Ultrastaging of ‘negative’ pelvic lymph nodes in patients with low- and intermediate-risk endometrioid endometrial cancer who developed non-vaginal recurrences

2021 ◽  
pp. ijgc-2021-002924
Author(s):  
Sarah E Gill ◽  
Simone Garzon ◽  
Francesco Multinu ◽  
Alexis N Hokenstad ◽  
Jvan Casarin ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Myometrial Invasion ◽  
Figo Stage ◽  
Peritoneal Cytology ◽  
Intermediate Risk ◽  
Pelvic Lymph Nodes ◽  
Vaginal Recurrence ◽  
Lymphovascular Space Invasion

ObjectiveEvidence 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.MethodsRecords of all patients with endometrial cancer surgically managed at the Mayo Clinic before sentinel lymph node implementation (1999–2008) 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.ResultsAmong 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–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).ConclusionThere 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.

scholarly journals Pitfalls in pre-operative prediction of lymph node metastasis in early endometrial cancer

2020 ◽  
Author(s):  
Pampapati Veena ◽  
Rajalakshmi Ilango ◽  
Jayalakshmi Durairaj
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tertiary Care ◽  
Myometrial Invasion ◽  
Tumor Grade ◽  
Nodal Metastasis ◽  
Lymph Nodal Metastasis ◽  
Node Metastasis ◽  
Lymphovascular Space Invasion

AbstractObjectiveThe role of lymphadenectomy in early stage endometrial cancer is controversial as it is associated with intra-operative complications and its therapeutic benefit is not established. Prediction of lymph nodal metastasis so as to perform selective lymph node dissection is desirable. This study was conducted to study grade of the tumor obtained by endometrial biopsy specimen and depth of myometrial invasion assessed by imaging pre-operatively as predictors of lymph nodal metastasis in early endometrial cancers.MethodsOur study was a cross sectional study done in a tertiary care center in south India, where 100 patients were studied from August 2016 to May 2018. After Ethical Committee clearance, all patients who were diagnosed with early endometrial cancer and who underwent surgery in our hospital were included in the study after getting informed consent. Pre-operative tumor grade and depth of myometrial invasion were studied as predictors of lymph nodal metastasis. They were also correlated with post-operative grade and myometrial invasion.ResultsThe present study recruited 100 women of which 3 cases were excluded because of non-endometrioid histology. The incidence of positive lymph node metastasis in our study was 18.6%. Both pre-operative tumor grade and depth of myometrial invasion were not significantly associated with lymph node metastasis. There was significant variation between pre-operative and post-operative tumor grade and depth of myometrial invasion. Among post-operative histopathological factors, only lymphovascular space invasion was found to be significantly associated with lymph node metastasis.ConclusionIn our study, neither pre-operative nor post-operative grade of the tumor and depth of myometrial invasion were significantly associated with lymph node metastasis. There was considerable variation between pre-op and post-op grade of the tumor making pre-op grade an unreliable factor in predicting lymph node metastasis in endometrial cancer. Among post-operative histopathological factors, only lymphovascular space invasion was found to be significantly associated with lymph node metastasis.Key messageConsiderable variation between pre-op and post-op grade of the tumor makes pre-op grade an unreliable factor in predicting lymph node metastasis in endometrial cancer

Heparanase expression in both normal endometrium and endometrial cancer

2006 ◽  
Vol 16 (3) ◽  
pp. 1401-1406 ◽  
Author(s):  
J. Kodama ◽  
T. Kusumoto ◽  
N. Seki ◽  
T. Matsuo ◽  
Y. Ojima ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Survival Rates ◽  
Myometrial Invasion ◽  
Immunohistochemical Analysis ◽  
Figo Stage ◽  
Peritoneal Cytology ◽  
Normal Endometrium ◽  
Deep Myometrial Invasion ◽  
Endometrial Cancers ◽  
The Relationship

The aim of this study was to investigate the relationship between heparanase expression and prognostic factors in endometrial cancer, as well as the relationship between heparanase expression during phases of the normal endometrial cycle. Immunohistochemical analysis of 166 endometrial cancers and 34 normal endometria in various phases of growth was performed. The heparanase expression in the late-proliferative phase of normal endometria was found to be significantly higher than in either the early-proliferative or the secretory phases (P = .012 and P = .044, respectively). Heparanase expression was also significantly higher in endometrial cancer patients with tumors of an advanced FIGO stage (P = .0003) and high FIGO grade (P = .004) and with cancers showing either deep myometrial invasion (P = .023), lymph node metastasis (P = .006), lymphvascular space involvement (P = .048), or positive peritoneal cytology (P = .010). The disease-free and overall survival rates of patients with intense heparanase expression were significantly lower than those of patients with absent or moderate heparanase expression (P = .004 and P = .002, respectively). Heparanase may participate in normal endometrial remodeling and can serve as an indicator of the aggressive potential and poor prognosis of endometrial cancers.

