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De Vitis LA, Fumagalli D, Schivardi G, Capasso I, Grcevich L, Multinu F, Cucinella G, Occhiali T, Betella I, Guillot BE, Pappalettera G, Shahi M, Fought AJ, McGree M, Reynolds E, Colombo N, Zanagnolo V, Aletti G, Langstraat C, Mariani A, Glaser G. Incidence of sentinel lymph node metastases in apparent early-stage endometrial cancer: a multicenter observational study. Int J Gynecol Cancer 2024:ijgc-2023-005173. [PMID: 38514100 DOI: 10.1136/ijgc-2023-005173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE Ultrastaging is accurate in detecting nodal metastases, but increases costs and may not be necessary in certain low-risk subgroups. In this study we examined the risk of nodal involvement detected by sentinel lymph node (SLN) biopsy in a large population of apparent early-stage endometrial cancer and stratified by histopathologic characteristics. Furthermore, we aimed to identify a subgroup in which ultrastaging may be omitted. METHODS We retrospectively included patients who underwent SLN (with bilateral mapping and no empty nodal packets on final pathology) ± systematic lymphadenectomy for apparent early-stage endometrial cancer at two referral cancer centers. Lymph node status was determined by SLN only, regardless of non-SLN findings. The incidence of macrometastasis, micrometastasis, and isolated tumor cells (ITC) was measured in the overall population and after stratification by histotype (endometrioid vs serous), myometrial invasion (none, <50%, ≥50%), and grade (G1, G2, G3). RESULTS Bilateral SLN mapping was accomplished in 1570 patients: 1359 endometrioid and 211 non-endometrioid, of which 117 were serous. The incidence of macrometastasis, micrometastasis, and ITC was 3.8%, 3.4%, and 4.8%, respectively. In patients with endometrioid histology (n=1359) there were 2.9% macrometastases, 3.2% micrometastases, and 5.3% ITC. No macro/micrometastases and only one ITC were found in a subset of 274 patients with low-grade (G1-G2) endometrioid endometrial cancer without myometrial invasion (all <1%). The incidence of micro/macrometastasis was higher, 2.8%, in 708 patients with low-grade endometrioid endometrial cancer invading <50% of the myometrium. In patients with serous histology (n=117), the incidence of macrometastases, micrometastasis, and ITC was 11.1%, 6.0%, and 1.7%, respectively. For serous carcinoma without myometrial invasion (n=36), two patients had micrometastases for an incidence of 5.6%. CONCLUSIONS Ultrastaging may be safely omitted in patients with low-grade endometrioid endometrial cancer without myometrial invasion. No other subgroups with a risk of nodal metastasis of less than 1% have been identified.
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Affiliation(s)
- Luigi Antonio De Vitis
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Diletta Fumagalli
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Gabriella Schivardi
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Ilaria Capasso
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Leah Grcevich
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Francesco Multinu
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Cucinella
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Tommaso Occhiali
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
- Clinic of Obstetrics and Gynecology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Ilaria Betella
- Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Benedetto E Guillot
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
- Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Giulia Pappalettera
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
- Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Maryam Shahi
- Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Angela J Fought
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Michaela McGree
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Evelyn Reynolds
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicoletta Colombo
- Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Faculty of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Vanna Zanagnolo
- Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giovanni Aletti
- Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Carrie Langstraat
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gretchen Glaser
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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