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Diniz TP, Menezes JN, Goncalves BT, Faloppa CC, Mantoan H, Kumagai LY, Badiglian-Filho L, Bovolim G, Guimaraes APG, De Brot L, Baiocchi G. Can mismatch repair status be added to sentinel lymph node mapping algorithm in endometrioid endometrial cancer? Gynecol Oncol 2023; 169:131-136. [PMID: 36580755 DOI: 10.1016/j.ygyno.2022.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the relation between mismatch repair (MMR) status and the risk of lymph node metastasis in endometrial cancer, and whether this additional data can be incorporated to current SLN (sentinel lymph node) algorithm. METHODS We included a series of 332 women that underwent SLN mapping ± systematic lymphadenectomy from January 2013 to December 2021. Protein expressions of MLH1, MSH2, MSH6, PMS2 were examined by immuno-histochemistry and considered MMRd (deficient) when at least one protein was not expressed. RESULTS MMRd was noted in 20.8% of cases and correlated to grade 3 (p = 0.018) and presence of lymphovascular space invasion (p = 0.032). Moreover, MMRd was an independent risk factor for lymph node metastasis (OR 2.76, 95% CI 1.36-5.62). Notably, 21.7% (15/69) cases with MMRd had lymph node metastasis compared to 9.5% (25/263) of cases with MMRp (proficient) (p = 0.005). The overall and bilateral SLN detection rates were 91.9% and 75.9%, respectively. Of the 80 (24%) cases of non-bilateral SLN detection, 66.2% had low-grade tumors (G1/G2) and myometrial invasion <50%. Considering MMR status an independent prognostic factor for lymph node metastasis, a systematic lymphadenectomy (side specific or bilateral) would forgo in 53.7% (43/80) of cases with non-bilateral detection, representing 13% (43/332) of all endometroid tumors. CONCLUSION MMR status was independently related to lymph node metastasis in endometrioid EC. Moreover, MMR status may help to select patients that can forgo systematic lymphadenectomy in case of undetected SLN.
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Affiliation(s)
| | | | | | | | - Henrique Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | - Graziele Bovolim
- Department of Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | - Louise De Brot
- Department of Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
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Abt D, Macharia A, Hacker MR, Baig R, Esselen KM, Ducie J. Endometrial stripe thickness: a preoperative marker to identify patients with endometrial intraepithelial neoplasia who may benefit from sentinel lymph node mapping and biopsy. Int J Gynecol Cancer 2022; 32:ijgc-2022-003521. [PMID: 35868657 DOI: 10.1136/ijgc-2022-003521] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The goal of our study was to identify preoperative factors in patients with endometrial intraepithelial neoplasia that are associated with concurrent endometrial cancer to select patients who may benefit from sentinel lymph node (SLN) assessment at the time of hysterectomy. METHODS Retrospective single institution cohort study of patients with a preoperative diagnosis of endometrial intraepithelial neoplasia who underwent hysterectomy with or without staging from January 2010 to July 2020. Modified Poisson regression was used to calculate risk ratios (RR) and 95% confidence intervals (CI). RESULTS Of 378 patients with a preoperative diagnosis of endometrial intraepithelial neoplasia, 275 (73%) had endometrial intraepithelial neoplasia and 103 (27%) had invasive cancer on final pathology. Age (p=0.003), race (p=0.02), and hypertension (p=0.02) were significantly associated with concurrent endometrial cancer. The median preoperative endometrial stripe was significantly greater in the endometrial cancer group (14 mm (range 10-19)) than in the endometrial intraepithelial neoplasia group (11 mm (range 8-16); p=0.002). A preoperative endometrial stripe ≥20 mm was associated with double the risk of endometrial cancer on final pathology (crude RR 2.0, 95% CI 1.3 to 2.9) and preoperative endometrial stripe ≥15 mm was 2.5 times more likely to be associated with high risk Mayo criteria on final pathology (crude RR 2.5, 95% CI 1.2 to 5.2). Of those with concurrent endometrial cancer, 5% were stage IB, 29% had tumors >2 cm, and 1% had grade 3 histology. Only 3% of all patients underwent lymph node evaluation. CONCLUSIONS In a large cohort of patients with a preoperative diagnosis of endometrial intraepithelial neoplasia, less than a third had invasive cancer and even fewer had pathologic features considered high risk for nodal metastasis, arguing against the use of routine SLN dissection in these patients. Endometrial stripe ≥15 mm may be a useful preoperative marker to identify patients at higher risk for concurrent endometrial cancer and may be an important criterion for use of selective SLN dissection in carefully selected patients with endometrial intraepithelial neoplasia.
