Highlights
- •Incidence of endometrial cancer has increased by approximately 3.6% yearly between 2006 and 2016.
- •Preoperative imaging increased from 22.2% of patients in 2006 to 39.3% of patients in 2016, representing a 77.0% increase.
- •There was no correlation between published guidelines in 2013 and decreasing use of preoperative imaging in low risk cancers.
Abstract
Objectives
Clinical practice guidelines recommend against routine preoperative axial imaging
studies (CT/MRI) for endometrial cancer, except for cases of locally advanced disease
or aggressive histologies. This study utilized population-based data to evaluate the
use of preoperative imaging and factors associated with its use.
Methods
A population-based cohort of women diagnosed with endometrial cancer from 2006 to
2016 were identified from the Ontario Cancer Registry in Ontario, Canada. Patients
were excluded if they had: hysterectomy prior to the date of diagnosis, non-epithelial
histology or a prior cancer diagnosis within 5 years. Preoperative imaging (CT or
MRI) rates were calculated over time. Predictive factors for preoperative imaging
use were determined using multi-variable regression analysis.
Results
17,718 cases were eligible for analysis. From 2006 to 2016, the proportion of patients
receiving preoperative imaging increased from 22.2% to 39.3%. In a subgroup of patients
with low-risk disease (stage 1, endometrioid adenocarcinoma), imaging increased from
16.3% to 29.5%. Multivariate analysis showed an association between preoperative imaging
and advanced stage, advanced grade, non-endometrioid morphology, surgery with a gynecologic
oncologist, surgery at a teaching hospital and a later year of diagnosis. From 2006
to 2016, the yearly incidence of endometrial cancer increased from 22.3/100,000 to
36.1/100,000, representing a mean annual increase of 3.6% per year.
Conclusions
Endometrial cancer incidence and the use of preoperative imaging are increasing. Factors
most associated with preoperative imaging are high-risk features. However, preoperative
imaging is still being performed in low-risk patients, indicating non-adherence to
guidelines, which has implications for constrained healthcare resources.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gynecologic OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Statistics. CCSsACoC. Canadian Cancer Statistics 2017 Toronto, ON:2017 [Canadian Cancer Statistics]. Available from: http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2017-EN.pdf?la=en.
- Endometrial cancer in Brazil: preparing for the rising incidence.Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics. 2018; 40: 577-579
- International patterns and trends in endometrial Cancer incidence, 1978–2013.JNCI: J. National Cancer Institute. 2018; 110: 354-361
- Cancer Facts & Figures United States2019.(Available from:)
- All Races, Females by SEER Summary Stage 2000 2017.(Available from)https://seer.cancer.gov/statfacts/html/corp.htmlDate: 2007-2013
- Endometrial cancer: a review and current management strategies: part I.Gynecol. Oncol. 2014; 134: 385-392
- Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium.Int. J. Gynecol. Obstet. 2009; 105: 103-104
- Endometrial cancer: a review and current management strategies: part II.Gynecol. Oncol. 2014; 134: 393-402
- Preoperative imaging of uterine malignancy: a low-value service.Gynecol. Oncol. 2015; 137: 285-290
- Computed tomography in endometrial carcinoma.Obstet. Gynecol. 2000; 95: 692-696
- Clinical utility of preoperative computed tomography in patients with endometrial Cancer.Int. J. Gynecol. Cancer. 2017; 27: 1685-1693
- The utility and cost effectiveness of preoperative computed tomography for patients with uterine malignancies.Gynecol. Oncol. 2008; 111: 208-212
- Utilization of preoperative imaging in uterine cancer patients.Gynecol. Oncol. 2009; 115: 226-230
- Impact of wait times on survival for women with uterine cancer.J. Clin. Oncol. 2014; 32: 27-33
- 2nd. Survival implications of time to surgical treatment of endometrial cancers.Am. J. Obstet. Gynecol. 2017; 216 (e1-.e18): 268
- Endometrial cancer: a review and current management strategies: part I.Gynecol. Oncol. 2014; 134: 385-392
- Epidemiology and investigations for suspected endometrial cancer.J. Obstet. Gynaecol. Can. 2013; 35: 380-381
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.J. Clin. Epidemiol. 1992; 45: 613-619
- Measuring ‘rurality’ for purposes of health-care planning: an empirical measure for Ontario.Ontario Med. Rev. 2000; (October)
- Measuring Rurality - RIO2008_BASIC: Methodology and Results.Department OE, 2009
Statistics Canada. Table 17-10-0005-01 Population estimates on July 1st, by age and sex. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000501.
- Organizational guideline for gynecological services in Ontario.Cancer Care Ontario: Program in Evidence-based Care Evidence-based Series. 2013; 4: 1-99
- Defensive medicine among high-risk specialist physicians in a volatile malpractice environment.JAMA. 2005; 293: 2609
- Finding the truth in medical imaging: painting the picture of appropriateness for magnetic resonance imaging in Canada.Can. Assoc. Radiol. J. 2015; 66: 323-331
- Baseline staging imaging for distant metastasis in women with stages I, II, and III breast cancer.Curr. Oncol. (Toronto, Ont). 2020; 27 (e123-e45)
- American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology.J. Clin. Oncol. 2012; 30: 1715-1724
- Baseline radiological staging in primary breast cancer: impact of educational interventions on adherence to published guidelines.J. Eval. Clin. Pract. 2007; 13: 647-650
- Adherence to guidelines for baseline staging in newly diagnosed localized breast cancer.Cancer Treatment and Research Communications. 2019; 22: 100160
- Prostate Cancer imaging trends after a Nationwide effort to discourage inappropriate prostate Cancer imaging.JNCI J. National Cancer Institute. 2013; 105: 1306-1313
- Unnecessary imaging for the staging of low-risk prostate Cancer is common.Urology. 2011; 77: 274-278
Article info
Publication history
Published online: March 06, 2021
Accepted:
February 11,
2021
Received:
October 8,
2020
Identification
Copyright
Crown Copyright © 2021 Published by Elsevier Inc. All rights reserved.
