Preoperative Identification of a Low-Risk Group for Lymph Node Metastasis in Endometrial Cancer: A Korean Gynecologic Oncology Group Study

2012 ◽  
Vol 30 (12) ◽  
pp. 1329-1334 ◽  
Author(s):  
Sokbom Kang ◽  
Woo Dae Kang ◽  
Hyun Hoon Chung ◽  
Dae Hoon Jeong ◽  
Sang-Soo Seo ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Risk Group ◽  
False Negative ◽  
False Negative Rate ◽  
Low Risk ◽  
Ca 125 ◽  
Node Metastasis ◽  
Negative Rate

Purpose The aim of this study was to develop a preoperative risk prediction model for lymph node metastasis in patients with endometrial cancer and to identify a low-risk group before surgery. Patients and Methods The medical records of 360 patients with endometrial cancer who underwent surgical staging were collected from four institutions and were retrospectively reviewed. By using serum CA-125 levels, preoperative biopsy data, and magnetic resonance imaging (MRI) data, a multivariate logistic model was created. Patients whose predicted probability was less than 4% were defined as low risk. The developed model was externally validated in 180 patients from two independent institutions. Results Serum CA-125 levels and three MRI parameters (deep myometrial invasion, lymph node enlargement, and extension beyond uterine corpus) were found to be independent risk factors for nodal metastasis. The model classified 53% of patients as part of a low-risk group, and the false negative rate was 1.7%. In the validation cohort, the model classified 43% of patients as low-risk, and the false negative rate was 1.4%. The model showed good discrimination (area under the receiver operator characteristic curve = 0.85) and was calibrated well. The negative likelihood ratio of our low-risk criteria was 0.11 (95% CI, 0.04 to 0.29), which was equivalent to the false-negative rate of 1.3% (95% CI, 0.5% to 3.3%) at the assumed prevalence of nodal metastasis of 10%. Conclusion Using serum CA-125 and MRI as criteria resulted in the accurate identification of a low-risk group for lymph node metastasis among patients with endometrial cancer.

Robotic sentinel lymph node (SLN) mapping in endometrial cancer: SLN symmetry and implications of mapping failure

2019 ◽  
Vol 30 (3) ◽  
pp. 305-310 ◽  
Author(s):  
Amanda J Stephens ◽  
Jessica A Kennard ◽  
Christine K Fitzsimmons ◽  
Madhavi Manyam ◽  
James E Kendrick ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Node Metastasis ◽  
Clinical Stage ◽  
False Negative ◽  
False Negative Rate ◽  
Concordance Rate ◽  
Node Metastasis ◽  
Internal Iliac

PurposeTo establish the bilateral pelvic concordance rate of the sentinel lymph node (SLN) and determine the likelihood of lymph node metastasis in cases of mapping failure.MethodsA database analysis was performed on 414 patients with clinical stage I endometrial cancer who underwent SLN mapping followed by robotic hysterectomy and completion pelvic (n=414, 100%) and aortic (n=186, 44.9%) lymphadenectomy from March 2011 to August 2016. Stage, histology, SLN sites, and surgico-pathologic findings were analyzed. The bilateral concordance rate of SLN location, successful unilateral and bilateral mapping rates, false negative rate, and non-SLN metastasis associated with mapping failure were calculated.ResultsHistologies included 354 (85.5%) endometrioid, 39 (9.4%) serous, 16 (3.9%) carcinosarcoma, 4 (1.0%) clear cell, and 1 (0.2%) undifferentiated. Final stages included 262 (63.3%) IA, 36 (8.7%) IB, 15 (3.6%) II, 6 (1.4%) IIIA, 68 (16.4%) IIIC1, and 27 (6.5%) IIIC2. Bilateral SLN mapping was successful in 355 (85.7%) patients, and 266 (74.9%) demonstrated mapping to the symmetrical lymphatic group contralaterally. The mapping failure rate was 13.5% (56/414) unilaterally and 0.7% (3/414) bilaterally. SLN locations were external iliac (69.1%), obturator (25.1%), internal iliac (2.2%), common iliac (1.9%), pre-sacral (0.9%), aortic (0.4%), parametrial (0.3%), and para-rectal (0.1%). Lymph node metastases were identified in 95 (22.9%) pelvic and 27 (6.5%) aortic nodes. 10 (16.9%) cases with mapping failure had lymph node metastasis on completion lymphadenectomy, similar to the proportion of SLNs with metastases (p=0.35). However, macro-metastases were more common in mapping failure completion lymphadenectomies than in the positive SLNs (80% vs 22.3%, p<0.001).ConclusionThe contralateral SLN location concordance rate was 75%. Most SLNs were along the medial external iliac or obturator locations. The rate of positive lymph nodes associated with SLN mapping failure was 16.9%, similar to the overall node-positive rate. The detection of pelvic node metastasis with SLN mapping failure was largely populated with macro-metastases and confirms the necessity of completion lymphadenectomy with mapping failure.

