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Standard ultra-staging compared to one-step nucleic acid amplification for the detection of sentinel lymph node metastasis in endometrial cancer patients: a retrospective cohort comparison
  1. Francesco Fanfani1,2,
  2. Giorgia Monterossi2,
  3. Maria Letizia Di Meo3,
  4. Eleonora La Fera1,
  5. Federica Dell'Orto3,
  6. Alessandro Gioè1,
  7. Maria Lamanna3,
  8. Debora Ferrari3,
  9. Elena De Ponti4,
  10. Patrizia Perego5,
  11. Stefano Restaino2,
  12. Ronsini Carlo2,
  13. Gian Franco Zannoni1,6,
  14. Fabio Landoni3,
  15. Giovanni Scambia1,2 and
  16. Alessandro Buda3
  1. 1Università Cattolica del Sacro Cuore, Roma, Italy
  2. 2Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
  3. 3Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
  4. 4Gynecologic Pathology Unit, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
  5. 5Department of Pathology, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
  6. 6Department of Physical Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
  1. Correspondence to Professor Giovanni Scambia, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma 00168, Italy; giovanni.scambia{at}policlinicogemelli.it

Abstract

Introduction The objective of this study was to compared standard ultra-staging (SU) with one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node (SLN) metastasis in women with apparent uterine-confined endometrial cancer.

Methods All women underwent SLN identification with complete surgical staging. All SLNs were cut perpendicular to the long axis and two adjacent 5 µm sections were cut at each of two levels 50 µm apart. At each level, one slide was stained with hematoxylin and eosin and the other with immunohistochemistry using the AE1/AE3 anti-cytokeratin antibody, as well as one negative control slide for a total of five slides per block. For OSNA analysis, the 2 mm sections of the lymph nodes were homogenized to form a lysate. The lysate was then centrifuged and inserted into the RD 100i instrument where the isothermal amplification of CK19 mRNA was executed.

Results Of the 396 patients included in the retrospective analysis, 214 were in the SU group, and 182 in the OSNA group. Overall 869 SLNs were identified (490 SU, 379 OSNA). Sixty patients exhibited SLN metastasis (34 SU, 26 OSNA). Macrometastasis, micrometastases, and isolated tumor cells (ITC) were 5.1%, 4.1%, and 0.2%, respectively, in the US group, and 2.4%, 6.3%, and 0.1%, respectively, in the OSNA group (p=0.022).

Conclusions The OSNA assay detected a higher rate of micrometastasis and a lower rate of macrometastasis and ITC when compared with SU. The clinical and prognostic impact of ITC is debatable and controversial. Further studies are needed to clarify the respective roles of the OSNA and SU methods, and the possible role of ITC in the prognosis of patients with apparent early-stage endometrial cancer.

  • sentinel lymph node
  • endometrium
  • pathology
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Footnotes

  • Editor's note This paper will feature in a special issue on sentinel lymph node mapping in 2020.

  • Twitter @frafanfani

  • Contributors All the authors contributed to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request. starcenter@policlinicogemelli.it

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