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Gynecol Oncol. 2019 Jul;154(1):60-64. doi: 10.1016/j.ygyno.2019.05.008. Epub 2019 May 22.

Ultrastaging of negative pelvic lymph nodes to decrease the true prevalence of isolated paraaortic dissemination in endometrial cancer.

Author information

1
Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America; Department of Surgical Sciences, University of Cagliari, Cagliari, Italy; Department of Gynecology, IEO, European Institute of Oncology IRCSS, Milan, Italy.
2
Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America.
3
Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, United States of America.
4
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States of America.
5
Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
6
Division of Gynecology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America.
7
Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America. Electronic address: mariani.andrea@mayo.edu.

Abstract

OBJECTIVE:

This study aimed to determine the prevalence of occult pelvic lymph node metastasis in patients with endometrial cancer (EC) with isolated paraaortic dissemination who underwent pelvic and paraaortic lymphadenectomy.

METHODS:

From 2004 to 2008, patients undergoing surgery for EC at our institution were prospectively treated according to a validated surgical algorithm relying on intraoperative frozen section. For the current study, we re-reviewed pathologic slides obtained at the time of diagnosis and performed ultrastaging of all negative pelvic lymph nodes to assess the prevalence of occult pelvic lymph node metastasis.

RESULTS:

Of 466 patients at risk for lymphatic dissemination, 394 (84.5%) underwent both pelvic and paraaortic lymphadenectomy. Of them, 10 (2.5%) had isolated paraaortic metastasis. Pathologic review of hematoxylin-eosin-stained slides identified 1 patient with micrometastasis in 1 of 18 pelvic lymph nodes removed. Ultrastaging of 296 pelvic lymph nodes removed from the 9 other patients (median [range], 32 [20-50] nodes per patient) identified 2 additional cases (1 with micrometastasis and 1 with isolated tumor cells), for a total of 3/10 patients (30%) having occult pelvic dissemination.

CONCLUSIONS:

Ultrastaging and pathologic review of negative pelvic lymph nodes of patients with presumed isolated paraaortic metastasis can identify occult pelvic dissemination and reduce the prevalence of true isolated paraaortic disease. In the era of the sentinel lymph node (SLN) algorithm for EC staging, which incorporates ultrastaging of the SLNs removed, these findings demonstrate that use of the SLN algorithm can further mitigate the concern of missing cases of isolated paraaortic dissemination.

KEYWORDS:

Endometrial cancer; Isolated paraaortic metastasis; Lymph nodes; Stage IIIC; Ultrastaging

PMID:
31126637
PMCID:
PMC6612056
DOI:
10.1016/j.ygyno.2019.05.008
[Indexed for MEDLINE]
Free PMC Article

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