Utility of computerized tomography in clinical staging and surgical decision making in patients with uterine cancer

We investigated the utility of pre-operative computerized tomography (CT) abdomen and pelvis on clinical staging and surgical decision making for uterine carcinoma.

This retrospective cohort study included patients treated surgically for uterine carcinoma between 2010 and 2021 at a single academic center. Data on patient demographics, tumor characteristics, CT imaging results, and surgical procedures were collected. Diagnostic accuracy metrics (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) were analyzed to assess the predictive value of CT for determining extrauterine disease, lymphadenopathy, and omental involvement. The impact of CT imaging on surgical management decisions was also evaluated.

Of 409 patients meeting inclusion criteria, 68.9 % underwent pre-operative CT imaging. CT demonstrated moderate sensitivity (67.0 %, 61/91) and high specificity (87.4 %, 145/166) for detecting extrauterine disease, which was comparable across those with low grade endometrioid, high grade endometrioid, and non-endometrioid histotypes. Patients with abnormal CT findings were significantly more likely to have advanced stage disease (FIGO stage III/IV; p < 0.001), undergo tumor debulking (p < 0.001), and receive pelvic (p = 0.001) and para-aortic lymphadenectomy (p < 0.001). Conversely, patients with normal CT scans more frequently underwent minimally invasive surgery (MIS) and sentinel lymph node (SLN) procedures (p < 0.001).

Preoperative CT shows moderate sensitivity but high specificity for identifying extrauterine disease in uterine carcinoma, supporting continued use for high risk histotypes. Among patients with low-grade histotypes, risk-adaptive use of CT may be valuable in determining eligibility for either MIS or SLN mapping. This is an increasingly relevant consideration as MIS and SLN are becoming more widely adopted.