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Intraoperative clinical evaluation of lymph nodes in women with gynecologic cancer.

OBJECTIVE
This study was undertaken to determine the accuracy of systematic intraoperative clinical evaluation of lymph nodes in women with gynecologic cancers and to examine the factors affecting such accuracy.


STUDY DESIGN
The characteristics and overall intraoperative clinical impression of lymph node metastases were prospectively recorded for 178 consecutive women undergoing lymphadenectomy. The overall clinical impression and lymph node characteristics (enlargement, firmness, and adherence) were correlated with the final histopathologic diagnosis.


RESULTS
The overall clinical impression showed excellent agreement with the final histopathologic diagnosis (kappa = 0.753) but had a high false-negative rate (25.8%). The combination of enlargement and firmness had the highest overall accuracy (93.3%). Accuracy of clinical evaluation varied significantly according to the type of cancer, node positivity, and the proportion of positive nodes with respect to the total number of nodes.


CONCLUSION
Although systematic intraoperative clinical evaluation of lymph nodes by a trained surgeon has high overall accuracy and correlates well with the final histopathologic diagnosis, it has a high false-negative rate and cannot substitute for histopathologic examination.