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

Goebel, Emily A.; Laurent, J.D. St.; Nucci, Marisa R.; Feltmate, Colleen M.

doi:10.1136/ijgc-2019-000934

Cited by 19 publications

(12 citation statements)

References 29 publications

(56 reference statements)

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“…believed that the patients with MM detected in SLN should receive adjuvant therapy, whereas whether ITC undergoes adjuvant therapy depends on uterine factors ( 130 ). The similar conclusion was reached by Goebe et al, in which they sent 155 SLN negative patients tissue slides into IHC staining retrospectively ( 144 ). Even though 13.5% of SLN negative patients found ITCs, no recurrence was found in patients had previously undetected ITCs without receiving adjuvant therapy as well, suggesting that ITCs may not be relevant to recurrence risk.…”

Section: Controversial Issuessupporting

confidence: 72%

“…The results showed a 14.8% incidence of LVMD and deep myometrial invasion was significantly associated with ITC/MM (p=0.028). Bogoni et al (130) (144). Even though 13.5% of SLN negative patients found ITCs, no recurrence was found in patients had previously undetected ITCs without receiving adjuvant therapy as well, suggesting that ITCs may not be relevant to recurrence risk.…”

Section: Controversial Issues Pathological Ultra-staging and Lvmdmentioning

confidence: 99%

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Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review

et al. 2021

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Endometrial cancer (EC) is known as a common gynecological malignancy. The incidence rate is on the increase annually. Lymph node status plays a crucial role in evaluating the prognosis and selecting adjuvant therapy. Currently, the patients with high-risk (not comply with any of the following: (1) well-differentiated or moderately differentiated, pathological grade G1 or G2; (2) myometrial invasion< 1/2; (3) tumor diameter < 2 cm are commonly recommended for a systematic lymphadenectomy (LAD). However, conventional LAD shows high complication incidence and uncertain survival benefits. Sentinel lymph node (SLN) refers to the first lymph node that is passed by the lymphatic metastasis of the primary malignant tumor through the regional lymphatic drainage pathway and can indicate the involvement of lymph nodes across the drainage area. Mounting evidence has demonstrated a high detection rate (DR), sensitivity, and negative predictive value (NPV) in patients with early-stage lower risk EC using sentinel lymph node mapping (SLNM) with pathologic ultra-staging. Meanwhile, SLNM did not compromise the patient’s progression-free survival (PFS) and overall survival (OS) with low operative complications. However, the application of SLNM in early-stage high-risk EC patients remains controversial. As revealed by the recent studies, SLNM may also be feasible, effective, and safe in high-risk patients. This review aims at making a systematic description of the progress made in the application of SLNM in the treatment of EC and the relevant controversies, including the application of SLNM in high-risk patients.

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Section: Controversial Issuessupporting

confidence: 72%

Section: Controversial Issues Pathological Ultra-staging and Lvmdmentioning

confidence: 99%

Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review

et al. 2021

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“…In brief, the thresholds in size are more than 2 mm for macro-metastasis, 0.2–2 mm for micro-metastasis, and less than 200 μm diameter for isolated tumor cells (i+). The terms low-volume disease and ultra-low volume disease were avoided as authors vary in their definitions [ 20 , 21 , 30 , 38 ].…”

Section: Methodsmentioning

confidence: 99%

Pathological processing of sentinel lymph nodes in endometrial carcinoma — routine aspects of grossing, ultra-staging, and surgico-pathological parameters in a series of 833 lymph nodes

Rau¹,

Deppeler²,

Christe³

et al. 2022

Virchows Arch

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Sentinel lymph nodes are widely accepted in the treatment of endometrial carcinoma. Whereas surgical aspects are well studied, the pathological work-up in terms of grossing, frozen section, and the so-called ultra-staging is still a matter of debate. This results in conflicting national or center-based recommendations. In a series of consecutive 833 sentinel lymph nodes from 206 patients in endometrial carcinomas, we compared three different grossing techniques and the use of frozen section in terms of anatomy, detection rates, and survival. In total, 42 macro-metastases, 6 micro-metastases, and 25 nodes with isolated tumor cells were found. Lymph nodes affected at least with micro-metastasis were about 0.5cm enlarged. Detection rates in lamellation technique increased with a step of 5.9% to 8.3% in comparison to bi-valved or complete embedding. The lamellation technique presented with a slight beneficial prognosis in pN0 subgroup (OS, p=0.05), which besides size effects might be attributed to trimming loss. In frozen section, this effect was less pronounced than expected (OS, p=0.56). Ultra-staging only revealed additional micro-metastases and isolated tumor cells. Exclusively, macro-metastases showed poor survival (p<0.001). In multivariate analysis, T-stage, subtype, and lympho-vascular invasion status outperformed this staging parameter significantly. Grossing of sentinel lymph nodes is the most essential step with evidence to prefer lamellation in 2 mm steps. Step sectioning should consider widely spaced protocols to exclude macro-metastases. Frozen sections might add value to the intra-operative assessment of endometrial carcinoma in selected cases. The excellent biological behavior of cases with isolated tumor cells might question the routine application of pan-cytokeratin as ultra-staging method.

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“…She had a pelvic node, a para-aortic node, and an adnexal metastasis, but all metastatic diseases were micrometastasis (<2 mm). Similarly, isolated tumor cells detected in removed sentinel nodes may not decrease survival, even without adjuvant therapy [ 123 , 124 , 125 , 126 ].…”

Section: Benefit Of Systematic Lymphadenectomy In Node-negative Patie...mentioning

confidence: 99%

Therapeutic Benefit of Systematic Lymphadenectomy in Node-Negative Uterine-Confined Endometrioid Endometrial Carcinoma: Omission of Adjuvant Therapy

Otsuka

2022

Cancers

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Endometrial cancer is the most common gynecological tract malignancy in developed countries, and its incidence has been increasing globally with rising obesity rates and longer life expectancy. In endometrial cancer, extrauterine disease, in particular lymph node metastasis, is an important prognostic factor. Nevertheless, pelvic lymphadenectomy is not considered to have a therapeutic benefit, as it did not improve survival in randomized studies. However, lymphadenectomy may have a therapeutic benefit if adjuvant therapy can be omitted without decreasing oncological outcomes, as the long-term quality of life is maintained by avoiding morbidities associated with adjuvant therapy. In intermediate- and high-risk endometrioid endometrial carcinomas, adjuvant therapy may be safely omitted without decreasing long-term survival by open surgery including systematic pelvic and para-aortic lymphadenectomy when patients are node-negative. Systematic lymphadenectomy may remove undetectable low-volume lymph node metastasis in both pelvic and para-aortic regions, and open surgery may reduce vaginal recurrence even without vaginal brachytherapy. However, lymphadenectomy may not improve survival in elderly patients and patients with p53-mutant tumors. In this review, I discuss the characteristics of lymph node metastasis, the methods of lymph node assessment, and the therapeutic benefits of systematic lymphadenectomy in patients with intermediate- and high-risk endometrioid endometrial carcinoma.

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

Cited by 19 publications

References 29 publications

Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review

Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review

Pathological processing of sentinel lymph nodes in endometrial carcinoma — routine aspects of grossing, ultra-staging, and surgico-pathological parameters in a series of 833 lymph nodes

Therapeutic Benefit of Systematic Lymphadenectomy in Node-Negative Uterine-Confined Endometrioid Endometrial Carcinoma: Omission of Adjuvant Therapy

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