Correlation between clinical and histopathologic risk factors and lymph node metastases in early endometrial cancer (a multivariate analysis of 183 cases)

1994 ◽  
Vol 4 (5) ◽  
pp. 306-309 ◽  
Author(s):  
A. Ayhan ◽  
R. Tuncer ◽  
Z. S. Tuncer ◽  
K. YÜCe ◽  
T. KÜÇÜKali
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Clinical Stage ◽  
Myometrial Invasion ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Lymph Node Status ◽  
Peritoneal Cytology ◽  
Node Metastases

This study includes 183 patients with clinical stage I endometrial cancer subjected to peritoneal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and para-aortic lymphadenectomy and omental biopsy during a 12-year period in a single institution. The factors analyzed were age, menopausal state, cell type, grade, mitotic activity, myometrial invasion, lymphovascular space invasion, cervical involvement, microscopic vaginal metastases, adnexal metastases, peritoneal cytology, presence of concomitant endometrial hyperplasia and lymph node status. The overall incidences of pelvic and para-aortic lymph node metastases were found to be 15.3% (28/183) and 9.3% (17/183), respectively. In five of 17 patients (29.4%) with para-aortic nodal metastases, pelvic nodes were free of tumor. The most significant prognostic factors for positive pelvic and/or para-aortic nodes were found to be the depth of myometrial invasion, grade of tumor and age.

scholarly journals Relationship between CA-125 Levels and Extrauterine Spread in Endometrial Cancer Endometrioid Type at Dr. Soetomo General Hospital Surabaya

2021 ◽  
Vol 15 (2) ◽  
pp. 60
Author(s):  
Brahmana Askandar ◽  
Andika Adi Saputra
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Significant Relationship ◽  
Early Stage ◽  
Clinical Stage ◽  
Myometrial Invasion ◽  
Ca 125 ◽  
Cancer Antigen 125 ◽  
Cancer Management

Background: Endometrial cancer is the sixth most common malignancy incidence in women worldwide. The surgical staging in endometrial cancer management such as bilateral salpingooophorectomy and lymphadenectomy is not a routine procedure for all endometrial cancer patients. Therefore, a biomarker to estimate the presence of endometrial cancer metastases to adnexa and lymph nodes is needed. This study aims to find out the level of cancer antigen 125 (CA-125) in endometrial cancer endometrioid type and the relationship between the level of CA-125 and the incidence of adnexal metastases, lymph node metastases, clinical stage, and myometrial invasion.Methods: This observational analytic study used a direct observational design. The in-vitro quantitative examination was performed to measure CA-125 levels using CA-125 Advia Centaur CA-125 Kit. Fischer exact test used to analyzed CA-125 levels with the subject characteristics. All the statistical analyses were performed using SPSS v. 21.0.Results: Of the 30 research subjects with the characteristics of the most age groups of 51–60 years (60%), with the most multiparous parity (73.3%), grade III (43.3%), myometrial invasion > 50% by 66.7%, early-stage (63.3%), the incidence of adnexal metastases (30%), and the incidence of lymph node (LN) metastases (10%), a significant relationship between CA-125 levels and lymph node (LN) metastases was found with a p = 0.041 and the phi association of 0.016 and between CA-125 levels and adnexal metastases with a p = 0.035 and the phi association of 0.026. There was also a significant relationship between CA-125 levels and the clinical stage (advanced stage) with p = 0.004 and the phi association of 0.002. There is no significant relationship with a p = 0.702 and a phi association value of -0.098.Conclusions: CA-125 can be used as a tumor marker to predict the presence of extrauterine metastases (adnexa & lymph nodes).

scholarly journals A prospective multicenter international single-arm observational study on the oncological safety of the sentinel lymph node algorithm in stage I intermediate-risk endometrial cancer (SELECT, SEntinel Lymph node Endometrial Cancer Trial)