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Affiliation(s)
- Devon Abt
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Annliz Macharia
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michele R Hacker
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Rasha Baig
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Katharine McKinley Esselen
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Ducie
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
- Midwest Gyn Oncology, Nebraska Methodist Hospital, Omaha, Nebraska, USA
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Abstract
PURPOSE OF REVIEW To provide an overview of the current knowledge and recent advances of sentinel lymph node (SLN) assessment in uterine, cervical, vulvar, and ovarian cancers. RECENT FINDINGS In endometrial cancer, SLN evaluation has become increasingly utilized as part of the treatment of early-stage disease, with data showing improved detection of pelvic lymph node metastasis. In cervical cancer, SLN biopsy has also gained increasing traction with studies demonstrating the feasibility and accuracy of SLN detection. Evaluation with frozen section, however, remains limited in the detection of metastases. The prognostic significance of positive SLN in vulvar cancer is currently being investigated, with preliminary data showing lower recurrence rates in patients receiving adjuvant radiation. SUMMARY SLN evaluation remains standard of care to detect lymph node metastasis in early-staged endometrial cancer. In cervical cancer, SLN biopsy has been shown to be reliable, while decreasing morbidity without impacting disease-free survival in select patients. The technique and high sensitivity of SLN biopsy in vulvar cancer has been demonstrated in large prospective trials. There are no randomized controlled trials in ovarian cancer that evaluate the role of SLN biopsy on treatment and outcome; current SLN evaluation remains investigational.
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Abdallah R, Khalil A, Ghunaim S, El Housheimi A, Khalife D, Sassine D, Khoury K, Mailhac A, Nassour F, Saliba M, Seoud M. The accuracy and clinical impact of intraoperative frozen section in determining the extent of surgical intervention in patients with early stage endometrial cancer. J OBSTET GYNAECOL 2022; 42:1474-1481. [PMID: 35020562 DOI: 10.1080/01443615.2021.2004583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The aim of this study was to compare intraoperative frozen section (FS) with the final pathology (FP), and determine its clinical impact in clinically apparent early stage endometrial cancer (EC) at the American University of Beirut Medical Center (AUBMC). Data for patients 18 years or older, with clinically apparent early stage, grade 1 or 2, endometrioid EC, who underwent hysterectomy ± lymph node dissection (LND) at AUBMC between January 1st 1996 and June 30th 2016 were retrospectively reviewed. 70 patients were included. The overall concordance between FS and FP was 92.3% for histological subtype, 77% for tumour grade, 82% for Myometrial invasion (MI) and 100% for tumour size. At a median follow up of 30 months, 8 recurrences (11.4%) were noted, with a 5-year PFS and OS of 76 and 84% respectively, with a trend towards lower recurrence and improved survival in patients who underwent FS or LND.Impact statementWhat is already known on this subject? Hysterectomy and bilateral salpingo-oophorectomy is the standard surgery for stage I endometrial cancer (EC). Intraoperative frozen section (FS) facilitates the decision on performing lymph node dissection (LND). However, its accuracy and clinical impact have been questioned.What do the results of this study add? Our objective is to compare FS with the final pathology (FP), and determine its clinical impact in clinically apparent early stage EC at the American University of Beirut Medical Center (AUBMC). There is a lack of standardisation regarding FS use and reporting at AUBMC.What are the implications of these findings for clinical practice and/or further research? The strong correlation between FS and FP can serve as a tool to guide decision to perform LND in patients with apparent early stage disease, where use of sentinel LN biopsy technique is not available.