Predicting Model of Lymph Node Metastasis Using Preoperative Tumor Grade, Transvaginal Ultrasound, and Serum CA-125 Level in Patients With Endometrial Cancer

2016 ◽  
Vol 26 (9) ◽  
pp. 1630-1635 ◽  
Author(s):  
Jisun Lee ◽  
Tae-Wook Kong ◽  
Jiheum Paek ◽  
Suk-Joon Chang ◽  
Hee-Sug Ryu
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Myometrial Invasion ◽  
Tumor Grade ◽  
Ca 125 ◽  
Transvaginal Sonography ◽  
Endometrioid Adenocarcinoma ◽  
Predicting Model ◽  
Node Metastasis

ObjectiveThe purpose of this study was to evaluate the predicting model for lymph node metastasis using preoperative tumor grade, transvaginal sonography (TVS), and serum cancer antigen 125 (CA-125) level in patients with endometrial cancer.Materials and MethodsBetween January 2000 and February 2013, we identified 172 consecutive patients with surgically staged endometrial cancer. Transvaginal sonography was performed by an expert gynecologic radiologist in all patients. All patients had complete staging surgery including total hysterectomy with bilateral pelvic and para-aortic lymphadenectomy and were staged according to the 2009 International Federation of Gynecology and Obstetrics classification. Various clinicopathologic data were obtained from medical records and were retrospectively analyzed.ResultsOf 172 patients, 138 patients presented with stage I (118 IA and 20 IB), 12 had stage II, 18 had stage III (2 IIIA, 1 IIIB, 8 IIIC1, and 7 IIIC2), and 2 had stage IV diseases. Most patients had endometrioid adenocarcinoma (88.4%), and others (12.6%) had nonendometrioid histology. Eighteen patients (10.5%) were found to have lymph node metastasis. Deep myometrial invasion on preoperative TVS (≥50%), high serum CA-125 level (≥ 35 IU/mL), preoperative grade 2 or 3 tumors were significant preoperative factors predicting lymph node metastasis. There was no significant association between preoperative histology and lymph node metastasis. We calculated the simple model predicting lymph node metastasis based on preoperative tumor grade, TVS findings, and CA-125 level using logistic regression analysis. The sensitivity and specificity of this model were 94% and 57%, respectively (area under the curve, 0.84; 95% confidence interval [CI], 0.74–0.93; P < 0.01).ConclusionsPreoperative tumor grade, myometrial invasion on preoperative TVS, and CA-125 can accurately predict lymph node metastasis in patients with endometrial cancer. The current study suggests the possibility that TVS could be positively used for preoperative evaluation strategy in the low-resource countries instead of expensive imaging modalities such as magnetic resonance imaging or positron emission tomography–computed tomography.

scholarly journals Implications of Isolated Para-Aortic Lymph Node Metastasis in Endometrial Cancer: A Large-Scale, Multicenter, and Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Wenting Li ◽  
Jie Jiang ◽  
Yu Fu ◽  
Yuanming Shen ◽  
Chuyao Zhang ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Large Scale ◽  
Low Risk ◽  
Surgical Staging ◽  
Node Metastasis ◽  
Aortic Lymph Node ◽  
Risk Patients ◽  
Metastatic Sites

