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

Christine H. Kim, Fady Khoury-Collado, Emma L. Barber, Robert A. Soslow, Vicky Makker, Mario M. Leitao, Yukio Sonoda, Kaled M. Alektiar, Richard R. Barakat, Nadeem R. Abu-Rustum*

*Corresponding author for this work

Research output: Contribution to journalArticle

32 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)714-719
Number of pages6
JournalGynecologic oncology
Volume131
Issue number3
DOIs
StatePublished - Dec 1 2013

Keywords

  • Endometrial cancer staging
  • Isolated tumor cells
  • Low-grade endometrioid carcinoma
  • Micrometastasis
  • Sentinel lymph node mapping
  • Ultrastaging

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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    Kim, C. H., Khoury-Collado, F., Barber, E. L., Soslow, R. A., Makker, V., Leitao, M. M., Sonoda, Y., Alektiar, K. M., Barakat, R. R., & Abu-Rustum, N. R. (2013). Sentinel lymph node mapping with pathologic ultrastaging: A valuable tool for assessing nodal metastasis in low-grade endometrial cancer with superficial myoinvasion. Gynecologic oncology, 131(3), 714-719. https://doi.org/10.1016/j.ygyno.2013.09.027