THE SIGNIFICANCE OF THE MICROCYSTIC, ELONGATED AND FRAGMENTED (MELF) PATTERN MYOMETRIAL INVASION ON LYMPHOVASCULAR SPACE INVASION AND LYMPH NODE METASTASIS IN ENDOMETRIAL CANCER

2016 ◽  
Author(s):  
Ece Uslu
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Myometrial Invasion ◽  
Node Metastasis ◽  
Lymphovascular Space Invasion

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

scholarly journals Association of Myometrial Invasion With Lymphovascular Space Invasion, Lymph Node Metastasis, Recurrence, and Overall Survival in Endometrial Cancer: A Meta-Analysis of 79 Studies With 68,870 Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Jianzhang Wang ◽  
Ping Xu ◽  
Xueying Yang ◽  
Qin Yu ◽  
Xinxin Xu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Meta Analysis ◽  
Myometrial Invasion ◽  
Clinicopathological Characteristics ◽  
Node Metastasis ◽  
Deep Myometrial Invasion ◽  
Lymphovascular Space Invasion

BackgroundMyometrial invasion has been demonstrated to correlate to clinicopathological characteristics and prognosis in endometrial cancer. However, not all the studies have the consistent results and no meta-analysis has investigated the association of myometrial invasion with lymphovascular space invasion (LVSI), lymph node metastasis (LNM), recurrence, and overall survival (OS). Therefore, a meta-analysis was performed to evaluate the relationship between myometrial invasion and clinicopathological characteristics or overall survival in endometrial cancer.Materials and MethodsA search of Pubmed, Embase, and Web of Science was carried out to collect relevant studies from their inception until June 30, 2021. The quality of each included study was evaluated using Newcastle–Ottawa scale (NOS) scale. Review Manager version 5.4 was employed to conduct the meta-analysis.ResultsA total of 79 articles with 68,870 endometrial cancer patients were eligible including 9 articles for LVSI, 29 articles for LNM, 8 for recurrence, and 37 for OS in this meta-analysis. Myometrial invasion was associated with LVSI (RR 3.07; 95% CI 2.17–4.35; p < 0.00001), lymph node metastasis (LNM) (RR 4.45; 95% CI 3.29–6.01; p < 0.00001), and recurrence (RR 2.06; 95% CI 1.58–2.69; p < 0.00001). Deep myometrial invasion was also significantly related with poor OS via meta-synthesis of HRs in both univariate survival (HR 3.36, 95% CI 2.35–4.79, p < 0.00001) and multivariate survival (HR 2.00, 95% CI 1.59–2.53, p < 0.00001). Funnel plot suggested that there was no significant publication bias in this study.ConclusionDeep myometrial invasion correlated to positive LVSI, positive LNM, cancer recurrence, and poor OS for endometrial cancer patients, indicating that myometrial invasion was a useful evaluation criterion to associate with clinical outcomes and prognosis of endometrial cancer since depth of myometrial invasion can be assessed before surgery. The large scale and comprehensive meta-analysis suggested that we should pay more attention to myometrial invasion in clinical practice, and its underlying mechanism also deserves further investigation.

The incidence of pelvic lymph node metastasis by FIGO staging for patients with adequately surgically staged endometrial adenocarcinoma of endometrioid histology

2008 ◽  
Vol 18 (2) ◽  
pp. 269-273 ◽  
Author(s):  
D. S. Chi ◽  
R. R. Barakat ◽  
M. J. Palayekar ◽  
D. A. Levine ◽  
Y. Sonoda ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Myometrial Invasion ◽  
Tumor Grade ◽  
Pelvic Lymph Node ◽  
Study Cohort ◽  
Node Metastasis ◽  
Figo Staging ◽  
Pelvic Lymph Node Metastasis

The seminal Gynecologic Oncology Group study on surgical pathologic spread patterns of endometrial cancer demonstrated the risk of pelvic lymph node metastasis for clinical stage I endometrial cancer based on tumor grade and thirds of myometrial invasion. However, the FIGO staging system assigns surgical stage by categorizing depth of myometrial invasion in halves. The objective of this study was to determine the incidence of pelvic lymph node metastasis in endometrial cancer based on tumor grade and myometrial invasion as per the current FIGO staging system. We reviewed the records of all patients who underwent primary surgical staging for clinical stage I endometrial cancer at our institution between May 1993 and November 2005. To make the study cohort as homogeneous as possible, we included only cases of endometrioid histology. We also included only patients who had adequate staging, which was defined as a total hysterectomy with removal of at least eight pelvic lymph nodes. During the study period, 1036 patients underwent primary surgery for endometrial cancer. The study cohort was composed of the 349 patients who met study inclusion criteria. Distribution of tumor grade was as follows: grade 1, 80 (23%); grade 2, 182 (52%); and grade 3, 87 (25%). Overall, 30 patients (9%) had pelvic lymph node metastasis. The incidence of pelvic lymph node metastasis in relation to tumor grade and depth of myometrial invasion (none, inner half, and outer half) was as follows: grade 1–0%, 0%, and 0%, respectively; grade 2–4%, 10%, and 17%, respectively; and grade 3–0%, 7%, and 28%, respectively. We determined the incidence of pelvic nodal metastasis in a large cohort of endometrial cancer patients of uniform histologic subtype in relation to tumor grade and a one-half myometrial invasion cutoff. These data are more applicable to current surgical practice than the previously described one-third myometrial invasion cutoff results.