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Affiliation(s)
- Reem Abdallah
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Khalil
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Suleiman Ghunaim
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alaa El Housheimi
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dalia Khalife
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dib Sassine
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karinia Khoury
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aurelie Mailhac
- Clinical Research Institute, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Farah Nassour
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maelle Saliba
- Department of Pathology & Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhieddine Seoud
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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Frozen Section as an Intraoperative Guide to Tailor Surgical Staging in Early-Stage Endometrial Cancer. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00601-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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6
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Evaluation of frozen section biopsy for fast track diagnosis of endometrial pathology in high-risk women with abnormal uterine bleeding. Eur J Obstet Gynecol Reprod Biol 2021; 264:97-102. [PMID: 34298451 DOI: 10.1016/j.ejogrb.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/20/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To study the accuracy of frozen section biopsy for endometrial pathology in high-risk women with abnormal uterine bleeding (AUB). STUDY DESIGN A case-control study was conducted between November 2017 to April 2019, a total of 150 women with postmenopausal bleeding, perimenopausal AUB, and high-risk women of age < 40 years with AUB were recruited. All women underwent transvaginal sonography and Doppler, based on age-appropriate endometrial thickness cut-offs 80 women then underwent hysteroscopy. Based on hysteroscopy, women suspicious of malignancy were taken as cases (n = 40) and those with benign findings as controls (n = 40). All cases and controls underwent dilatation and curettage (D & C) with frozen section (FS) and routine histopathology. RESULTS The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR), negative LR, and overall test accuracy of FS were 90.9%, 93.19%, 83.33%, 96.19%, 13.8, 0.1 and 86.25% respectively for diagnosing endometrial hyperplasia and cancer taking histopathology as the gold standard. Correlation between frozen section biopsy and histopathology was highly significant (p < 0.001) on D & C specimens and the level of agreement was good (K = 0.778). CONCLUSION In women suspicious of malignancy on hysteroscopy, frozen section has high accuracy on D&C specimen and can be used to diagnose endometrial hyperplasia and cancer in an effort to fast-track investigations and work-up for definitive treatment while awaiting final histopathology.
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Jónsdóttir B, Marcickiewicz J, Borgfeldt C, Bjurberg M, Dahm-Kähler P, Flöter-Rådestad A, Hellman K, Holmberg E, Kjølhede P, Rosenberg P, Tholander B, Åvall-Lundqvist E, Stålberg K, Högberg T. Preoperative and intraoperative assessment of myometrial invasion in endometrial cancer-A Swedish Gynecologic Cancer Group (SweGCG) study. Acta Obstet Gynecol Scand 2021; 100:1526-1533. [PMID: 33721324 DOI: 10.1111/aogs.14146] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Deep myometrial invasion (≥50%) is a prognostic factor for lymph node metastases and decreased survival in endometrial cancer. There is no consensus regarding which pre/intraoperative diagnostic method should be preferred. Our aim was to explore the pattern of diagnostic methods for myometrial invasion assessment in Sweden and to evaluate differences among magnetic resonance imaging (MRI), transvaginal sonography, frozen section, and gross examination in clinical practice. MATERIAL AND METHODS This is a nationwide historical cohort study; women with endometrial cancer with data on assessment of myometrial invasion and FIGO stage I-III registered in the Swedish Quality Registry for Gynecologic Cancer (SQRGC) between 2017 and 2019 were eligible. Data on age, histology, FIGO stage, method, and results of myometrial invasion assessment, pathology results, and hospital level were collected from the SQRGC. The final assessment by the pathologist was considered the reference standard. RESULTS In the study population of 1401 women, 32% (n = 448) had myometrial invasion of 50% of more. The methods reported for myometrial invasion assessment were transvaginal sonography in 59%, MRI in 28%, gross examination in 8% and frozen section in 5% of cases. Only minor differences were found for age and FIGO stage when comparing methods applied for myometrial invasion assessment. The sensitivity, specificity, and accuracy to find myometrial invasion of 50% or more with transvaginal sonography were 65.6%, 80.3%, and 75.8%, for MRI they were 76.9%, 71.9%, and 73.8%, for gross examination they were 71.9%, 93.6%, and 87.3%, and for frozen section they were 90.0%, 92.7%, and 92.0%, respectively. CONCLUSIONS In Sweden, the assessment of deep myometrial invasion is most often performed with transvaginal sonography, but the sensitivity is lower than for the other diagnostic methods. In clinical practice, the accuracy is moderate for transvaginal sonography and MRI.
