Low-Volume Lymph Node Metastases in Endometrial Carcinoma

Clinton, Lani K.; Kondo, Jordan; Carney, Michael E.; Tauchi-Nishi, Pamela; Terada, Keith Y.; Shimizu, David

doi:10.1097/igc.0000000000001016

Cited by 20 publications

(9 citation statements)

References 25 publications

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“…Eventually, fourteen peer-reviewed and published studies were selected that met all the eligibility criteria, and of which data were available ( Fig. 1 ) [ 14 15 28 29 30 31 32 33 34 35 36 37 38 39 ]. The risk of bias, using the QUADAS-2 tool, is depicted in Figs.…”

Section: Resultsmentioning

confidence: 99%

“…In some studies, not all patients had ICG as tracer for SLN mapping, thus only a selection of the study population could be included in our study [ 30 33 37 ]. In another included study, the decision regarding lymph node dissection was at the discretion of the individual surgeon [ 31 ]. Some patients had SLN biopsy with or without subsequent lymph node dissection, and some patients had no lymph node sampling (SLN mapping or lymph node dissection) at all.…”

Section: Discussionmentioning

confidence: 99%

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The added value of SLN mapping with indocyanine green in low- and intermediate-risk endometrial cancer management: a systematic review and meta-analysis

et al. 2022

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Objective The aim of this study was to assess the SLN detection rate in presumed early stage, low- and intermediate-risk endometrial cancers, the incidence of SLN metastases, and the negative predictive value of SLN mapping performed with indocyanine green (ICG). Methods A systematic review with meta-analyses was conducted. Study inclusion criteria were A) low- and intermediate-risk endometrial cancer, B) the use of ICG per cervical injection; C) a minimum of twenty included patients per study. To assess the negative predictive value of SLN mapping, D) a subsequent lymphadenectomy was an additional inclusion criterion. Results Fourteen studies were selected, involving 2,117 patients. The overall and bilateral SLN detection rates were 95.6% (95% confidence interval [CI]=92.4%–97.9%) and 76.5% (95% CI=68.1%–84.0%), respectively. The incidence of SLN metastases was 9.6% (95% CI=5.1%–15.2%) in patients with grade 1–2 endometrial cancer and 11.8% (95% CI=8.1%–16.1%) in patients with grade 1–3 endometrial cancer. The negative predictive value of SLN mapping was 100% (95% CI=98.8%–100%) in studies that included grade 1–2 endometrial cancer and 99.2% (95% CI=97.9%–99.9%) in studies that also included grade 3. Conclusion SLN mapping with ICG is feasible with a high detection rate and negative predictive value in low- and intermediate-risk endometrial cancers. Given the incidence of SLN metastases is approximately 10% in those patients, SLN mapping may lead to stage shifting with potential therapeutic consequences. Given the high negative predictive value with SLN mapping, routine lymphadenectomy should be omitted in low- and intermediate-risk endometrial cancer.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The added value of SLN mapping with indocyanine green in low- and intermediate-risk endometrial cancer management: a systematic review and meta-analysis

et al. 2022

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“…Currently micrometastases and macrometastases are considered to be equal in terms of requiring adjuvant treatment, and no definitive data are available about the possibility of treating these two pathologic entities with different approaches as is proposed for other solid tumors. The widespread adoption of SLN mapping and pathologic SU increases the detection of low-volume nodal metastases in around 20%–30% of patients with early-stage endometrial cancer, and because of these findings an increased proportion of low-risk patients are subjected to adjuvant treatments 24 25. Consequently, further studies should be performed to better clarify this particular issue.…”

Section: Discussionmentioning

confidence: 99%

Standard ultra-staging compared to one-step nucleic acid amplification for the detection of sentinel lymph node metastasis in endometrial cancer patients: a retrospective cohort comparison

