ORIGINAL ARTICLE Preoperative work-up for definition of lymph node risk involvement in early stage endometrial cancer: 5-year follow-up Pietro Cignini 1 • Salvatore Giovanni Vitale 2 • Antonio Simone Lagana ` 2 • Antonio Biondi 3 • Valentina Lucia La Rosa 4 • Giuseppe Cutillo 5 Received: 7 December 2016 / Accepted: 9 January 2017 Ó Italian Society of Surgery (SIC) 2017 Abstract This prospective cohort study aimed to analyze the accuracy of magnetic resonance imaging (MRI) and hysteroscopic excisional biopsy (HEB) for predicting the low- and high-risk patients with endometrial carcinoma for nodal involvement at preoperative evaluation. From Jan- uary 2005 to December 2006, all patients with a diagnosis of endometrial carcinoma were prospectively included in the study and underwent pelvic MRI and HEB. The pelvic MRI (without contrast) was aimed to evaluate the extent of myometrial invasion (MI \ 50%, MI C 50%), the possible involvement of cervical stroma, the ovarian, and lymph nodes status. HEB was performed under general anesthesia, retrieving multiple biopsies through a 5-mm, monopolar, loop electrode. According to our data analysis, the inte- gration of MRI and HEB showed an elevated accuracy and high rates of sensitivity (85.0%), specificity (88.5%), negative predictive value (91.9%) and positive predictive value (79.0%) in identifying low-risk patients who do not need comprehensive surgical staging. Keywords Gynaecological oncology Á Endometrial carcinoma Á Surgical staging Á Lymphadenectomy Á Magnetic resonance imaging Á Hysteroscopic biopsy Introduction Gynaecological surgery plays a key role in the current management of both benign [1, 2] as well as malignant diseases, including ovarian [3–7], endometrial [8–10], cervical [11, 12], and vulvar cancer [13, 14]. In developed countries, endometrial cancer (EC) rep- resents the most common gynaecologic cancer [15]. In the United States, approximately 49,560 cases are diagnosed annually [16] and about 7900 new cases are diagnosed in Italy every year. The diagnosis is usually performed at early stage and approximately 70% of ECs are diagnosed at stage I resulting in a good prognosis, with a 5-year overall survival (OS) rate of 90–95% [17, 18]. The presence of lymph node involvement is one of the most important adverse prognostic factors and is correlated to histotype, tumor grade, myometrial invasion (MI), and new prognostic factors as biological overexpression of p53 protein and aneuploidy [19]. In particular, patients with well-differentiated tumor (grade 1), MI \ 50%, and no evidence of intraperitoneal disease have a low-risk ( \ 5%) of nodal spreading [20]. Patients with intermedi- ate/poorly differentiated tumor (grade 2–3), MI \ 50%, and no intraperitoneal disease have a 5–9% incidence of pelvic node involvement and a 4% incidence of positive para-aortic nodes [21]. Patients with MI C 50% and grade 3 and/or intraperitoneal disease have a significant risk of & Valentina Lucia La Rosa psicolarosa@gmail.com 1 Unit of Obstetrics and Gynecology, ‘‘San Camillo de Lellis’’ Hospital, Viale Kennedy 1, 02100 Rieti, Italy 2 Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood ‘‘G. Barresi’’, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy 3 Department of Surgery, Vittorio Emanuele Hospital, University of Catania, Via Plebiscito 628, 95124 Catania, Italy 4 Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Via Santa Sofia 78, 95124 Catania, Italy 5 Department of Oncological Surgery, Gynecologic Oncologic Unit, ‘‘Regina Elena’’ National Cancer Institute, Via Elio Chianesi 53, 00198 Rome, Italy 123 Updates Surg DOI 10.1007/s13304-017-0418-z