Table 1 Diagnostic accuracy of tests to determine lymph node metatasis in primary endometrial cancer: study characteristics

Burke TW

1996

15 women recruited 15 women had index test and reference standard Stage: not stated Pelvic and paraaortic selective lymphadenectomy Open surgery

Hospital – Not stated Country – USA Dates – not stated

SN biopsy using 3 mls blue dye injected into subserosal myometrium 1 women unable to identify SN, positive lymph node status

Histological method not stated

Echt M

1999

8 women recruited 8 women had index test and 7 reference standard Advanced disease prevented lymphadenectomy Stage:IB Pelvic and paraaortic lymphadenectomy Open surgery

Hospital – Alton Ochsner Medical Foundation and University of South Florida Collage of Medicine Dates – 01/01/1993 – 31/03/1995

SN biopsy using 2 mls blue dye injected into uterine funds In all 7 women unable to identify SN, 1 women positive histology

Histological method not stated

Holub Z

2001

8 women recruited 8 women had index test and reference standard Stage:IA-1, IB-5, IC-1, IIIC-1 Pelvic lymphadenectomy Laparoscopic surgery

Hospital – Not stated Country – Czech Republic Dates – 01/200 – 11/2000

SN biopsy using 2 mls blue dye injected into subserosal myometrium 3 women unable to identify SN, all women histology negative

Histological method not stated

Niikura H

2003

28 women recruited 28 women had index test and reference standard Stage: IA-7, IB-11, IIA-2, IIB-1, IIIA-1, IIIC-2 Pelvic and paraaortic lymphadenectomy Open surgery

Hospital – Tohoku University School of Medicine Country – Japan Dates – 06/01 – 01/03

SN biopsy using 70 MBq technetium-99 m colloidal albumin injected hysteroscopically into endomertium 5 women unable to identify a SN, 1 women positive histology

H and E staining and mmunohistochemistry

Pelosi E

2003

16 women recruited 16 women had index test and reference standard Stage: Ib-16 Pelvic lymphadenectomy Laparoscopic surgery

Hospital – Not stated Country – Italy Dates – 02/02 – 04/02

SN biopsy using 37 MBq technetium-99 m colloidal albumin and 4 ml blue dye injected into the cervix 1 women unable to identify SN, negative lymph node status

H and E staining and immunohistochemistry

Raspagliesi F

2003

18 women recruited18 women had index test14 women had reference standard4 excluded, 2 due to disease stageStage IA-4, IB-9, IIIA-1, IIIC-4Pelvic lymphadenectomy in all women, paraaortic only if deemed necessaryOpen surgery

Hospital – Not statedCountry – ItalyDates – Not stated

SN biopsy using 111 MBq technetium-99 m colloidal albumin injected hysteroscopically into sub endomertium

H and E staining

Fersis N

2003

10 Women recruited 10 women had index test and reference standard Stage : Ib pelvic +/- paraaortic lymphadenectomy Open surgery

Hospital – Not stated Country – Germany Dates – Not stated

SN biopsy using 40–100 MBq technetium-99 m colloidal albumin injected hysteroscopically into tumour 3 patients unable to identify SN, patient's lymph node status was negative

Histological method not stated

Holub Z

2004

25 women recruited 25 women had index test and reference standard Stage: not stated Pelvic lymphadenectomy (yes patent had sampling only) Laparoscopic surgery

Hospital – Not stated Country – Czech Republic Dates – 02/00 – 08/03

SN using 5 ml blue dye injected into cervix and uterine fundus 4 patients unable to identify SN, patients lymph node status was negative

Histological method not stated

Lelievre L

2004

12 women recruited 12 women had index test and reference standard Stage: Ib-2, Ic-5, IIa-1, IIb-1, IIIc-3 Pelvic lymphadenectomy Laparoscopic surgery

Hospital – Not stated Country – France Dates 01/02 – 12/02

SN biopsy using 120 MBq technetium-99 m colloidal albumin injected in to the cervix and 2 mls blue dye injected into the cervix 11 patients had SN identified using combined technique, 10 using technetium-99 m alone and 9 using blue dye alone