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Affiliation(s)
- Björg Jónsdóttir
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Janusz Marcickiewicz
- Department of Obstetrics and Gynecology, Varbergs Hospital, Region Halland, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital, and Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Maria Bjurberg
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Angelique Flöter-Rådestad
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet. Stockholm, Sweden
| | - Kristina Hellman
- Department of Gynecologic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Holmberg
- Regional Cancer Center Western Sweden, Gothenburg, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Rosenberg
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Bengt Tholander
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Elisabeth Åvall-Lundqvist
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Karin Stålberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Thomas Högberg
- Department of Medical Oncology, Institute of Clinical Sciences, Lund University, Lund, Sweden
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8
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Doğan Durdağ G, Alemdaroğlu S, Aka Bolat F, Yılmaz Baran Ş, Yüksel Şimşek S, Çelik H. Accuracy of intra-operative frozen section in guiding surgical staging of endometrial cancer. Arch Gynecol Obstet 2021; 304:725-732. [PMID: 33608802 DOI: 10.1007/s00404-021-05979-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Surgery consists the main treatment of endometrial cancer; however, decision of lypmhadenectomy is controversial. Intra-operative frozen section (FS) is commonly used in guiding surgical staging; nevertheless, there are different reports regarding its adequacy and reliability. Aim of this study is to assess accuracy of FS in predicting paraffin section (PS) results in patients with endometrium cancer. METHODS Data of 223 cases, who were operated for endometrial cancer at a tertiary hospital in 2012-2019, were analyzed retrospectively. Histological type, grade, tumor diameter, depth of myometrial invasion, and cervical and adnexal involvement in frozen and paraffin section were evaluated. Positive and negative predictive values and accuracy of frozen results in predicting paraffin results for each parameter was assessed. Statistical significance was taken as 0.05 in all tests. RESULTS Accuracy of FS in predicting PS results were 76.23% for histology, 75.45% for grade, 85.31% for depth of myometrial invasion, and 95.45% for tumor diameter. Surgery, based on FS results, caused undertreatment in 4 patients, while metastatic lymph node ratios were found in only 35.3-50.0% of cases who had high risk parameters at FS. CONCLUSION Our FS results have reasonable accuracy rates in predicting PS results, in comparison with the previous literature. However, even if the high risk parameters detected in FS predict PS accurately, absence of lymph node involvement in all cases with high risk parameters indicates that FS-based triage cannot prevent unnecessary lymphadenectomies.
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Affiliation(s)
- Gülşen Doğan Durdağ
- Faculty of Medicine, Department of Gynecology and Obsterics, Başkent University, Adana Application and Research Hospital, Adana, Turkey.
