Comparison of a sentinel lymph node mapping algorithm and comprehensive lymphadenectomy in the detection of stage IIIC endometrial carcinoma at higher risk for nodal disease.

Abstract

OBJECTIVE:

To determine if a sentinel lymph node (SLN) mapping algorithm will detect metastatic nodal disease in patients with intermediate-/high-risk endometrial carcinoma.

METHODS:

Patients were identified and surgically staged at two collaborating institutions. The historical cohort (2004-2008) at one institution included patients undergoing complete pelvic and paraaortic lymphadenectomy to the renal veins (LND cohort). At the second institution an SLN mapping algorithm, including pathologic ultra-staging, was performed (2006-2013) (SLN cohort). Intermediate-risk was defined as endometrioid histology (any grade), ≥50% myometrial invasion; high-risk as serous or clear cell histology (any myometrial invasion). Patients with gross peritoneal disease were excluded. Isolated tumor cells, micro-metastases, and macro-metastases were considered node-positive.

RESULTS:

We identified 210 patients in the LND cohort, 202 in the SLN cohort. Nodal assessment was performed for most patients. In the intermediate-risk group, stage IIIC disease was diagnosed in 30/107 (28.0%) (LND), 29/82 (35.4%) (SLN) (P=0.28). In the high-risk group, stage IIIC disease was diagnosed in 20/103 (19.4%) (LND), 26 (21.7%) (SLN) (P=0.68). Paraaortic lymph node (LN) assessment was performed significantly more often in intermediate-/high-risk groups in the LND cohort (P<0.001). In the intermediate-risk group, paraaortic LN metastases were detected in 20/96 (20.8%) (LND) vs. 3/28 (10.7%) (SLN) (P=0.23). In the high-risk group, paraaortic LN metastases were detected in 13/82 (15.9%) (LND) and 10/56 (17.9%) (SLN) (%, P=0.76).

CONCLUSIONS:

SLN mapping algorithm provides similar detection rates of stage IIIC endometrial cancer. The SLN algorithm does not compromise overall detection compared to standard LND.

• Authors: Jennifer A Ducie, Ane Gerda Zahl Eriksson, Narisha Ali, Michaela E McGree, Amy L Weaver, Giorgio Bogani, William A Cliby, Sean C Dowdy, Jamie N Bakkum-Gamez, Robert A Soslow, Gary L Keeney, Nadeem R Abu-Rustum, Andrea Mariani, Mario M Leitao Jr
• Journal: Gynecologic oncology (Gynecol Oncol) Vol. 147 Issue 3 Pg. 541-548 (12 2017) ISSN: 1095-6859 [Electronic] United States
• PMID: 28965698 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Topics

• Aged
• Algorithms
• Carcinoma, Endometrioid (diagnosis, pathology, surgery)
• Endometrial Neoplasms (diagnosis, pathology, surgery)
• Female
• Humans
• Lymph Node Excision (methods)
• Lymph Nodes (pathology, surgery)
• Middle Aged
• Neoplasm Grading
• Neoplasm Staging
• Retrospective Studies
• Risk Factors
• Sentinel Lymph Node Biopsy (methods)