Fanfani

Monterossi

Meo

et al. 2020

International Journal of Gynecological Cancer

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IntroductionThe objective of this study was to compared standard ultra-staging (SU) with one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node (SLN) metastasis in women with apparent uterine-confined endometrial cancer.MethodsAll women underwent SLN identification with complete surgical staging. All SLNs were cut perpendicular to the long axis and two adjacent 5 µm sections were cut at each of two levels 50 µm apart. At each level, one slide was stained with hematoxylin and eosin and the other with immunohistochemistry using the AE1/AE3 anti-cytokeratin antibody, as well as one negative control slide for a total of five slides per block. For OSNA analysis, the 2 mm sections of the lymph nodes were homogenized to form a lysate. The lysate was then centrifuged and inserted into the RD 100i instrument where the isothermal amplification of CK19 mRNA was executed.ResultsOf the 396 patients included in the retrospective analysis, 214 were in the SU group, and 182 in the OSNA group. Overall 869 SLNs were identified (490 SU, 379 OSNA). Sixty patients exhibited SLN metastasis (34 SU, 26 OSNA). Macrometastasis, micrometastases, and isolated tumor cells (ITC) were 5.1%, 4.1%, and 0.2%, respectively, in the US group, and 2.4%, 6.3%, and 0.1%, respectively, in the OSNA group (p=0.022).ConclusionsThe OSNA assay detected a higher rate of micrometastasis and a lower rate of macrometastasis and ITC when compared with SU. The clinical and prognostic impact of ITC is debatable and controversial. Further studies are needed to clarify the respective roles of the OSNA and SU methods, and the possible role of ITC in the prognosis of patients with apparent early-stage endometrial cancer.

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“…However, in our LVM cohort, 50% of patients presented ≥50% myometrial invasion or cervical stromal involvement. Myometrial invasion was the only histopathological characteristic that behaved like an independent risk factor for lymph node disease in our study population [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Low-Volume Nodal Metastasis in Endometrial Cancer: Risk Factors and Prognostic Significance

García-Pineda

Gutiérrez

Gracia

et al. 2020

JCM

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Objective: To evaluate the oncological outcomes of patients with low-volume metastasis compared to those with macrometastasis and negative nodes in endometrial cancer. Methods: A single institutional retrospective study was carried out, which included all patients with endometrial cancer who underwent surgical treatment between January 2007 and December 2016. We analyzed the progression-free survival (PFS) and overall survival (OS) of all patients after sentinel node biopsy and full nodal surgical staging according to their final pathological nodal status, focusing on the impact of the size of nodal metastasis. Results: A total of 270 patients were operated on during the study period; among them, 230 (85.2%) patients underwent nodal staging. On final pathology, 196 (85.2%) patients had negative lymph nodes; low-volume metastasis (LVM) was present in 14 (6.1%) patients: 6 (2.6%) patients had isolated tumor cells (ITCs) and 8 (3.5%) patients presented just micrometastasis; additionally, 20 (8.7%) patients presented macrometastasis. After a median (range) follow-up of 60 (0–146) months, patients with macrometastasis showed a significantly worse PFS compared to LVM and node-negative patients (61.1% vs. 71.4% vs. 83.2%, respectively; p = 0.018), and similar results were obtained for 5-year OS (50% vs. 78.6% vs. 81.5%, respectively; p < 0.001). Half of the patients presenting LVM did not receive adjuvant treatment. Moreover, LVM had a moderate nonsignificant decrease in 5-year PFS compared to node-negative patients. Conclusions: Patients with endometrial cancer and low-volume nodal metastasis demonstrated a better prognosis than those presenting macrometastasis. Low-volume metastasis did not show worse oncological outcomes than node-negative patients, although there was a slight decrease in progression-free survival.

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Low-Volume Lymph Node Metastases in Endometrial Carcinoma

Cited by 20 publications

References 25 publications

The added value of SLN mapping with indocyanine green in low- and intermediate-risk endometrial cancer management: a systematic review and meta-analysis

The added value of SLN mapping with indocyanine green in low- and intermediate-risk endometrial cancer management: a systematic review and meta-analysis

Standard ultra-staging compared to one-step nucleic acid amplification for the detection of sentinel lymph node metastasis in endometrial cancer patients: a retrospective cohort comparison

Low-Volume Nodal Metastasis in Endometrial Cancer: Risk Factors and Prognostic Significance

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