| | - Songül Alemdaroğlu
- Faculty of Medicine, Department of Gynecology and Obsterics, Başkent University, Adana Application and Research Hospital, Adana, Turkey
| | - Filiz Aka Bolat
- Faculty of Medicine, Department of Pathology, Başkent University, Adana Application and Research Hospital, Adana, Turkey
| | - Şafak Yılmaz Baran
- Faculty of Medicine, Department of Gynecology and Obsterics, Başkent University, Adana Application and Research Hospital, Adana, Turkey
| | - Seda Yüksel Şimşek
- Faculty of Medicine, Department of Gynecology and Obsterics, Başkent University, Adana Application and Research Hospital, Adana, Turkey
| | - Hüsnü Çelik
- Faculty of Medicine, Department of Gynecology and Obsterics, Başkent University, Adana Application and Research Hospital, Adana, Turkey
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Pinelli C, Artuso V, Bogani G, Laganà AS, Ghezzi F, Casarin J. Lymph node evaluation in endometrial cancer: how did it change over the last two decades? Transl Cancer Res 2020; 9:7778-7784. [PMID: 35117380 PMCID: PMC8799029 DOI: 10.21037/tcr-20-2165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/31/2020] [Indexed: 12/24/2022]
Abstract
Endometrial cancer (EC) is the most common gynecological malignancy in developed countries, and surgery represents the pivotal part of treatment. Hysterectomy and salpingo-oophorectomy allow removing the primary tumor and defining patients at higher risk, who might benefit from adjuvant therapies. Minimally invasive surgery is associated with superior postoperative outcomes and represents a safe and effective approach for surgical staging of EC. The lymph node status evaluation in EC is still a matter of debate. Over the last twenty years much has changed, moving from a full systematic pelvic and paraaortic lymphadenectomy for staging purpose to the removal of the pelvic (with or without paraaortic) lymph nodes only in selected EC classes of risk. Two randomized trials failed to demonstrate survival benefits of lymphadenectomy in case of apparent early stage EC; however, its prognostic role has never been questioned. At present, with the aim of reducing the surgical-related morbidity, sentinel node mapping is emerging as a safe and valid alternative to lymphadenectomy for EC staging, demonstrating high accuracy and an increased detection of lymph nodes metastasis. Here, we performed a review of the most significant studies, which supported the changes in the lymph node status evaluation for EC over the last two decades.
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Affiliation(s)
- Ciro Pinelli
- Obstetrics and Gynecology Department, the University of Insubria, Varese, Italy
| | - Valeria Artuso
- Obstetrics and Gynecology Department, the University of Insubria, Varese, Italy
| | - Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Fabio Ghezzi
- Obstetrics and Gynecology Department, the University of Insubria, Varese, Italy
| | - Jvan Casarin
- Obstetrics and Gynecology Department, the University of Insubria, Varese, Italy
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Liu C, Zhao J, Liu S, Ma Y, Yang Y, Qu P. Effect of Pelvic Lymphadenectomy on Survival in Patients with Low-Risk Early-Stage Endometrial Cancer Diagnosed Intraoperatively Using Frozen Tissue Sections: A Retrospective Analysis. Cancer Manag Res 2020; 12:10715-10723. [PMID: 33149678 PMCID: PMC7605598 DOI: 10.2147/cmar.s274992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To determine whether pelvic lymphadenectomy improved survival in patients diagnosed with low-risk early-stage endometrial cancer by intraoperative pathology. Methods This retrospective analysis included 238 patients at our hospital. Results The lymphadenectomy and non-lymphadenectomy groups contained 121 and 117 patients, respectively. In both groups, more than half the patients had tumor size ≥2 cm, and most had myometrial invasion <50%, stage Ia disease and no lymphovascular space invasion. Age, tumor size, myometrial invasion, surgical-pathologic stage and postoperative adjuvant therapy use were comparable between groups. The non-lymphadenectomy group had more patients treated laparoscopically (36.8% vs 10.7%; P<0.001) and fewer patients with histologic grade 2 disease (35.9% vs 62.8%; P<0.001) than the lymphadenectomy group. In the non-lymphadenectomy group, intraoperative frozen section pathology disagreed with postoperative pathology in only 31/117 cases for histologic grade (none upgraded to grade 3), 1/117 cases for myometrial invasion (one case revised from <50% to ≥50%) and 3/117 cases for surgical-pathologic stage (upgraded from Ia to Ib or II). Disease recurrence rate and overall survival did not differ significantly between the lymphadenectomy and non-lymphadenectomy groups. In multivariate Cox regression analysis, only surgical-pathologic stage >Ia (odds ratio, 47.7; 95% confidence interval, 6.7–340.8; P=0.031) was associated with increased odds of disease recurrence. Conclusion Pelvic lymphadenectomy may not be necessary in patients with an intraoperative diagnosis of low-risk endometrial cancer.
