Low-volume disease in endometrial cancer: The role of micrometastasis and isolated tumor cells

Retrospective detection of isolated tumor cells by immunohistochemistry in sentinel lymph node biopsy performed for endometrial carcinoma: is there clinical significance?

“…Older studies suggest that cytokeratin staining in lymph nodes in patients with endometrial carcinoma and otherwise no known metastasis is a predictor of recurrence27; however this is not supported by ours and other studies 21–23. We have shown that no patients with endometrial carcinoma and ITCs and no adjuvant treatment recurred in a median follow-up of 32.6 months.…”

“…The management of patients with ITCs is controversial and, depending on the center, some patients receive adjuvant treatment on the basis of the presence of ITCs, while others are observed. Studies examining patients with endometrial carcinoma and ITCs have shown that patients with ITCs often receive adjuvant therapy with the percentage of patients receiving adjuvant treatment ranging from 57–87%,18 21 22 so the assessment of the clinical significance of ITCs is confounded 23. Due to the retrospective nature of detecting ITCs in our study, patients were not known to have ITCs at the time of diagnosis and their presence was not factored into treatment decisions.…”

“…ITCs are considered negative in TNM staging and should be reported as pN0(i+) 20. The clinical significance of detecting ITCs remains unclear; furthermore, there is no consensus regarding clinical management of patients with ITCs and only a few studies have assessed the clinical outcomes of patients with ITCs 21–23…”

LVSI positive and NX in early endometrial cancer: Surgical restaging (and no further treatment if N0), or adjuvant ERT?

“…Because, lymph node metastasis ranges from less than 1% in low grade patients without myometrial invasion to >25% in patients with high grade tumors and deep invasion [58]. Appropriate risk stratification is essential for adequate therapeutic interventions.…”

Sentinel Node Mapping in Endometrial Cancer

“…Accumulating data suggested that sentinel node mapping improves detection rate of positive nodes in comparison to lymphadenectomy, thanks to the application of ultrastaging on sentinel nodes harvested. It is estimated that the adoption of sentinel node mapping (and ultrastaging) increase positive node detection rate of more than 30%, being ultrastaging able to detect low volume disease not detectable with conventional histological examination [5].…”