Elsevier

Gynecologic Oncology

Volume 147, Issue 3, December 2017, Pages 541-548
Gynecologic Oncology

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

https://doi.org/10.1016/j.ygyno.2017.09.030Get rights and content

Highlights

  • The SLN algorithm does not compromise overall detection of higher-risk Stage IIIC EC

  • Stage IIIC2 is detected more frequently by LND than by SLN in deeply invasive EC

  • Use of an SLN algorithm may be considered in the detection of nodal metastasis

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.

Section snippets

Background

Endometrial cancer is the most common gynecologic malignancy in the United States. Approximately 60,050 women were diagnosed with endometrial cancer in 2016 [1]. Surgical staging has been the standard modality for evaluation of metastatic disease since 1988, when the International Federation of Gynecology and Obstetrics (FIGO) changed the staging system for endometrial cancer from clinical to surgico-pathologic [2]. Important prognostic information can be obtained from surgical staging,

Methods

Institutional Review Board approval and data-transfer permission were obtained at both collaborating institutions. Patients who were surgically staged for endometrial cancer were identified at each center. In this study, we limited our analysis to patients with deeply invasive endometrioid endometrial cancer and serous or clear cell carcinoma. Patients were stratified into two risk groups. Intermediate-risk disease was defined as endometrioid histology, of any grade, with ≥ 50% myometrial

Results

We identified 412 surgically staged patients at the two participating institutions who met the inclusion criteria. Two-hundred and two patients were in the SLN cohort, and 210 were in the LND cohort. Table 1, Table 2 summarize the demographic and pathologic information for patients with endometrioid histology (“intermediate-risk”). Table 3, Table 4 summarize data for patients with serous and clear cell carcinoma of the endometrium (“high-risk”).

Discussion

The role and extent of LND in the surgical staging of endometrial cancer remains controversial. The therapeutic benefit of LND has been debated for years. Some argue that it provides a survival advantage [25]. Kilgore and colleagues argued that systematic LND is essential because it yields important prognostic information and may influence survival. They reported that patients with multi-site LND had improved survival compared to those who had no lymph nodes removed. However, no difference in

Conflict of interest statement

None of the authors declare conflicts of interest.

Funding support

This study was funded in part through the NIH/NCI Support Grant P30 CA008748 (Dr. Soslow, Dr. Abu-Rustum, Dr. Leitao).

References (42)

  • C.L. Creutzberg et al.

    Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma

    Lancet

    (2000)
  • H.C. Kitchener

    Sentinel-node biopsy in endometrial cancer: a win-win scenario?

    Lancet Oncol

    (2011)
  • S. Kumar et al.

    Prospective assessment of the prevalence of pelvic, paraaortic and high paraaortic lymph node metastasis in endometrial cancer

    Gynecol. Oncol.

    (2014)
  • J.N. Barlin et al.

    The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes

    Gynecol. Oncol.

    (2012)
  • K.C. Podratz et al.

    Staging and therapeutic value of lymphadenectomy in endometrial cancer

    Gynecol. Oncol.

    (1998)
  • L.C. Kilgore et al.

    Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling

    Gynecol. Oncol.

    (1995)
  • R.W. Naumann

    The role of lymphadenectomy in endometrial cancer: was the ASTEC trial doomed by design and are we destined to repeat that mistake?

    Gynecol. Oncol.

    (2012)
  • S. Uccella et al.

    Lymphadenectomy in endometrial cancer

    Lancet

    (2009)
  • A.A. Secord et al.

    A multicenter evaluation of sequential multimodality therapy and clinical outcome for the treatment of advanced endometrial cancer

    Gynecol. Oncol.

    (2009)
  • A. Alvarez Secord et al.

    The role of multi-modality adjuvant chemotherapy and radiation in women with advanced stage endometrial cancer

    Gynecol. Oncol.

    (2007)
  • P.J. Rossi et al.

    Adjuvant brachytherapy removes survival disadvantage of local disease extension in stage IIIC endometrial cancer: a SEER registry analysis

    Int. J. Radiat. Oncol. Biol. Phys.

    (2008)
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    Present address: The Norwegian Radium Hospital, Oslo, Norway.

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