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Affiliation(s)
- Caiyan Liu
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, People's Republic of China
| | - Jianguo Zhao
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, People's Republic of China
| | - Shasha Liu
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, People's Republic of China
| | - Yaomei Ma
- Department of Gynecological Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, People's Republic of China
| | - Yun Yang
- Department Of Gynecology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, People's Republic of China
| | - Pengpeng Qu
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, People's Republic of China
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Molecular characterization in the prediction of disease extent in endometrial carcinoma. Eur J Obstet Gynecol Reprod Biol 2020; 256:478-483. [PMID: 33189427 DOI: 10.1016/j.ejogrb.2020.10.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Patients with endometrial carcinoma are usually triaged to staging lymphadenectomy selectively based on estimated risk of lymphatic spread. The risk is generally assessed by the presence of uterine risk factors, but their preoperative and intraoperative identification remain a challenge. The objective of this study was to assess the capability of molecular classification, described by The Cancer Genome Atlas (TCGA), to predict the stage of endometrial carcinoma. STUDY DESIGN Sequencing of polymerase-ε (POLE) and immunohistochemistry of mismatch repair (MMR) proteins and p53 were performed to stratify endometrial carcinomas into subgroups of POLE exonuclease domain mutation (EDM), MMR deficiency, abnormal p53 (p53 abn) and 'no specific molecular profile' (NSMP). NSMP was the reference subgroup for comparisons. Associations of molecular subgroups and uterine risk factors with stage were examined in univariable and multivariable analyses. RESULTS Six hundred and four patients were included in the study. None of the POLE EDM tumours extended beyond the uterine cervix. In an unadjusted analysis, p53 abn was associated with increased risk for stage IIIC-IV disease [odds ratio (OR) 4.6, 95% confidence interval (CI) 2.3-9.2; p < 0.0005]. When controlling for uterine risk factors (histotype and grade, depth of myometrial invasion, tumour size, lymphovascular space invasion), p53 was not an independent predictor of advanced disease. In contrast, POLE EDM independently predicted local disease (OR 0.12, 95% CI 0.015-0.99; p = 0.049 for stage II-IV cancer). Of the molecular subgroups, p53 abn was most strongly associated with the presence of high-risk uterine factors (ORs between 2.2 and 19; p ≤ 0.010). CONCLUSION Of the TCGA-based molecular subgroups, POLE EDM independently predicted early-stage endometrial carcinoma. Although p53 abn was not an independent predictor of advanced disease, its association with uterine risk factors could allow utilization of molecular data in deciding the type of staging surgery if knowledge of uterine factors is deficient.
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12
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A Modern Approach to Endometrial Carcinoma: Will Molecular Classification Improve Precision Medicine in the Future? Cancers (Basel) 2020; 12:cancers12092577. [PMID: 32927671 PMCID: PMC7564776 DOI: 10.3390/cancers12092577] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/22/2020] [Accepted: 08/30/2020] [Indexed: 12/19/2022] Open
Abstract
Endometrial cancer has been histologically classified as either an estrogen-dependent cancer with a favorable outcome or an estrogen-independent cancer with a worse prognosis. These parameters, along with the clinical attributions, have been the basis for risk stratification. Recent molecular and histopathological findings have suggested a more complex approach to risk stratification. Findings from the Cancer Genome Atlas Research Network established four distinctive genomic groups: ultramutated, hypermutated, copy-number low and copy-number high prognostic subtypes. Subsequently, more molecular and histopathologic classifiers were evaluated for their prognostic and predictive value. The impact of molecular classification is evident and will be recognized by the upcoming WHO classification. Further research is needed to give rise to a new era of molecular-based endometrial carcinoma patient care.