Lymph Node Metastasis in Patients With Endometrioid Endometrial Cancer: Overtreatment Is the Main Issue

2017 ◽  
Vol 27 (4) ◽  
pp. 748-753 ◽  
Author(s):  
Alper Karalok ◽  
Taner Turan ◽  
Derman Basaran ◽  
Osman Turkmen ◽  
Gunsu Comert Kimyon ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Histological Grade ◽  
Myometrial Invasion ◽  
Lymph Node Involvement ◽  
Node Metastasis ◽  
Deep Myometrial Invasion ◽  
Endometrioid Endometrial Cancer ◽  
Grade 3

ObjectiveThe aim of this study was to evaluate the effectiveness of histological grade, depth of myometrial invasion, and tumor size to identify lymph node metastasis (LNM) in patients with endometrioid endometrial cancer (EC).MethodsA retrospective computerized database search was performed to identify patients who underwent comprehensive surgical staging for EC between January 1993 and December 2015. The inclusion criterion was endometrioid type EC limited to the uterine corpus. The associations between LNM and surgicopathological factors were evaluated by univariate and multivariate analyses.ResultsIn total, 368 patients were included. Fifty-five patients (14.9%) had LNM. Median tumor sizes were 4.5 cm (range, 0.7–13 cm) and 3.5 cm (range, 0.4–33.5 cm) in patients with and without LNM, respectively (P = 0.005). No LMN was detected in patients without myometrial invasion, whereas nodal spread was observed in 7.7% of patients with superficial myometrial invasion and in 22.6% of patients with deep myometrial invasion (P < 0.0001). Lymph node metastasis tended to be more frequent in patients with grade 3 disease compared with those with grade 1 or 2 disease (P = 0.131).ConclusionsThe risk of lymph node involvement was 30%, even in patients with the highest-risk uterine factors, that is, those who had tumors of greater than 2 cm, deep myometrial invasion, and grade 3 disease, indicating that 70% of these patients underwent unnecessary lymphatic dissection. A precise balance must be achieved between the desire to prevent unnecessary lymphadenectomy and the ability to diagnose LNM.

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 Impact of depth and extent of lymphovascular space invasion on lymph node metastasis and recurrence patterns in endometrial cancer

2015 ◽  
Vol 112 (6) ◽  
pp. 669-676 ◽  
Author(s):  
Koji Matsuo ◽  
Jocelyn Garcia-Sayre ◽  
Fabiola Medeiros ◽  
Jennifer K. Casabar ◽  
Hiroko Machida ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Node Metastasis ◽  
Recurrence Patterns ◽  
Lymphovascular Space Invasion

scholarly journals Comparison of integrated PET/MRI with PET/CT in evaluation of endometrial cancer: a retrospective analysis of 81 cases

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7081 ◽  
Author(s):  
Li-hua Bian ◽  
Min Wang ◽  
Jing Gong ◽  
Hong-hong Liu ◽  
Nan Wang ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Regional Lymph Node ◽  
Myometrial Invasion ◽  
Regional Lymph Node Metastasis ◽  
Primary Tumors ◽  
Node Metastasis ◽  
Pet Ct ◽  
Invasion Detection

Background The objective of this study was to compare the diagnostic value of integrated PET/MRI with PET/CT for assessment of regional lymph node metastasis and deep myometrial invasion detection of endometrial cancer. Methods Eighty-one patients with biopsy-proven endometrial cancer underwent preoperative PET/CT (n = 37) and integrated PET/MRI (n = 44) for initial staging. The diagnostic performance of PET/CT and integrated PET/MRI for assessing the extent of the primary tumor and metastasis to the regional lymph nodes was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. McNemar’s test was employed for statistical analysis. Results Integrated PET/MRI and PET/CT both detected 100% of the primary tumors. Integrated PET/MRI proved significantly more sensitivity and specificity than PET/CT in regional lymph node metastasis detection (P = 0.015 and P < 0.001, respectively). The overall accuracy of myometrial invasion detection for PET/CT and Integrated PET/MRI was 45.9% and 81.8%, respectively. Integrated PET/MRI proved significantly more accurate than PET/CT (P < 0.001). Conclusion Integrated PET/MRI, which complements the individual advantages of MRI and PET, is a valuable technique for the assessment of the lymph node metastasis and myometrial invasion in patients with endometrial cancer.

scholarly journals The Relationship Between Lymphovascular Space Invasion and Lymph Node Metastasis In Endometrial Cancer

2014 ◽  
Vol 11 (1) ◽  
pp. 29-34
Author(s):  
Emine Karabuk ◽  
Ipek Nur Balin Duzguner ◽  
Hilal Ilgin ◽  
Soner Duzguner ◽  
Ozge Yucel ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Node Metastasis ◽  
The Relationship ◽  
Lymphovascular Space Invasion
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