2020 ◽  
Vol 30 (10) ◽  
pp. 1627-1632 ◽  
Author(s):  
Tommaso Grassi ◽  
Andrea Mariani ◽  
David Cibula ◽  
Pamela T Soliman ◽  
Vera J Suman ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Endometrial Carcinoma ◽  
Adjuvant Treatment ◽  
Sentinel Lymph Nodes ◽  
Stage I ◽  
Intermediate Risk ◽  
Endometrioid Endometrial Carcinoma ◽  
Vaginal Recurrence

BackgroundIn the primary treatment of apparent uterine-confined endometrial carcinoma, pelvic ± para-aortic lymphadenectomy has been considered the standard of care. Although some retrospective data suggest that the sentinel lymph node algorithm without complete lymphadenectomy can be used without jeopardizing oncologic outcome, prospective data are lacking.Primary ObjectivesTo assess the 36 month incidence of pelvic/non-vaginal recurrence in women with pathologically confirmed stage I intermediate-risk endometrioid endometrial carcinoma who have bilateral negative pelvic sentinel lymph nodes.Study HypothesisWe hypothesize that patients with stage I, intermediate-risk endometrioid endometrial carcinoma who have bilateral negative pelvic sentinel lymph nodes will demonstrate a pelvic/non-vaginal recurrence rate comparable to historical estimate of stage I, intermediate-risk endometrioid endometrial carcinoma patients (estimated 2.5%).Trial DesignThis prospective multicenter single-arm observational study will follow women with stage I, intermediate risk endometrioid endometrial adenocarcinoma who have undergone successful hysterectomy, bilateral salpingo-oophorectomy, and bilateral sentinel lymph node biopsies, for recurrence. All patients will undergo lymphatic mapping using indocynanine green and will either receive no adjuvant treatment or vaginal brachytherapy only. Patients will be followed for 36 months.Major Inclusion/Exclusion CriteriaPatients will be enrolled in the study cohort if all the following criteria are met: (i) at time of surgery: hysterectomy with bilateral adnexectomy, and successful bilateral pelvic sentinel lymph node mapping; (ii) on final pathology: pathologic stage I, intermediate-risk endometrioid endometrial carcinoma (grade 1 or grade 2 with ≥50% myometrial invasion, or grade 3 with <50% myometrial invasion), negative pelvic peritoneal cytology, and bilateral sentinel lymph nodes negative for malignancy; (iii) recommended adjuvant treatment: vaginal brachytherapy or no adjuvant treatment.Primary EndpointIncidence of pelvic/non-vaginal recurrence at 36 months.Sample Size182 patients for study cohortEstimated Dates for Completing Accrual and Presenting ResultsAccrual will be completed in 2023 with results reported in 2026.Trial RegistrationNCT04291612

Clinical study of the clinical characteristics and prognosis of 1219 cases of endometrial cancer with lymph node metastasis

2021 ◽  
pp. 096032712110085
Author(s):  
Z Li ◽  
W Zhang ◽  
Z Luo ◽  
J Huang ◽  
L Li
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Clinical Characteristics ◽  
Infiltration Depth ◽  
Pelvic Lymph Nodes ◽  
Node Metastasis ◽  
Metastasis Rate

To analyze the clinical characteristics and prognosis of endometrial cancer patients with lymph node metastasis to provide a reference for lymphadenectomy in endometrial cancer. The data used in this study were extracted from a tertiary hospital in Guangxi, China based on the hospital information system. 1219 patients with endometrial malignancy who were treated in our hospital. The lymph node metastasis rate was 9.8%. The metastasis rate of the abdominal aorta + pelvic lymph nodes (56.7%) was significantly higher than that of the pelvic (24.2%) or para-aortic (19.2%) lymph nodes alone. The proportion of postmenopausal patients with lymph node metastasis was higher than that of premenopausal patients. The proportion of patients with lymph node metastasis with vaginal and uterus involvement, HPV detection, Thinprep Cytologic Testresults, CRP level <10 ug/mL, G3 tumor grade, postoperative pathology indicating cervical invasion, lymphovascular invasion, and muscular infiltration depth > 1/2 was higher than that of patients without lymph node metastasis. The proportion of endometrial cancer patients with lymph node metastasis with CA125 ≥ 35 U/ml was higher than that of those with CA125 < 35 U/ml. The lymph node-positive rate is related to tissue differentiation, lymphangitic infiltration, cervical invasion, muscle infiltration depth > 1/2, and CA125 level. The metastasis rate of pelvic and para-aortic lymph nodes is higher than that of pelvic lymph nodes or para-aortic lymph nodes alone. There was no statistically significant difference in the overall survival rate among the three groups.

