Diagnostic value of intraoperative ultrasonography to assess para-aortic lymph nodes in women with ovarian and uterine corpus malignancy.

Abstract

To examine the ability of intraoperative ultrasonography to detect enlarged para-aortic lymph nodes, and to assess its potential use in reducing the number of unnecessary para-aortic lymphadenectomies performed in women with ovarian and uterine corpus malignancies. Computed tomography (CT), palpation during surgery, and intraoperative ultrasonography were used to assess whether para-aortic lymph nodes were enlarged in 163 women with ovarian and uterine corpus malignancy. All the women underwent para-aortic lymphadenectomy, and nodes were assessed for metastasis. Thirty-five women had pathological para-aortic node metastasis. The sensitivity, specificity, and positive and negative predictive values of CT for the diagnosis of metastasis were 42.9, 96.1, 75.0 and 86.0%, respectively. These values were 60.0, 82.0, 47.7 and 88.2% for palpation, and 91.4, 69.5, 45.1 and 96.7% for intraoperative ultrasonography, respectively. If para-aortic lymphadenectomy had been performed only when enlarged lymph nodes were detected on CT then the number performed would have been reduced from 163 to 20 (12.3%); however, node metastasis would have been missed in 20 out of 35 women. On the same basis, the number of lymphadenectomies performed would have been 44 (27.0%) and metastasis would have been missed in 14 women on palpation during surgery, and 71 lymphadenectomies (43.6%) would have been performed and metastasis would have been missed in three women on intraoperative ultrasonography. Intraoperative ultrasonography is a highly sensitive tool with which to diagnose lymph node metastasis. Its high negative predictive value allows avoidance of unnecessary para-aortic lymphadenectomy in women with ovarian and uterine corpus malignancy.