Incidence of pelvic lymph node metastasis using modern FIGO staging and sentinel lymph node mapping with ultrastaging in surgically staged patients with endometrioid and serous endometrial carcinoma Journal Article


Authors: Mueller, J. J.; Pedra Nobre, S.; Braxton, K.; Alektiar, K. M.; Leitao, M. M. Jr; Aghajanian, C.; Ellenson, L. H.; Abu-Rustum, N. R.
Article Title: Incidence of pelvic lymph node metastasis using modern FIGO staging and sentinel lymph node mapping with ultrastaging in surgically staged patients with endometrioid and serous endometrial carcinoma
Abstract: Objective: We report the incidence of occult nodal metastasis in patients who underwent primary surgical staging for apparent early endometrioid or serous endometrial cancer with bilateral SLN mapping and enhanced pathology. Occult ovarian metastasis rates were also reported. Methods: Patients with clinical stage I serous or endometrioid endometrial cancer who underwent primary staging surgery with successful bilateral SLN mapping from 1/2005–12/2018 were retrospectively evaluated. Rates of isolated tumor cells (ITCs), micro- and macrometastatic nodal disease, and occult ovarian involvement were reported. Results: Of 1044 patients, 959 had endometrioid and 85 serous carcinoma. There were no positive SLNs among 510 patients with noninvasive FIGO grade 1/2 endometrioid carcinoma and < 1%ITCs. Grade 1: 4.5%(9/202) with inner-half and 10%(6/62) with outer-half myoinvasion had positive SLNs. Grade 2: rates were 4%(3/76) and 20%(8/41), respectively. Grade 3: 5%(1/20) with noninvasive, 3%(1/31) with inner-half, and 24%(4/17) with outer-half myoinvasion had positive SLNs. ITC incidence increased with depth of myoinvasion—25% of deeply invasive grade 1/2 and 18% of deeply invasive grade 3 tumors. Four (10%) of 41 patients with noninvasive serous endometrial carcinoma had ITCs or positive SLNs. There were no occult ovarian metastases with grades 1/2 disease, 2/68 (3%) with grade 3 disease, and 2/85 (2%) with serous endometrial carcinoma. Conclusion: Ultrastaging SLNs may be unwarranted in low-grade noninvasive endometrioid cancer but valuable in noninvasive serous carcinoma. Occult ovarian metastasis is uncommon in early endometrial carcinoma and occurs in 2–3% of high-risk histologies. Further research is needed to determine ITC significance, particularly with regard to adjuvant treatment. © 2020 Elsevier Inc.
Keywords: endometrial cancer; sentinel lymph node; isolated tumor cells
Journal Title: Gynecologic Oncology
Volume: 157
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2020-06-01
Start Page: 619
End Page: 623
Language: English
DOI: 10.1016/j.ygyno.2020.03.025
PUBMED: 32247604
PROVIDER: scopus
PMCID: PMC7293586
DOI/URL:
Notes: Article -- Export Date: 3 August 2020 -- Source: Scopus
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MSK Authors
  1. Kaled M Alektiar
    286 Alektiar
  2. Mario Leitao
    434 Leitao
  3. Jennifer Jean Mueller
    95 Mueller