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Altin D, Taşkın S, Kahramanoglu I, Vatansever D, Tokgozoglu N, Karabük E, Turan H, Takmaz Ö, Naki MM, Güngör M, Köse MF, Ortac F, Arvas M, Ayhan A, Taskiran C. Combination of sentinel lymph node mapping and uterine frozen section examination to reduce side-specific lymphadenectomy rate in endometrial cancer: a Turkish Gynecologic Oncology Group study (TRSGO-SLN-002). Int J Gynecol Cancer 2020; 30:1005-1011. [PMID: 32474451 DOI: 10.1136/ijgc-2020-001353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aimed to find out whether side-specific pelvic lymphadenectomy can be omitted without compromising diagnostic efficacy according to "reflex frozen section" analysis of the uterus in case of sentinel lymph node (SLN) mapping failure. METHODS Patients who underwent surgery for endometrial cancer with an SLN algorithm were stratified as low-risk or high-risk according to the uterine features on the final pathology reports. Two models for low-risk patients were defined to omit side-specific pelvic lymphadenectomy: strategy A included patients with endometrioid histology, grade 1-2, and <50% myometrial invasion irrespective of the tumor diameter; strategy B included all factors of strategy A with the addition of tumor diameter ≤2 cm. Theoretical side-specific pelvic lymphadenectomy rates were calculated for the two strategies, assuming side-specific pelvic lymphadenectomy was omitted if low-risk features were present on reflex uterine frozen examination, and compared with the standard National Comprehensive Cancer Network (NCCN) SLN algorithm. RESULTS 372 endometrial cancer patients were analyzed. 230 patients (61.8%) had endometrioid grade 1 or 2 tumors with <50% myometrial invasion (strategy A), and in 123 (53.4%) of these patients the tumor diameter was ≤2 cm (strategy B); 8 (3.5%) of the 230 cases had lymphatic metastasis. None of them were detected by side-specific pelvic lymphadenectomy and metastases were limited to SLNs in 7 patients. At least one pelvic side was not mapped in 107 (28.8%) cases in the entire cohort, and all of these cases would require a side-specific pelvic lymphadenectomy based on the NCCN SLN algorithm. This rate could have been significantly decreased to 11.8% and 19.4% by applying reflex frozen section examination of the uterus using strategy A and strategy B, respectively. CONCLUSION Reflex frozen section examination of the uterus can be a feasible option to decide whether side-specific pelvic lymphadenectomy is necessary for all the patients who failed to map with an SLN algorithm. If low-risk factors are found on frozen section examination, side-specific pelvic lymphadenectomy can be omitted without compromising diagnostic efficacy for lymphatic spread.
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Affiliation(s)
- Duygu Altin
- Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Salih Taşkın
- Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Ilker Kahramanoglu
- Obstetrics and Gynecology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Dogan Vatansever
- Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - Nedim Tokgozoglu
- Obstetrics and Gynecology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Emine Karabük
- Gynecology and Obstetrics, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Hasan Turan
- Gynecology and Obstetrics, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Özgüç Takmaz
- Gynecology and Obstetrics, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Murat Naki
- Gynecology and Obstetrics, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Mete Güngör
- Gynecology and Obstetrics, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Faruk Köse
- Gynecology and Obstetrics, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Firat Ortac
- Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Macit Arvas
- Obstetrics and Gynecology, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Ali Ayhan
- Gynecology and Obstetrics, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Cagatay Taskiran
- Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
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Giglio A, Miller B, Curcio E, Kuo YH, Erler B, Bosscher J, Hicks V, ElSahwi K. Challenges to Intraoperative Evaluation of Endometrial Cancer. JSLS 2020; 24:e2020.00011. [PMID: 32425481 PMCID: PMC7208917 DOI: 10.4293/jsls.2020.00011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Intraoperative evaluation of the uterus has been reported to predict risk of lymph node spread in endometrial cancer. Four criteria have been prospectively validated by the Mayo Clinic; histopathology, grade, tumor size, and depth of myometrial invasion. The objective of this study is to assess the accuracy of intraoperative evaluation in a university-affiliated teaching setting. METHODS This study was a retrospective chart review of 105 cases of endometrial cancer who underwent robotic-assisted staging from January 2016 through December 2017. RESULTS Seventy-five cases were included. The mean age was 65 y and mean body mass index was 33 kg/m2. Fifty-eight patients (80.6%) had no change between intraoperative and postoperative grade. This yielded a 19.4% discordance rate with a significant disagreement (P = .003, Cohen's κ = 0.705). Fifty-eight patients (82.9%) had no change in depth of invasion. This yielded a 17.1% discordance rate with a significant disagreement (P = .0498, Cohen's kappa of 0.69 [95% confidence interval, 0.53-0.85]). Average tumor diameter was 3.4 cm. Seven patients (11.7%) were upsized from the low-risk (≤2 cm) to the high-risk category (>2 cm). This led to an 11.7% discordance rate, with a significant disagreement (P = .008, Cohen's kappa of 0.69 [95% confidence interval, 0.48-0.89]). In 15 of 75 cases (20%), intraoperative evaluation of the size of the tumor was not possible and deferred to the final pathology report. CONCLUSION We conclude the Mayo Clinic Criteria cannot be universally adopted until all four criteria can be validated through a prospective study that includes institutions that have variable resources.
