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Accuracy of Intraoperative Clinical Evaluation of Lymph Nodes in Women with Gynecologic Cancer


Jakkapan Khunnarong MD*,
Peerapong Inthasorn MD*, Dittakarn Boriboonhirunsarn MD, MPH, PhD*

*Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University


Objective : To determine the accuracy of intraoperative clinical evaluation of lymph node metastasis in gynecologic cancer women.
Method : From May 2003 to April 2004, the characteristics of lymph node metastasis in women who underwent lymphadenectomy, lymph node sampling, or lymph node biopsy for surgical procedure of gynecologic malignancies were evaluated in 124 cases. The operation was performed by gynecologic oncologists. The overall clinical impression and lymph node characteristics ( lymph node enlargement, consistency, shape, and adherence ) were correlated with histologic diagnosis.
Results : The mean age was 51 years. The type of cancer were cervical cancer (48%), endometrial cancer (33%), ovarian cancer (17%), and vulvar cancer (2%). Overall, intraoperative clinical evaluation for lymph node metastasis had a high sensitivity, specificity, and accuracy( 81%, 91%, and 90%, respectively), but had a high false-negative rate (19%). The positive and negative predictive values of intraoperative lymph node evaluation were 65% and 96%, respectively. Lymph node enlargement (size>2 cm) had a highest sensitivity(94%) and round shape of lymph nodes had highest specificity and accuracy (97% and 94%, respectively).
Conclusion : Intraoperative lymph nodes clinical evaluation for detecting lymph node metastasis in gynecologic malignancy had a high accuracy (when performed by experience surgeon) and may be useful in situation that complete lymphadenectomy is not feasible.

Keyword : Gynecologic cancer, Lymphadenectomy, Clinical evaluation

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