Sentinel lymph node mapping with pathologic ultrastaging: A valuable tool for assessing nodal metastasis in low-grade endometrial cancer with superficial myoinvasion Journal Article


Authors: Kim, C. H.; Khoury-Collado, F.; Barber, E. L.; Soslow, R. A.; Makker, V.; Leitao, M. M. Jr; Sonoda, Y.; Alektiar, K. M.; Barakat, R. R.; Abu-Rustum, N. R.
Article Title: Sentinel lymph node mapping with pathologic ultrastaging: A valuable tool for assessing nodal metastasis in low-grade endometrial cancer with superficial myoinvasion
Abstract: Objective To report the incidence of nodal metastases in patients presenting with presumed low-grade endometrioid adenocarcinomas using a sentinel lymph node (SLN) mapping protocol including pathologic ultrastaging. Methods All patients from 9/2005 to 12/2011 who underwent endometrial cancer staging surgery with attempted SLN mapping for preoperative grade 1 (G1) or grade 2 (G2) tumors with < 50% invasion on final pathology, were included. All lymph nodes were examined with hematoxylin and eosin (H&E). Negative SLNs were further examined using an ultrastaging protocol to detect micrometastases and isolated tumor cells. Results Of 425 patients, lymph node metastasis was found in 25 patients (5.9%) on final pathology-13 cases on routine H&E, 12 cases after ultrastaging. Patients whose tumors had a DMI < 50% were more likely to have positive SLNs on routine H&E (p < 0.005) or after ultrastaging (p = 0.01) compared to those without myoinvasion. Conclusions Applying a standardized SLN mapping algorithm with ultrastaging allows for the detection of nodal disease in a presumably low-risk group of patients who in some practices may not undergo any nodal evaluation. Ultrastaging of SLNs can likely be eliminated in endometrioid adenocarcinoma with no myoinvasion. The long-term clinical significance of ultrastage-detected nodal disease requires further investigation as recurrences were noted in some of these cases. © 2013 Elsevier Inc.
Keywords: adult; aged; cancer surgery; major clinical study; cancer adjuvant therapy; cancer patient; preoperative care; cancer staging; lymph node metastasis; antineoplastic agent; endometrioid carcinoma; sentinel lymph node mapping; cancer grading; endometrium cancer; sentinel lymph node; clinical protocol; cell isolation; micrometastasis; eosin; hematoxylin; diagnostic test; isolated tumor cells; tumor invasion; lymph vessel metastasis; ultrastaging; human; female; priority journal; article; endometrial cancer staging; low-grade endometrioid carcinoma
Journal Title: Gynecologic Oncology
Volume: 131
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2013-12-01
Start Page: 714
End Page: 719
Language: English
DOI: 10.1016/j.ygyno.2013.09.027
PROVIDER: scopus
PMCID: PMC3881432
PUBMED: 24099838
DOI/URL:
Notes: Export Date: 2 January 2014 -- CODEN: GYNOA -- Source: Scopus
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MSK Authors
  1. Vicky Makker
    149 Makker
  2. Richard R Barakat
    629 Barakat
  3. Kaled M Alektiar
    287 Alektiar
  4. Yukio Sonoda
    370 Sonoda
  5. Mario Leitao
    442 Leitao
  6. Robert Soslow
    754 Soslow
  7. Christine Heesun Kim
    13 Kim