Nodal Metastasis Risk in Endometrioid Endometrial Cancer

Abstract

Objective To estimate the risk for nodal metastasis in women with endometrial cancer based on uterine characteristics on pathology. Methods From a study of staging for uterine cancer, women were identified as low risk for nodal metastasis based on three specific criteria on final pathology reports: 1) less than 50% invasion; 2) tumor size less than 2 cm; and 3) well or moderately differentiated endometrioid histology. If the uterine specimen did not meet all three criteria, it was viewed as high risk for nodal metastasis. Results Nine hundred seventy-one women were included in this analysis. Approximately 40% (or 389/971) of patients in this study were found to be low risk with a rate of nodal metastasis of only 0.8% (3/389; exact 95% CI, 0.16%–2.2%). No statistical differences in median age, body mass index (BMI), race, performance status, missing clinical data, or open or minimally invasive techniques were found among the patients with and without nodal metastases. Patients with high-risk characteristics on their uterine specimens compared to low risk have 6.3 times the risk of nodal metastasis (95% CI, 1.67–23.8; P = 0.007). Conclusion Low-risk endometrioid uterine cancer criteria may be used to help guide treatment planning for reoperation in patients with incomplete surgical staging information.

Clinical significance of tumor volume in endometrial cancer: A Japan–Korea cooperative study

“…On the other hand, Mariani et al reported that lymphadenectomy can be omitted under the following conditions: endometrioid histology (grade 1 or 2), myometrial invasion b 50%, and tumor diameter b 2 cm [7]. Gynecologic oncologists in the United States regard these three factors as being important and have named them "Mayo criteria" [8]. A unique point of the Mayo criteria is that tumor size is used together with myometrial invasion.…”

Accuracy of robotic sentinel lymph node detection (RSLND) for patients with endometrial cancer (EC)

“…Nonetheless, a wide range of intraoperative treatment options including comprehensive lymphadenectomy, selective lymphadenectomy or no staging at all exists. In the study of 970 women with EC, Milam et al estimated less than 1% risk of nodal metastasis in Mayo clinic low risk EC patients [19]. Therefore, there is a general consensus among many gynecologic oncologists not to perform comprehensive lymphadenectomy for the Mayo Clinic low risk patients with EC.…”

Staging for endometrial cancer: The controversy around lymphadenectomy – Can this be resolved?

“…Several authors have proposed different scores in order to predict LN metastasis [45][46][47][48][49][50][51][52][53] (table 2).…”