Ultrastaging of lymph node in uterine cancers

Abstract

BackgroundLymph node status is an important prognostic factor and a criterion for adjuvant therapy in uterine cancers. While detection of micrometastases by ultrastaging techniques is correlated to prognosis in several other cancers, this remains a matter of debate for uterine cancers. The objective of this review on sentinel nodes (SN) in uterine cancers was to determine the contribution of ultrastaging to detect micrometastases.MethodsReview of the English literature on SN procedure in cervical and endometrial cancers and histological techniques including hematoxylin and eosin (H&E) staining, serial sectioning, immunohistochemistry (IHC) and molecular techniques to detect micrometastases.ResultsIn both cervical and endometrial cancers, H&E and IHC appeared insufficient to detect micrometastases. In cervical cancer, using H&E, serial sectioning and IHC, the rate of macrometastases varied between 7.1% and 36.3% with a mean value of 25.8%. The percentage of women with micrometastases ranged from 0% and 47.4% with a mean value of 28.3%. In endometrial cancer, the rate of macrometastases varied from 0% to 22%. Using H&E, serial sectioning and IHC, the rate of micrometastases varied from 0% to 15% with a mean value of 5.8%. In both cervical and endometrial cancers, data on the contribution of molecular techniques to detect micrometastases are insufficient to clarify their role in SN ultrastaging.ConclusionIn uterine cancers, H&E, serial sectioning and IHC appears the best histological combined technique to detect micrometastases. Although accumulating data have proved the relation between the risk of recurrence and the presence of micrometastases, their clinical implications on indications for adjuvant therapy has to be clarified.

Sentinel lymph node in endometrial cancer: an overview

“…Ultrastaging of lymph nodes is a main focus of the SLN concept and implies serial sectioning and IHC [11,34]. The main limitation of these techniques is their time-consuming and costly nature, inappropriate for routine use [3,34].…”

“…At the Philadelphia Consensus Conference, macrometastasis was defined as a single focus of metastastic disease per node measuring more than 2 mm, micrometastasis measuring between 0.2 and 2 mm and submicrometastasis measuring less than 0.02 mm, including the presence of a single noncohesive tumor cell [9,34]. The relation between micrometastasis and risk of recurrence/prognosis has been demonstrated in an increasing number of malignancies suggesting that micrometastasis should be an indication for adjuvant therapy, including early EC [34].…”

“…The relation between micrometastasis and risk of recurrence/prognosis has been demonstrated in an increasing number of malignancies suggesting that micrometastasis should be an indication for adjuvant therapy, including early EC [34]. Yabushita et al analyzed the relation between disease recurrence and presence of pelvic nodes micrometastasis in early EC and found its presence was associated with recurrent disease [34].…”

“…Ultrastaging protocols involve serial sectioning techniques (with intervals of 3 mm), and each of these sections will be analyzed into a panel of anti-cytokeratin antibodies [9,34]. The signal amplification produced by IHC may improve sensitivity of micrometastasis detection [32].…”

“…Identification of microscopic disease outside the uterus can help to determine the need of adjuvant therapy. SLN application in EC is more accurate than MRI and intra-operative frozen section analysis in assessing lymph node status [1,8] and SLNs are three times more likely to harbor disease than non-SLNs [34]. SLN in EC, incorporating ultrastaging, may improve selection of women at high risk and could potentially avoid 80 % full unnecessary lymphadenectomy [6].…”