Patterns of Myoinvasion in Endometrial Adenocarcinoma

Cole, Adam; Quick, Charles M.

doi:10.1097/pap.0b013e31828d17cc

Cited by 32 publications

(33 citation statements)

References 27 publications

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“…Measuring MI is more difficult in the presence of an irregular endometrial/myometrial junction, of a polypoid tumor, or of adenomyosis, and also when the pattern of MI is unusual, such as diffusely infiltrative, or microcystic, elongated, and fragmented (MELF) [12, 23–26]. Because these are not yet regularly reported in daily clinical practice, this was beyond the scope of our study.…”

Section: Discussionmentioning

confidence: 99%

Reproducibility of measurement of myometrial invasion in endometrial carcinoma

et al. 2016

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Myometrial invasion (MI) as a percentage (%MI), categorized into <50 or ≥50 %, is an important predictor of prognosis in endometrial carcinoma. Recent studies suggest that tumor-free distance (TFD) to serosa and the absolute depth of invasion (DOI) might be stronger predictors of prognosis. Although reproducibility is important in clinical practice for patient prognostication and treatment, reproducibility of these methods for the measurement of MI is largely unknown. One or two slides from 50 patients with FIGO stage I endometrioid endometrial carcinoma were viewed by seven gynecological pathologists, who were requested to measure %MI, TFD, and DOI. We categorized %MI as <50 % (including no MI) or ≥50 %, TFD as ≤1.75 or >1.75 mm (including no MI), ≤7 or >7 mm (including no MI), and ≤10 or >10 mm (including no MI) and DOI as <4 mm (including no MI) or ≥4 mm. Light’s kappa for multi-rater agreement was calculated. The %MI, TFD, and DOI could be measured in 88, 83, and 79 % of cases, respectively. Kappa was 0.75 for %MI, 0.77, 0.73, and 0.69 respectively for TFD with cutoffs of 1.75, 7, and 10 mm, and 0.59 for DOI. Pathologists reach substantial agreement when measuring %MI and TFD and moderate agreement when measuring DOI. The %MI can be measured in more cases than TFD and DOI. This supports the use of %MI in daily clinical practice, but future studies should compare %MI and TFD more extensively, including inter-observer variability.

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Section: Discussionmentioning

confidence: 99%

Reproducibility of measurement of myometrial invasion in endometrial carcinoma

et al. 2016

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“…Histologic review was done blinded to clinical outcome. The descriptions of five myometrial invasion patterns in Cole et al 5 were utilized to classify each invasive case: irregular or infiltrative invasion, MELF invasion, invasion with pushing borders (broad front), adenomyosis-like invasion, and adenoma malignum-like invasion. For cases with multiple patterns of invasion, each pattern and its relative proportion was recorded.…”

Section: Methodsmentioning

confidence: 99%

“…4 EEC are histologically heterogeneous and the morphologic pattern of myometrial invasion may be related to biologic potential. 5–6 Specifically, myometrial invasion with an infiltrative gland pattern has been recently associated with higher stage, lymphovascular invasion and recurrence. 6 Additionally, a readily recognizable pattern of myometrial invasion characterized by microcystic elongated and fragmented (MELF) glands surrounded by myxoid and inflamed stroma has been associated with lymphovascular invasion 7–8 and lymph node metastases.…”