H and E staining and immunohistochemistry

CT

Balfe DM

1983

61 women recruited 18 women had index test and reference standard 43 women excluded without explanation Stage: not stated Pelvic and paraaortic lymphadenectomy Open surgery

Hospital – Mallinckrodt Institute of Radiology Country – USA Dates – 07/76 – 07/81

CT using EMI CT500S and EMI 7070 3s scanners Lymph nodes > 10 mm abnormal

Histological method not stated

Varpula MJ

1993

47 women recruited47 women had index test43 women had index test and reference standard, 4 women excluded as suitable for dxt onlyStage: I-36, II-7Pelvic and paraaortic unilateral and bilateral clearance and samplingOpen surgery

Hospital – Not statedCountry – FinlandDates – 05/87 – 05/90

CT scan using Siemans Somatom CR/General Electric 9800 scannerslymph nodes > 10 mm abnormal

Histological method not stated

La Fianza A

1997

125 women recruited 125 women index test and reference standard Stage: I-125, II-12, III-8 Pelvic lymphadenectomy Open surgery

Hospital – Not stated Country – Italy Dates – 01/1996 – 09/1993

CT using III generation Somatom 2, Somatome Plus and Siemens scanner

Histological method not stated

Conner JP

2000

702 women were eligible, 210 excluded follow up at another centre, secondary malignancy or no surgery planned 487 women excluded as no CT 75 women had index test 56 women had reference standard, 6 had no lymphadenectomy due to index test results, 13 no explanation Stage : I-350, II-73, III-49, IV-20 Pelvic and paraaortic lymph node sampling Open surgery

Hospital – University of Iowa Hospital and Clinics Country – USA Dates – 1979 – 1993

CT scanner model not stated

Histological method not stated

Zerbe M

2000

54 women recruited 54 women index test 36 women reference standard, no explanation for exclusion Stage I–III Lymph node type not stated Surgery type not stated

Hospital – Baltimore Medical Centre Country – USA Dates – 01/90 – 12/98

CT scanner model not stated No definition for lymph node abnormality

Histological method not stated

USS

Sawicki W

2003

90 women recruited90 women had index test and reference standardStage – not statedlymph node type not statedSurgery type, not stated

Hospital – Not statedCountry – PolandDates – Not stated

USS either abdominal or transvaginal using Siemens Sonoline Versu Prox with a 6.5–7.5 MHZ probe for transvaginal and 3.5 MHZ probe for abdominal definition for lymph node abnormality

Histological method not stated

MRI

Hricak H

1991

20 women recruited 20 women had the index test and reference standard Stage: I-16, II-1, III-3 Pelvic lymph node sampling Open surgery

Hospital – Not stated Country – USA Dates – 01/02/89 – 01/12/89

MRI using 1.5T Sigma and 1.5T Magnetom scanner lymph nodes > 10 mm abnormal

Histological method not stated

Varpula MJ

1993

46 women recruited 46 women had index test 43 women had the index test and reference standard, 3 excluded as suitable for DXT only Stage: I-36, II-7 Pelvic and paraaortic unilateral and bilateral clearance and sampling Open surgery

Hospital – Not stated Country – Finland Dates – 05/87 – 05/90

MRI using < 0.05T Acut scanner Lymph nodes > 10 mm abnormal

Histological method not stated

Taieb S

2002

86 women recruited 86 women had index test and reference standard Stage: Ia-24, Ib-26, Ic-14, IIa-2, Iib-2, IIIc-15, IVa-2, IVb-1 Pelvic and paraaortic lymphadenectomy Open surgery

Hospital – Not stated Country – France Dates – 01/97 – 03/02

MRI scanner type not stated

Histological method not stated

Manfredi R

2004

37 women recruited 37 women had index test 21 women had reference standard, 16 women excluded as no lymph nodes were palpable Stage: Ia-2, Ib-20, Ic-15 Pelvic lymph node sampling in 11, pelvic and paraaortic lymphadenectomy in 10 Open surgery

Hospital – Not stated Country – Italy Dates – 06/97 – 02-01

MRI using 1.5T Echospeed, GE medical System scanner Lymph nodes abnormal > 10 mm

Histological method not stated