Article Text

Download PDFPDF

Low-Volume Lymph Node Metastases in Endometrial Carcinoma
  1. Lani K. Clinton, MD, PhD*,
  2. Jordan Kondo, BS,
  3. Michael E. Carney, MD*,
  4. Pamela Tauchi-Nishi, MD*,,
  5. Keith Terada, MD* and
  6. David Shimizu, MD*,
  1. * John A. Burns School of Medicine, University of Hawaii; and
  2. Hawaii Pathologists’ Laboratory, Queen’s Medical Center, Honolulu, Hawaii.
  1. Address correspondence and reprint requests to David Shimizu, Hawaii Pathologists’ Laboratory, 1301 Punchbowl Street, Honolulu, HI 96813. E-mail: dshimizu{at}queens.org.

Abstract

Objective The aim of this study was to determine the histopathologic characteristics of patients with endometrial carcinoma with low-volume metastases (micrometastases and isolated tumor cells) compared with macrometastases.

Methods We performed a retrospective review of patients with endometrial carcinoma.

Results Among 350 robotic-assisted hysterectomies for endometrial cancer, 187 (53%) underwent attempted sentinel lymph node (SLN) biopsy. At least 1 SLN was detected in 185, a 99% overall detection rate; 108 (58%) also had non-SLNs removed. Among 91 patients with SLNs and non-SLNs from the ipsilateral hemipelvis, both were negative in 74 (81%) and positive in 7 (8%), and 10 (11%) had a positive SLN with negative non-SLNs. Among 17 patients with SLNs and non-SLNs from the contralateral hemipelvis, both were negative in 12 (71%), both were positive in 3 (18%), and 2 patients (12%) had negative SLNs with contralateral positive non-SLNs. Among 79 patients with only a SLN dissection, 4 (5%) were positive; among 69 patients with only a non-SLN dissection, 14 (20%) had positive lymph nodes. Among 24 patients with metastatic SLNs, 9 (38%) had isolated tumor cells, 3 (13%) had micrometastases, and 12 (50%) had macrometastases. Among the 40 total patients with metastatic lymph nodes, low-volume metastases represented the largest metastatic deposit in one third of patients, all of which had SLN dissection. All 12 with low-volume metastases had endometrioid histology compared with less than half (46%) of those with macrometastases (P < 0.01). Grade 1 carcinoma was present in 7 (58%) of the patients with low-volume metastases compared with 4 (14%) of those with macrometastases (P < 0.01) Furthermore, significantly more patients with low-volume metastases versus macrometastases had less than 50% myometrial invasion (67% vs 4%, P < 0.001).

Conclusions Low-volume disease was present in one third of patients with nodal metastases, the largest metastatic deposit only in patients who had SLN dissection; these patients were significantly more likely to have grade 1 endometrioid carcinoma with less than 50% myometrial invasion, traditional “low-risk” features.

  • Endometrial carcinoma
  • Sentinel lymph nodes
  • Micrometastasis
  • Isolated tumor cells

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Footnotes

  • The authors declare no conflicts of interest.