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

Christine H. Kim, Robert A. Soslow*, Kay J. Park, Emma Barber, Fady Khoury-Collado, Joyce N. Barlin, Yukio Sonoda, Martee L. Hensley, Richard R. Barakat, Nadeem R. Abu-Rustum

*Corresponding author for this work

Research output: Contribution to journalReview article

114 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)964-970
Number of pages7
JournalInternational Journal of Gynecological Cancer
Volume23
Issue number5
DOIs
StatePublished - Jun 1 2013

Fingerprint

Neoplasm Micrometastasis
Neoplasm Staging
Endometrial Neoplasms
Neoplasm Metastasis
Neoplasms
Lymph Nodes
Sentinel Lymph Node
Endometrioid Carcinoma
Incidence
Hematoxylin
Eosine Yellowish-(YS)
Paraffin
Immunohistochemistry
Staining and Labeling
Carcinoma

Keywords

  • Endometrial carcinoma
  • Low-volume metastasis
  • Micrometastasis
  • Sentinel lymph node
  • Ultrastaging

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Kim, Christine H. ; Soslow, Robert A. ; Park, Kay J. ; Barber, Emma ; Khoury-Collado, Fady ; Barlin, Joyce N. ; Sonoda, Yukio ; Hensley, Martee L. ; Barakat, Richard R. ; Abu-Rustum, Nadeem R. / Pathologic ultrastaging improves micrometastasis detection in sentinel lymph nodes during endometrial cancer staging. In: International Journal of Gynecological Cancer. 2013 ; Vol. 23, No. 5. pp. 964-970.
@article{5682fb0bc0e04496aaf76f4cc20c3c84,
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.",
keywords = "Endometrial carcinoma, Low-volume metastasis, Micrometastasis, Sentinel lymph node, Ultrastaging",
author = "Kim, {Christine H.} and Soslow, {Robert A.} and Park, {Kay J.} and Emma Barber and Fady Khoury-Collado and Barlin, {Joyce N.} and Yukio Sonoda and Hensley, {Martee L.} and Barakat, {Richard R.} and Abu-Rustum, {Nadeem R.}",
year = "2013",
month = "6",
day = "1",
doi = "10.1097/IGC.0b013e3182954da8",
language = "English (US)",
volume = "23",
pages = "964--970",
journal = "International Journal of Gynecological Cancer",
issn = "1048-891X",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

Kim, CH, Soslow, RA, Park, KJ, Barber, E, Khoury-Collado, F, Barlin, JN, Sonoda, Y, Hensley, ML, Barakat, RR & Abu-Rustum, NR 2013, 'Pathologic ultrastaging improves micrometastasis detection in sentinel lymph nodes during endometrial cancer staging', International Journal of Gynecological Cancer, vol. 23, no. 5, pp. 964-970. https://doi.org/10.1097/IGC.0b013e3182954da8

Pathologic ultrastaging improves micrometastasis detection in sentinel lymph nodes during endometrial cancer staging. / Kim, Christine H.; Soslow, Robert A.; Park, Kay J.; Barber, Emma; Khoury-Collado, Fady; Barlin, Joyce N.; Sonoda, Yukio; Hensley, Martee L.; Barakat, Richard R.; Abu-Rustum, Nadeem R.

In: International Journal of Gynecological Cancer, Vol. 23, No. 5, 01.06.2013, p. 964-970.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Pathologic ultrastaging improves micrometastasis detection in sentinel lymph nodes during endometrial cancer staging

AU - Kim, Christine H.

AU - Soslow, Robert A.

AU - Park, Kay J.

AU - Barber, Emma

AU - Khoury-Collado, Fady

AU - Barlin, Joyce N.

AU - Sonoda, Yukio

AU - Hensley, Martee L.

AU - Barakat, Richard R.

AU - Abu-Rustum, Nadeem R.

PY - 2013/6/1

Y1 - 2013/6/1

N2 - 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.

AB - 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.

KW - Endometrial carcinoma

KW - Low-volume metastasis

KW - Micrometastasis

KW - Sentinel lymph node

KW - Ultrastaging

UR - http://www.scopus.com/inward/record.url?scp=84880430412&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84880430412&partnerID=8YFLogxK

U2 - 10.1097/IGC.0b013e3182954da8

DO - 10.1097/IGC.0b013e3182954da8

M3 - Review article

C2 - 23694985

AN - SCOPUS:84880430412

VL - 23

SP - 964

EP - 970

JO - International Journal of Gynecological Cancer

JF - International Journal of Gynecological Cancer

SN - 1048-891X

IS - 5

ER -