Objective: To systematically evaluate lymph node metastasis (LNM) patterns in patients with endometrial cancer (EC) who underwent complete surgical staging, which included systematic pelvic and para-aortic lymphadenectomy.Methods: Four thousand and one patients who underwent complete surgical staging including systematic pelvic and para-aortic lymphadenectomy for EC were enrolled from 30 centers in China from 2001 to 2019. We systematically displayed the clinical and prognostic characteristics of patients with various LNM patterns, especially the PLN-PAN+ [para-aortic lymph node (PAN) metastasis without pelvic lymph node (PLN) metastasis]. The efficacy of PAN+ (para-aortic lymph node metastasis) prediction with clinical and pathological features was evaluated.Results: Overall, 431 of the 4,001 patients (10.8%) showed definite LNM according to pathological diagnosis. The PAN+ showed the highest frequency (6.6%) among all metastatic sites. One hundred fourteen cases (26.5%) were PLN-PAN+ (PAN metastasis without PLN metastasis), 167 cases (38.7%) showed PLN+PAN-(PLN metastasis without PAN metastasis), and 150 cases (34.8%) showed metastasis to both regions (PLN+PAN+). There was also 1.9% (51/2,660) of low-risk patients who had PLN-PAN+. There are no statistical differences in relapse-free survival (RFS) and disease-specific survival (DSS) among PLN+PAN-, PLN-PAN+, and PLN+PAN+. The sensitivity of gross PLNs, gross PANs, and lymphovascular space involvement (LVSI) to predict PAN+ was 53.8 [95% confidence interval (CI): 47.6–59.9], 74.2 95% CI: 65.6–81.4), and 45.8% (95% CI: 38.7–53.2), respectively.Conclusion: Over one-fourth of EC patients with LMN metastases were PLN-PAN+. PLN-PAN+ shares approximate survival outcomes (RFS and DSS) with other LNM patterns. No effective clinical methods were achieved for predicting PAN+. Thus, PLN-PAN+ is a non-negligible LNM pattern that cannot be underestimated in EC, even in low-risk patients.

Use of preoperative serum CA-125 levels for prediction of lymph node metastasis and prognosis in endometrial cancer

2006 ◽  
Vol 85 (12) ◽  
pp. 1501-1505 ◽  
Author(s):  
Hyun Hoon Chung ◽  
Jae Weon Kim ◽  
Noh-Hyun Park ◽  
Yong-Sang Song ◽  
Soon-Beom Kang ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Ca 125 ◽  
Node Metastasis ◽  
Preoperative Serum

scholarly journals High-Risk Endometrial Cancer Assessed by Immediate Intraoperative Frozen Sections of Sentinel Lymph Nodes - A Retrospective Study.

2021 ◽  
Author(s):  
Sarah Miller ◽  
Mahkam Tavallaee ◽  
Malte Renz ◽  
Ann Folkins ◽  
Amer Karam
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Lymph Nodes ◽  
False Negative ◽  
False Negative Rate ◽  
High Grade ◽  
Frozen Sections ◽  
Negative Rate ◽  
Undifferentiated Histology

While sentinel lymph node (SLN) sampling has been established for low-risk endometrial cancer, few data exists on high-risk histologies. This study aims to measure the accuracy of immediate intraoperative SLN biopsy with frozen section in high-risk endometrial cancer. Patients diagnosed with endometrial cancer of high-grade histology (grade 3 endometrioid, clear cell, serous, carcinosarcoma, de- or undifferentiated histology) between 2014 and 2019 at a single institution who underwent SLN mapping, followed by pelvic lymphadenectomy with or without para-aortic lymphadenectomy were included. SLNs were assessed intraoperatively using multiple frozen sections and H&E staining. Lymph node metastases detected by SLN biopsy were compared with complete lymphadenectomy specimens. 35 patients with high-grade endometrial cancer histology underwent SLN mapping followed by lymphadenectomy. In 34 of 35 (97%) of these patients mapping with at least one SLN was successful. Positive SLNs were identified in 7/34 patients (20.6%). There were no patients who had positive lymph nodes on complete lymphadenectomy without a positive SLN, resulting in 100% sensitivity, and 0% false-negative rate. SLN mapping using intraoperative frozen sections in high-risk endometrial cancer demonstrated 100% sensitivity and 0% false-negative rate, provides immediate feedback on successful SLN mapping and valuable intraoperative information on the disease status guiding the intraoperative decision for completion lymphadenectomy.

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