@article {Gillijgc-2021-002924, author = {Sarah E Gill and Simone Garzon and Francesco Multinu and Alexis N Hokenstad and Jvan Casarin and Serena Cappuccio and Michaela E McGree and Amy L Weaver and William A Cliby and Gary L Keeney and Andrea Mariani}, title = {Ultrastaging of {\textquoteleft}negative{\textquoteright} pelvic lymph nodes in patients with low- and intermediate-risk endometrioid endometrial cancer who developed non-vaginal recurrences}, elocation-id = {ijgc-2021-002924}, year = {2021}, doi = {10.1136/ijgc-2021-002924}, publisher = {BMJ Specialist Journals}, abstract = {Objective Evidence on micrometastases and isolated tumor cells as factors associated with non-vaginal recurrence in low- and intermediate-risk endometrial cancer is limited. The goal of our study was to investigate risk factors for non-vaginal recurrence in low- and intermediate-risk endometrial cancer.Methods Records of all patients with endometrial cancer surgically managed at the Mayo Clinic before sentinel lymph node implementation (1999{\textendash}2008) were reviewed. We identified all patients with endometrioid low-risk (International Federation of Gynecology and Obstetrics (FIGO) stage I, grade 1 or 2 with myometrial invasion \<50\% and negative peritoneal cytology) or intermediate-risk (FIGO stage I, grade 1 or 2 with myometrial invasion >=50\% or grade 3 with myometrial invasion \<50\% and negative peritoneal cytology) endometrial cancer at definitive pathology after pelvic and para-aortic lymph node assessment. All pelvic lymph nodes of patients with non-vaginal recurrence (any recurrence excluding isolated vaginal cuff recurrences) underwent ultrastaging.Results Among 1303 women, we identified 321 patients with low-risk (n=236) or intermediate-risk (n=85) endometrial cancer (median age 65.4 years; 266 (82.9\%) stage IA; 55 (17.1\%) stage IB). Of the total of 321, 13 patients developed non-vaginal recurrence (Kaplan{\textendash}Meier rate 4.7\% by 60 months; 95\% CI 2.1\% to 7.2\%): 11 hematogenous/peritoneal and two para-aortic and distant lymphatic. Myometrial invasion and lymphovascular space invasion were univariately associated with non-vaginal recurrence. In these patients, the original hematoxylin/eosin slides review confirmed all 646 pelvic and para-aortic removed lymph nodes as negative. The ultrastaging of 463 pelvic lymph nodes did not identify any occult metastases (prevalence 0\%; 95\% CI 0\% to 22.8\% considering 13 patients; 95\% CI 0\% to 0.8\% considering 463 pelvic lymph nodes).Conclusion There were no occult metastases in pelvic lymph nodes of patients with low- or intermediate-risk endometrial cancer with non-vaginal recurrence. Myometrial invasion and lymphovascular space invasion appear to be associated with non-vaginal recurrence.Data are available upon reasonable request. In accordance with the journal{\textquoteright}s guidelines, we will provide our data for the reproducibility of this study in other centers if such is requested.}, issn = {1048-891X}, URL = {https://ijgc.bmj.com/content/early/2021/10/27/ijgc-2021-002924}, eprint = {https://ijgc.bmj.com/content/early/2021/10/27/ijgc-2021-002924.full.pdf}, journal = {International Journal of Gynecologic Cancer} }