{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T07:58:10Z","timestamp":1759564690054},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2014,11,11]],"date-time":"2014-11-11T00:00:00Z","timestamp":1415664000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Society for gynecological surgery in Finland"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2015,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare two treatment strategies in women undergoing surgery for endometrial carcinoma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary care center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>1166 patients. Uterine biopsy\/curettage was obtained in 1140 women, of whom 229 also had pelvic magnetic resonance imaging (<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We compared two strategies: (i) routine pelvic lymphadenectomy and (ii) selective pelvic lymphadenectomy for women with high\u2010risk carcinomas as determined from preoperative histology and <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>. High\u2010risk carcinomas included grade 1\u20132 endometrioid carcinomas with \u226550% myometrial invasion, grade 3 endometrioid carcinomas, and nonendometrioid carcinomas. Others were considered low\u2010risk carcinomas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Diagnostic indices, treatment algorithms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the women who underwent lymphadenectomy, positive pelvic nodes were found in 2.3% of low\u2010risk carcinomas and 18.3% of high\u2010risk carcinomas. The combination of preoperative histology and <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> detected high\u2010risk carcinomas with a sensitivity of 85.7%, a specificity of 75.0%, a positive predictive value of 74.4%, and a negative predictive value of 86.1%. Area under curve was 0.804. In the routine lymphadenectomy algorithm, 54.1% of lymphadenectomies were performed for low\u2010risk carcinomas. In the selective lymphadenectomy algorithm, 14.3% of women with high\u2010risk carcinomas did not receive lymphadenectomy. Missed positive pelvic nodes were estimated to occur in 2.1% of patients in the selective strategy. Similarly, the estimated risk for isolated para\u2010aortic metastasis was 2.1%, regardless of treatment strategy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The combination of preoperative histology and <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> is moderately sensitive and specific in detecting high\u2010risk endometrial carcinomas. The clinical utility of the method is hampered by the relatively high proportion of high\u2010risk cases that remain unrecognized preoperatively.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.12523","type":"journal-article","created":{"date-parts":[[2014,10,7]],"date-time":"2014-10-07T08:08:42Z","timestamp":1412669322000},"page":"95-101","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Combined use of endometrial sample and magnetic resonance imaging in the preoperative risk\u2010stratification of endometrial carcinomas"],"prefix":"10.1111","volume":"94","author":[{"given":"Anna","family":"Luomaranta","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Helsinki University Central Hospital Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralf","family":"B\u00fctzow","sequence":"additional","affiliation":[{"name":"Department of Pathology Helsinki 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