ObjectiveTo investigate the value of preoperative and intraoperative evaluation on high-risk factors of lymph node metastasis in early endometrial carcinoma before. MethodsA total of 129 patients with early endometrial cancer (without consideration of lymph node metastasis) who underwent comprehensive staging operation were divided into low-risk group(n=44) and high-risk group(n=85) according to the classification of disease. The lymph node metastasis of both group was assessed. The risk factors were evaluated by preoperative segmental curettage, plevic MRI and intraoperative frozen section, then the diagnostic accuracy, specificity, sensitivity, negative predictive value and positive predictive value were compared among the three methods. Results① Of 129 patients with early endometrial cancer, elevation to stage IIIC due to lymph node metastasis was found in 8 patients . In the patients of the low-risk group, no pelvic lymph node metastasis was found, but abdominal paraaortic lymph node metastasis was found in 1 patient. The rates of pelvic lymph node metastasis and the abdominal paraaortic lymph node metastasis were 8.24% and 2.35% in the high-risk patients respectively. ② The segmental curettage combined with intraoperative frozen pathology obtained a improved diagnostic efficacy for the cases with pathological type II and pathological grade G3, and there were significant differences in the improvement of the diagnostic accuracy, sensitivity, and positive predictive value for the cases with pathological type II (P＜0.05). MRI obtained higher diagnostic accuracy, the sensitivity, specificity, positive predictive value and negative predictive value for the tumor with diameters ≥ 2cm was 89.15%, 87.69%, 90.63%, 90.48% and 87.88%, respectively. MRI combined with intraoperative frozen pathology obtained a improved diagnostic efficacy for the tumors with the invasion depth ≥1/2, and there were significant differences in the improvement of the diagnostic accuracy, sensitivity, negative predictive value and positive predictive value (P＜0.05). ConclusionPreoperative segmental curettage, pelvic MRI combine with intraoperative frozen pathology can improve the diagnostic efficacy for high risk factors in varying degrees. The abdominal paraaortic lymph node metastasis rate is extremely low in the patients with low-risk early endometrial cancer. Therefore, it is recommended that abdominal paraaortic lymph node resection should be conducted according to the evaluation by intraoperative frozen pathological result in the patients preoperatively diagnosed as low-risk early endometrial cancer.

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