scholarly journals Prognostic factors in endometrial cancer

2013 ◽  
Vol 35 (1) ◽  
pp. 9-17
Author(s):  
SR Bajracharya ◽  
FY Juan
Keyword(s):  
Endometrial Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Gynecological Cancer ◽  
Menopausal Status ◽  
Female Genital Tract ◽  
Myometrial Invasion ◽  
Peritoneal Cytology ◽  
Node Metastases

Introduction: Endometrial cancer (EC) is the most common malignancy of the female genital tract. It is now the fourth most common gynecological cancer among women and the sixth worldwide cancer in Western countries. It is the most curable of the 10 most common cancers in women and the most frequent and curable of the gynecologic cancers. The incidence is increasing when life expectancy rise. This study was carried out to evaluate the prognostic factors of Endometrial Cancer. Methods: Clinico-pathological characteristics and follow-up cases of endometrial cancer were analysed retrospectively between January 2000 to December 2007 with its prognostic factors influence were statistically analysed. Results: During the study period total 180 patients were taken. Univariate model revealed that the menopausal status, the FIGO stage, grade, histological type, myometrial invasion, ER, PR, peritoneal cytology, lymph node metastases, adjuvant therapy, and the method of operation were related with the prognosis significantly. The multivariate analysis Cox proportion hazards regression model showed that the ER (P=0.004), PR (P=0.000), myometrial invasion (P=0.006) and lymph node metastases (P=0.049) were related with the prognosis significantly. Conclusion: The clinico-pathological character of endometrial cancer is responsible for patient’s better survival. If the patients had early detection and treated in proper modalities, this might improve the good prognosis. DOI: http://dx.doi.org/10.2126/joim.v35i1.8891    Journal of Institute of Medicine, April, 2013; 35:9-17

scholarly journals Higher Preoperative Endometrial Cancer Risk Showed More Advanced Stage

2014 ◽  
pp. 99-105
Author(s):  
Jasmine Iskandar ◽  
Gregorius Tanamas ◽  
Tofan W. Utami ◽  
Tricia D. Anggraeni, ◽  
 Kartiwa H. Nuryanto
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Cancer Risk ◽  
Cancer Patients ◽  
Myometrial Invasion ◽  
Figo Stage ◽  
Positive Lymph Node ◽  
Cross Sectional ◽  
Endometrial Cancer Risk

Objective: To evaluate the pr eoperative endo metria l cancer risk as a guida nce to choose th e typ e of surg ical approach based on European Society for Medical Oncology guideline (200 9). Method: Cross-sectional study involved 73 endometrial cancer patients of Dr. Cipto Mangunkusumo Hospital, from january 200 6 to December 2012 whi ch obt ain ed from medical record. The inclusion criteria wer e endometr ial cancer pati ents with compl ete D&C, ultr asonographic, and postoperative histopathological rep orts. Endometrial cancer risk of recurren ce was classified acco rding to ESMO 2009 and final diagno sis and stage based on FIGO. Result: From 40 5 patients, only 73 patients had compl ete reports. Most of the them were postmenopaus al (54.8 %), non-nulliparity (79 .9%), and obese (49.5%) women.According to risk of recurren cestratification, low, intermediate and high risk were found in 12 patients, 27 patients, and 34 pati ents. Based on FIGO, there were 60.2% early and 39.8% advanced sta ge. In high risk gro up, rates of advan ced stage wer e prominent compar ed to othe r gro ups. There were 38.3% patients with postoper ativ e positive lymph nod es metastases. Conclusion: Most of th e endometrial cancer patients we re pr eoperatively diagnosed as high risk. The commones t stage after surgical examination were me. High risk of recurrence showed more positive lymph node compared to low or intermediat e risk. Result of preoperative histopathological and myometrial invasion compared to postoper ative results wer e showed to be inconsistent Pat ients with =1/2 myometrial invasion had more positive lymph nodes metastases. Endometrial cancer risks compared to FIGO stage showed the higher the risk, th e more advanced the stage were. Keywords: endometrial cancer, FIGO stage, high risk, histol ogical type, intermediate risk , low risk, lymph node.

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