Incidence of sentinel lymph node metastases in apparent early-stage endometrial cancer: a multicenter observational study.

Autor:	De Vitis LA; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.; Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy., Fumagalli D; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.; Department of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy., Schivardi G; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.; Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy., Capasso I; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.; Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy., Grcevich L; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA., Multinu F; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.; Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy., Cucinella G; 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., Occhiali T; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.; Clinic of Obstetrics and Gynecology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy., Betella I; Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy., Guillot BE; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.; Faculty of Medicine and Surgery, University of Milan, Milan, Italy., Pappalettera G; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.; Faculty of Medicine and Surgery, University of Milan, Milan, Italy., Shahi M; Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA., Fought AJ; Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA., McGree M; Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA., Reynolds E; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA., Colombo N; Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy.; Faculty of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy., Zanagnolo V; Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy., Aletti G; Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy.; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy., Langstraat C; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA., Mariani A; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA., Glaser G; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA glaser.gretchen@mayo.edu.
Jazyk:	angličtina
Zdroj:	International journal of gynecological cancer : official journal of the International Gynecological Cancer Society [Int J Gynecol Cancer] 2024 May 06; Vol. 34 (5), pp. 689-696. Date of Electronic Publication: 2024 May 06.
DOI:	10.1136/ijgc-2023-005173
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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