Diagnostic accuracy of preoperative tests for lymph node status in endometrial cancer: a systematic review.

BACKGROUND: Approximately 72% of endometrial cancers are FIGO stage I at diagnosis and about 10% have lymph node metastases. An ideal diagnostic test for nodal disease would be able to prevent both overtreatment (i.e. unnecessary lymphadenectomy) and undertreatment (i.e. withholding lymphadenectomy or adjuvant postoperative treatment to patients with lymph node metastases). OBJECTIVES: In this review we compare the accuracy of preoperative tests (computed tomography, magnetic resonance imaging, positron emission tomography-computed tomography, CA-125 serum levels, and ultrasonography) for the detection of lymph node metastases in endometrial cancers with the final histopathologic diagnosis after complete pelvic and para-aortic lymphadenectomy as the gold standard. METHOD: A systematic search in MEDLINE (using PubMed), Embase and The Cochrane Library was performed up to 23 July 2012. RESULTS: We found one article that met our inclusion criteria for computed tomography, none for magnetic resonance imaging, 2 for positron emission tomography/computed tomography), 2 for CA-125 and none for ultrasonography. CONCLUSIONS: Due to the lack of high-quality articles on a preoperative test for lymph node status in endometrial cancer, no proper comparison between these modalities can be made.

[Prolapse of appendices epiploicae due to vaginal vault [corrected] rupture]. / Prolaberende appendices epiploicae door een geruptureerde vaginatop.

A 52-year-old woman, para 2, presented with pain in her lower abdomen and a bleeding vaginal swelling. The night before she had fallen on her buttocks at a dancing party. The medical history listed a vaginal hysterectomy with anterior and posterior repair. On physical examination a mildly bleeding, red lobulated tumour protruded through the vaginal orifice. On closer inspection appendices epiploicae were seen to be bulging through a 3 cm wide, but narrow rupture in the vaginal vault. The patient denied having had sexual activity or any specific trauma. As some appendices epiploicae showed signs of necrosis, repositioning and repair was performed by laparotomy. Evisceration through a vaginal wall defect is a very rare, but potentially life threatening situation. Predisposing factors are postmenopausal status, a history of uterus extirpation and vaginal prolapse. In premenopausal women it is most often associated with coitus or trauma. The vaginal wall defect can be closed from a vaginal approach but if there is any doubt about the viability ofthe viscera, a laparotomy should be carried out.

[Diagnostic image (206). A woman with dyspnoea and retrosternal pain after vaginal delivery]. / Diagnose in beeld (206). Een vrouw met dyspnoe en retrosternale pijn na een vaginale partus.

A 27-year-old healthy woman suffered from dyspnoea and retrosternal pain after a spontaneous vaginal delivery due to a pneumomediastinum and subcutaneous emphysema caused by labour.