggradig en klinisch laagstadium endometriumcarcinoom. thesis, Medicine.
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Abstract
Objective: Dutch guidelines recommend a preoperative chest X-ray to detect pulmonary metastases at patients with an endometrial carcinoma. However, a recent study showed no pulmonary metastases in patients with low-risk endometrial cancer, therefore they omitted the thoracic imaging from the diagnostic workup. The aim of this study was to determine the incidence of pulmonary metastasis on thoracic imaging in low-risk endometrial cancer patients and thus to reconsider the decision of eliminating thoracic imaging. This study also investigates the degree of homogeneity between the preoperative and postoperative endometrial samples, as this will affect the related treatment opportunities. Method: Between January 2009 and December 2015, a retrospective cross-sectional study in the Medical Centre Leeuwarden was performed. A total of 150 patients with the diagnosis of endometrial cancer were included. The electronic medical records were analysed and the derived data was imported in SPSS. Low-risk patients are defined as patients with a preoperative histological sample showing a grade 1 or grade 2 endometrioid endometrial cancer. Results: A total of 150 patients were identified; 71 (47.3%) patients were classified as low-risk and had preoperative thoracic imaging. There were 51 low-risk patients who received preoperative a chest X-ray, none of them showed pulmonary metastasis at the time of diagnosis (0/51, 0%, 95% CI, 0-6.98). 20 low-risk patients were suspect for a higher clinical stage of endometrial cancer, therefore they received additional imaging (CT thorax/abdomen and PET-CT scans). Two patients received a PET-CT scan, which showed in both patients regional and pulmonary metastasis (2/71, 2.8%, 95% CI, 0.34-9.81). Both patients were classified with a clinical high stage of endometrial cancer, of which one was diagnosed after further analysis with a serous (high-risk) carcinoma. In 32.4% the preoperative tissue sampling was discordant with final surgical pathology; in 5.9% it even concerned a shift from preoperative low-risk to postoperative high-risk endometrial carcinoma. Conclusion: This study shows no pulmonary metastasis on a preoperative chest X-ray in patients with low-risk and a clinical low stage endometrial cancer. Particular in this group, a preoperative chest X-ray might be omitted. This study makes us aware that postoperative histology frequently shows a higher tumour grade than preoperative was presumed. Since only a shift from a preoperative low-risk to a postoperative high-risk tumour has clinical consequences, further research and consultation with pathologists is needed to declare the relatively high degree in non-homogeneity.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Stekelenburg, Prof. dr. J. Medisch Centrum Leeuwarden |
| Supervisor name: | Begeleider: and Keizer, Mw. H. H. and Medisch Centrum Leeuwarden |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:53 |
| Last Modified: | 25 Jun 2020 10:53 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1390 |
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