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Incidence of sentinel lymph node metastases in apparent early-stage endometrial cancer: a multicenter observational study.
- Source :
-
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society [Int J Gynecol Cancer] 2024 May 06; Vol. 34 (5), pp. 689-696. Date of Electronic Publication: 2024 May 06. - Publication Year :
- 2024
-
Abstract
- Objective: Ultrastaging is accurate in detecting nodal metastases, but increases costs and may not be necessary in certain low-risk subgroups. In this study we examined the risk of nodal involvement detected by sentinel lymph node (SLN) biopsy in a large population of apparent early-stage endometrial cancer and stratified by histopathologic characteristics. Furthermore, we aimed to identify a subgroup in which ultrastaging may be omitted.<br />Methods: We retrospectively included patients who underwent SLN (with bilateral mapping and no empty nodal packets on final pathology) ± systematic lymphadenectomy for apparent early-stage endometrial cancer at two referral cancer centers. Lymph node status was determined by SLN only, regardless of non-SLN findings. The incidence of macrometastasis, micrometastasis, and isolated tumor cells (ITC) was measured in the overall population and after stratification by histotype (endometrioid vs serous), myometrial invasion (none, <50%, ≥50%), and grade (G1, G2, G3).<br />Results: Bilateral SLN mapping was accomplished in 1570 patients: 1359 endometrioid and 211 non-endometrioid, of which 117 were serous. The incidence of macrometastasis, micrometastasis, and ITC was 3.8%, 3.4%, and 4.8%, respectively. In patients with endometrioid histology (n=1359) there were 2.9% macrometastases, 3.2% micrometastases, and 5.3% ITC. No macro/micrometastases and only one ITC were found in a subset of 274 patients with low-grade (G1-G2) endometrioid endometrial cancer without myometrial invasion (all <1%). The incidence of micro/macrometastasis was higher, 2.8%, in 708 patients with low-grade endometrioid endometrial cancer invading <50% of the myometrium. In patients with serous histology (n=117), the incidence of macrometastases, micrometastasis, and ITC was 11.1%, 6.0%, and 1.7%, respectively. For serous carcinoma without myometrial invasion (n=36), two patients had micrometastases for an incidence of 5.6%.<br />Conclusions: Ultrastaging may be safely omitted in patients with low-grade endometrioid endometrial cancer without myometrial invasion. No other subgroups with a risk of nodal metastasis of less than 1% have been identified.<br />Competing Interests: Competing interests: None declared.<br /> (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
- Subjects :
- Humans
Female
Retrospective Studies
Middle Aged
Aged
Incidence
Adult
Aged, 80 and over
Neoplasm Micrometastasis pathology
Endometrial Neoplasms pathology
Endometrial Neoplasms surgery
Endometrial Neoplasms epidemiology
Lymphatic Metastasis
Sentinel Lymph Node Biopsy
Sentinel Lymph Node pathology
Sentinel Lymph Node surgery
Neoplasm Staging
Subjects
Details
- Language :
- English
- ISSN :
- 1525-1438
- Volume :
- 34
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- International journal of gynecological cancer : official journal of the International Gynecological Cancer Society
- Publication Type :
- Academic Journal
- Accession number :
- 38514100
- Full Text :
- https://doi.org/10.1136/ijgc-2023-005173