Preoperative assessment of lymph node metastasis in endometrial cancer: A Korean Gynecologic Oncology Group study

Abstract

The low-risk criteria based on preoperative tests were confirmed to be reliable and accurate for identifying patients at low risk for lymph node metastasis. These criteria may facilitate patient counseling and surgical decision making. Cancer 2017;123:263-272. © 2016 American Cancer Society.

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

“…Using these criteria, the risk of lymph node metastasis in this low-risk group is well below 5% [14e16]. More recently, the Korean GOG published a negative predictive value of 97.1% for lymph node metastasis for patients with the following: endometrioid histology, no evidence of deep myometrial invasion on magnetic resonance imaging (MRI), no enlarged lymph nodes on MRI, no suspicious metastasis out of the uterine corpus, and serum cancer antigen 125 (CA 125) levels less than 35 U/mL [17]. Due to selective lymphadenectomy procedures, there are patients with LVSI seen on final pathology but NX.…”

Development and validation of prognostic factors for lymph node metastasis in endometrial cancer: A SEER analysis

“…So ane constructed a predictive model to identify high-risk LNM patients in early-stage type 1 EC [22] . Korean Gynecologic Oncology Group (KGOG) developed a preoperative assessment of LNM in EC that included features of MRI results and serum CA125 levels [23] . Lymph-vascular space invasion (LVSI) also has been shown to have a great impact on LNM in some studies [24,25] .…”

Omitting lymphadenectomy in patients with endometrial cancer

“…The primary endpoint was the negative predictive value (NPV), which was found to be 97.1% and above the predefined endpoint of 96%. On the basis of these results, the authors conclude that their proposed low‐risk criteria have been established to be reliable in identifying patients at low risk for lymph node metastasis …”

“…The issue is how to define either preoperatively or intraoperatively low‐risk criteria that will identify this group of low‐risk patients. In this issue of Cancer , the Korean Gynecologic Oncology Group (KGOG) examines this question in an article entitled “Preoperative Assessment of Lymph Node Metastasis in Endometrial Cancer: A Korean Gynecologic Oncology Group Study.”…”

“…On the basis of these results, the authors conclude that their proposed low-risk criteria have been established to be reliable in identifying patients at low risk for lymph node metastasis. 6 Other groups have also proposed low-risk criteria that would allow the omission of lymph node dissection for patients with endometrial cancers. The Mayo criteria advocate omitting node dissection for patients with grade I/II tumors of endometrioid histology that have less than 50% invasion and are less than or equal to 2 cm in diameter.…”