Page 90 - Hospital Authority Convention 2018

Masterclasses Masterclasses
HOSPITAL AUTHORITY CONVENTION 2018

M1.1 Multidisciplinary Management of Aortic Nodal Metastasis 10:45 Room 221
in Endometrial Cancer

Significance of Nodal Status and Dilemma in Aortic Node Dissection
Cheung TH
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong

Endometrial carcinoma is the commonest gynaecological malignancy in Hong Kong. The annual incidence in Hong Kong
has been increasing in the last decade and reached 978 cases in 2015. Although most patients presented early with good
prognosis, 10% patients with apparently localised disease to the uterus have nodal metastasis. Patients with occult nodal
metastasis may remain undetected without thorough pelvic and para-aortic lymphadenectomy. However, indiscriminate
application of radical surgical procedure to all endometrial cancer patients may do more harm than good because many
patients would be subject to longer operation time and higher surgical complications with no real benefit. This is a major
concern because many endometrial cancer patients have high surgical risks due to advanced age, obesity and co-morbid
conditions such as diabetes mellitus and hypertension. It has been shown that the chance of finding metastatic nodes
increases with the number of lymph node removed. The mean number of nodes removed is less than 10 in many surgical
reports signifying the inherent surgical difficulties.

To reduce surgical morbidity, we should limit radical nodal dissection to patients with significant risk of nodal metastasis and
spare patients with well differentiated carcinoma and superficial myoinvasion of the procedure. One key issue remains how to
Monday, 7 May 2018 generally available. Finding sentinel nodes has been shown to be highly sensitive in detecting nodal metastasis in cervical
accurately assess the tumour grade and depth of myoinvasion preoperatively. Furthermore, we could apply minimally invasive
surgery (MIS) to reduce surgical morbidity. However, thorough pelvic and aortic nodal dissection via MIS is technically
difficult that not many can master. The use of surgical robot has made the MIS easier, but it comes with a price and is not

and vulva carcinoma, its role in endometrial cancer remains to be defined.

M1.2 Multidisciplinary Management of Aortic Nodal Metastasis 10:45 Room 221
in Endometrial Cancer

MR and PET/MR Imaging of Endometrial Carcinoma
Lo G
Department of Diagnostic and Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong
Magnetic resonance (MR) provides exquisite soft tissue contrast and is especially appropriate for imaging the pelvis. MR can
separate out fibroids, adenomyosis, cervical carcinoma and endometrial lesions. The junctional zone between endometrium
and myometrium is well seen and tumour extension into myometrium can be identified. Multiparametric MR imaging
provides anatomic images as well as functional images. Functional data such as Diffusion Imaging and Dynamic Contrast
Enhancement increases diagnostic accuracy. In a cellular environment such as carcinoma, the diffusion of water molecules is
restricted and this can be seen as a very dark area on the Apparent Diffusion Coefficient (ADC) map.
The PET-MRI scanner at Hong Kong Sanatorium & Hospital was installed in March 2015. To date, we have scanned 1,521
patients by 2,236 scans in total. Multiparametric MR imaging with PET functional imaging combines the best morphologic
scan with the best functional scan. It is a one-stop-shop for patients and greatly increases diagnostic confidence and
accuracy. MR provides unmatched locoregional staging and PET-MR is well suited for detecting nodal and distant
metastases. PET-MR can also be done in a timely manner and can also reduce radiation dose by 50% to 70% compared to
PET-CT.
Since MR has a limitation of not detecting pulmonary nodules less than 5mm, an ultra-low dose CT thorax is performed on
our patients to ensure that all pulmonary metastases are detected.
Multiple examples of multiparametric MR and PET-MR examinations will be given.

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