Establishing guidelines for sentinel lymph node ultrastaging in endometrial cancer Journal Article
| Authors: | Chiang, S.; Tessier-Cloutier, B.; Klein, E.; Ardon, O.; Mueller, J. J.; Leitao, M. M. Jr; Abu-Rustum, N. R.; Ellenson, L. H. |
| Article Title: | Establishing guidelines for sentinel lymph node ultrastaging in endometrial cancer |
| Abstract: | Background Many sentinel lymph node (SLN) ultrastaging protocols for endometrial cancer exist, but there is no consensus method. Objective This study aims to develop guidelines for size criteria in SLN evaluation for endometrial cancer, to determine whether a single cytokeratin AE1:AE3 immunohistochemical slide provides sufficient data for diagnosis, and to compare cost efficiency between current and limited ultrastaging protocols at a large tertiary care institution. Methods Our current SLN ultrastaging protocol consists of cutting two adjacent paraffin block sections at two levels (L1 and L2), 50 μm apart, with two slides at each level stained with hematoxylin and eosin and cytokeratin AE1:AE3 immunohistochemistry. We retrospectively reviewed digitized L1 and L2 slides of all positive ultrastaged SLNs from patients treated for endometrial cancer between January 2013 and January 2020. SLN diagnosis was defined by measuring the largest cluster of contiguous tumor cells in a single cross section: macrometastasis (>2.0 mm), micrometastasis (>0.2 to ≤2.0 mm or >200 cells), or isolated tumor cells (≤0.2 mm or ≤200 cells). Concordance between L1 and L2 results was evaluated. Cost efficiency between current (two immunohistochemical slides per block) and proposed limited (one immunohistochemical slide per block) protocols was compared. Results Digitized slides of 147 positive SLNs from 109 patients were reviewed; 4.1% of SLNs were reclassified based on refined size criteria. Complete concordance between L1 and L2 interpretations was seen in 91.8% of SLNs. A false-negative rate of 0%–0.9% in detecting micrometastasis and macrometastasis using a limited protocol was observed. Estimated charge-level savings of a limited protocol were 50% per patient. Conclusion High diagnostic accuracy in SLN interpretation may be achieved using a limited ultrastaging protocol of one immunohistochemical slide per block and linear measurement of the largest cluster of contiguous tumor cells. Implementation of the proposed limited ultrastaging protocol may result in laboratory cost savings with minimal impact on health outcomes. © 2024 BMJ Publishing Group. All rights reserved. |
| Keywords: | immunohistochemistry; adult; controlled study; human tissue; aged; middle aged; retrospective studies; major clinical study; comparative study; cancer staging; lymph node metastasis; cancer diagnosis; endometrioid carcinoma; endometrial neoplasms; lymphatic metastasis; neoplasm staging; cancer grading; diagnostic accuracy; endometrium cancer; sentinel lymph node; sentinel lymph node biopsy; clinical protocol; practice guideline; pathology; retrospective study; false negative result; cost control; cost effectiveness analysis; clinical evaluation; practice guidelines as topic; tumor cell; micrometastasis; eosin; hematoxylin; endometrium tumor; cytokeratin ae1; cytokeratin ae3; paraffin embedding; procedures; international federation of gynecology and obstetrics; macrometastasis; sentinel lymph node metastasis; humans; human; female; article; tertiary care center |
| Journal Title: | International Journal of Gynecological Cancer |
| Volume: | 34 |
| Issue: | 5 |
| ISSN: | 1048-891X |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2024-05-01 |
| Start Page: | 681 |
| End Page: | 688 |
| Language: | English |
| DOI: | 10.1136/ijgc-2023-005157 |
| PUBMED: | 38388180 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF -- MSK corresponding author is Sarah Chiang -- Source: Scopus |
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