Section: Introductionmentioning

confidence: 99%

The Microcystic, Elongated, and Fragmented (MELF) Pattern of Invasion

Joehlin‐Price

McHugh²,

Stephens³

et al. 2017

American Journal of Surgical Pathology

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MELF invasion has been associated with non-vaginal recurrences and lymph node (LN) metastases in multi-institutional case control studies, but has not been well examined in large single institution cohorts. Hysterectomy specimens with FIGO 1 endometrioid endometrial carcinoma (EEC) and lymphadenectomies from 2007 to 2012 were identified. Electronic medical records and histologic slides were reviewed. Of 464 identified cases, 163 (35.1%) were noninvasive, 60 (12.9%) had MELF, 222 (47.8%) had a component of the infiltrative invasion pattern without MELF, 13 (2.8%) had pure pushing borders of invasion, 5 (1.1%) had pure adenomyosis-like invasion, and 1 (0.2%) had pure adenoma malignum-like invasion. Sixteen cases had LN metastases. Significantly more MELF cases had positive LNs than non-MELF cases overall (18.3% vs 1.2%, p<0.001). The results were almost identical when invasive infiltrative cases with and without MELF were compared (18.3% vs 1.8%, p<0.001). The maximum number of MELF glands per slide did not differ between cases with and without LN metastases, p=0.137. A majority of positive LNs, even in MELF cases, demonstrated non-histiocyte-like metastases. Only five cases (all with MELF invasion) demonstrated micrometastatic lesions or isolated tumor cells only. MELF cases demonstrated a non-significant decrease in time to extra-vaginal recurrence (p=0.082, log-rank test), for which analysis was limited by low recurrence rates. In summary, MELF is associated with LN metastases, even when compared to other infiltrative cases, and shows multiple patterns of growth in positive LNs. MELF cases additionally trended toward decreased time to extra-vaginal recurrence.

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“…Since the description of different myoinvasive patterns in EEC in 2013 by Cole and Quick [8], little attention has been paid to analyse the relation between these patterns and the outcome of the tumour [11,12]. To our knowledge, this is the first series correlating myoinvasive patterns with recurrence in low-grade, early-stage EEC.…”

Section: Discussionmentioning

confidence: 92%

“…Since the proper recognition of five patterns of EEC myoinvasion [8], much attention has been paid to the microcystic, elongated and fragmented glands (MELF) pattern of myoinvasion. The MELF pattern has been associated with an increased risk of lymph node metastases, but without any impact on prognosis [9,10].…”

Section: Introductionmentioning

confidence: 99%

Myoinvasive Pattern as a Prognostic Marker in Low-Grade, Early-Stage Endometrioid Endometrial Carcinoma

Ruz-Caracuel

Ramon-Patino

López-Janeiro

et al. 2019

Cancers

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Low-grade and early Federation for Gynecology and Obstetrics (FIGO) stage endometrioid endometrial carcinomas (EEC) have an excellent prognosis. However, approximately 10% of patients develop recurrence, which cannot be correctly predicted at diagnosis. We evaluated myoinvasive patterns as a prognostic factor of relapse in low-grade, early-stage EEC. Two-hundred and fifty-eight cases were selected according to the following inclusion criteria: (i) endometrioid endometrial carcinomas, (ii) grade 1 or 2 with (iii) FIGO stage I or II, and (iv) clinical follow-up. Slides were reviewed to annotate the myoinvasive pattern present in each case (infiltrative glands, microcystic, elongated and fragmented –MELF-, broad front, adenomyosis-like and adenoma malignum). Microsatellite instability was studied by immunoexpression of mismatch repair proteins (MLH1, PMS2, MSH2, and MSH6). There were 29 recurrences (11.2%) among the 258 cases analysed. A predominant broad front myoinvasive pattern was significantly associated with tumour relapse (p = 0.003). The presence of a pattern of infiltrative glands (p = 0.001) and microsatellite instability (p = 0.004) were associated with lower disease-free survival, without having an impact on overall survival. Our observations suggest the potential value of the pattern of myoinvasion as a prognostic factor in low-grade, early-stage endometrioid endometrial carcinoma.

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Patterns of Myoinvasion in Endometrial Adenocarcinoma

Cited by 32 publications

References 27 publications

Reproducibility of measurement of myometrial invasion in endometrial carcinoma

Reproducibility of measurement of myometrial invasion in endometrial carcinoma

The Microcystic, Elongated, and Fragmented (MELF) Pattern of Invasion

Myoinvasive Pattern as a Prognostic Marker in Low-Grade, Early-Stage Endometrioid Endometrial Carcinoma

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