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Tytuł:
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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.
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Autorzy:
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Ducie JA; Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Eriksson AGZ; Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ali N; Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
McGree ME; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Weaver AL; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Bogani G; Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
Cliby WA; Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
Dowdy SC; Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
Bakkum-Gamez JN; Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
Soslow RA; Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA.
Keeney GL; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
Abu-Rustum NR; Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
Mariani A; Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
Leitao MM Jr; Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA. Electronic address: .
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Źródło:
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Gynecologic oncology [Gynecol Oncol] 2017 Dec; Vol. 147 (3), pp. 541-548. Date of Electronic Publication: 2017 Sep 29.
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Typ publikacji:
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Journal Article; Research Support, N.I.H., Extramural
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Język:
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English
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Imprint Name(s):
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Original Publication: New York, Academic Press.
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MeSH Terms:
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Endometrial Neoplasms/*diagnosis
Lymph Node Excision/*methods
Lymph Nodes/*pathology
Lymph Nodes/*surgery
Sentinel Lymph Node Biopsy/*methods
Aged ; Algorithms ; Carcinoma, Endometrioid/diagnosis ; Carcinoma, Endometrioid/pathology ; Carcinoma, Endometrioid/surgery ; Endometrial Neoplasms/pathology ; Endometrial Neoplasms/surgery ; Female ; Humans ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Retrospective Studies ; Risk Factors
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Grant Information:
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P30 CA008748 United States CA NCI NIH HHS
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Contributed Indexing:
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Keywords: Endometrial carcinoma; Lymphadenectomy; Sentinel node mapping
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Entry Date(s):
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Date Created: 20171003 Date Completed: 20171128 Latest Revision: 20171211
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Update Code:
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20240105
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DOI:
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10.1016/j.ygyno.2017.09.030
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PMID:
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28965698
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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.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
