Pathologic ultrastaging improves micrometastasis detection in sentinel lymph nodes during endometrial cancer staging Journal Article


Authors: Kim, C. H.; Soslow, R. A.; Park, K. J.; Barber, E. L.; Khoury-Collado, F.; Barlin, J. N.; Sonoda, Y.; Hensley, M. L.; Barakat, R. R.; Abu-Rustum, N. R.
Article Title: Pathologic ultrastaging improves micrometastasis detection in sentinel lymph nodes during endometrial cancer staging
Abstract: Objective: To describe the incidence of low-volume ultrastage-detected metastases in sentinel lymph nodes (SLNs) identified at surgical staging for endometrial carcinoma and to correlate it with depth of myoinvasion and tumor grade. Methods: We reviewed all patients who underwent primary surgery for endometrial carcinoma with successful mapping of at least one SLN at our institution from September 2005 to December 2011. All patients underwent a cervical injection for mapping. The SLN ultrastaging protocol involved cutting an additional 2 adjacent 5-Km sections at each of 2 levels, 50-Km apart, from each paraffin block lacking metastatic carcinoma on routine hematoxylin and eosin (H & E) staining. At each level, one slide was stained with H & E and with immunohistochemistry (IHC) using anticytokeratin AE1:AE3. Micrometastases (tumor deposits 90.2 mm and e2 mm) and isolated tumor cells (e0.2 mm) were classified as low-volume ultrastage-detected metastases if pathologic ultrastaging was the only method allowing detection of such nodal disease. Results: Of 508 patients with successful mapping, 413 patients (81.3%) had endometrioid carcinoma. Sixty-four (12.6%) of the 508 patients had positive nodes: routine H & E detected 35 patients (6.9%), ultrastaging detected an additional 23 patients (4.5%) who would have otherwise been missed (4 micrometastases and 19 isolated tumor cells), and 6 patients (1.2%) had metastatic disease in their non-SLNs. The incidence rates of low-volume ultrastage-detected nodal metastases in patients with grades 1, 2, and 3 tumors were 3.8%, 3.4%, and 6.9%, respectively. The frequency rates of low-volume ultrastage-detected metastases in patients with a depth of myoinvasion of 0, less than 50%, and 50% or more were 0.8%, 8.0%, and 7.4%, respectively. Lymphovascular invasion was present in 20 (87%) of the cases containing low-volume ultrastage-detected metastases in the lymph nodes. Conclusions: Sentinel lymph node mapping with pathologic ultrastaging in endometrial carcinoma detects additional low-volume metastases (4.5%) that would otherwise go undetected with routine evaluations. Our data support the incorporation of pathologic ultrastaging of SLNs in endometrial carcinoma with any degree of myoinvasion. The oncologic significance of low-volume nodal metastases requires long-term follow-up. © 2013 by IGCS and ESGO.
Keywords: sentinel lymph node; micrometastasis; endometrial carcinoma; low-volume metastasis; ultrastaging
Journal Title: International Journal of Gynecological Cancer
Volume: 23
Issue: 5
ISSN: 1048-891X
Publisher: Lippincott Williams & Wilkins  
Date Published: 2013-06-01
Start Page: 964
End Page: 970
Language: English
DOI: 10.1097/IGC.0b013e3182954da8
PROVIDER: scopus
PUBMED: 23694985
PMCID: PMC4079038
DOI/URL:
Notes: --- - "Export Date: 1 August 2013" - "CODEN: IJGCE" - "Source: Scopus"
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MSK Authors
  1. Richard R Barakat
    629 Barakat
  2. Yukio Sonoda
    473 Sonoda
  3. Joyce Nuqui Barlin
    23 Barlin
  4. Kay Jung Park
    308 Park
  5. Robert Soslow
    797 Soslow
  6. Christine Heesun Kim
    13 Kim