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Affiliation(s)
| | | | | | - Yen-Hong Kuo
- Department of Biostatistics and Research Administration
| | - Brian Erler
- Department of Pathology, Hackensack Meridian Health, Jersey Shore University Medical Center, Neptune, New Jersey
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Stewart KI, Eska JS, Harrison RF, Suidan R, Abraham A, Chisholm GB, Meyer LA, Westin SN, Fleming ND, Frumovitz M, Aloia TA, Soliman PT. Implementation of a sentinel lymph node mapping algorithm for endometrial cancer: surgical outcomes and hospital charges. Int J Gynecol Cancer 2020; 30:352-357. [PMID: 31911539 DOI: 10.1136/ijgc-2019-000941] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION The purpose of this study was to compare operative times, surgical outcomes, resource utilization, and hospital charges before and after the implementation of a sentinel lymph node (SLN) mapping algorithm in endometrial cancer. METHODS All patients with clinical stage I endometrial cancer were identified pre- (2012) and post- (2017) implementation of the SLN algorithm. Clinical data were summarized and compared between groups. Total hospital charges incurred on the day of surgery were extracted from the hospital financial system for each patient and all charges were adjusted to 2017 US dollars. RESULTS A total of 203 patients were included: 71 patients in 2012 and 130 patients in 2017. There was no difference in median age, body mass index, or stage. In 2012, 35/71 patients (49.3%) underwent a lymphadenectomy. In 2017, SLN mapping was attempted in 120/130 patients (92.3%) and at least one SLN was identified in 110/120 (91.7%). Median estimated blood loss was similar between groups (100 mL vs 75 mL, p=0.081). There was a significant decrease in both median operative time (210 vs 171 min, p=0.007) and utilization of intraoperative frozen section (63.4% vs 14.6%, p<0.0001). No significant differences were noted in intraoperative (p=1.00) or 30 day postoperative complication rates (p=0.30). The median total hospital charges decreased by 2.73% in 2017 as compared with 2012 (p=0.96). DISCUSSION Implementation of an SLN mapping algorithm for high- and low-risk endometrial cancer resulted in a decrease in both operative time and intraoperative frozen section utilization with no change in surgical morbidity. While hospital charges did not significantly change, further studies are warranted to assess the true cost of SLN mapping.
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Affiliation(s)
- Katherine I Stewart
- Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jarrod S Eska
- Institute for Cancer Care Innovation, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ross F Harrison
- Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rudy Suidan
- Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ann Abraham
- Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gary B Chisholm
- Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Larissa A Meyer
- Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shannon N Westin
- Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicole D Fleming
- Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Frumovitz
- Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Thomas A Aloia
- Institute for Cancer Care Innovation, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pamela T Soliman
- Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Chambers LM, Vargas R, Michener CM. Sentinel lymph node mapping in endometrial and cervical cancer: a survey of practices and attitudes in gynecologic oncologists. J Gynecol Oncol 2019; 30:e35. [PMID: 30887757 PMCID: PMC6424853 DOI: 10.3802/jgo.2019.30.e35] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To determine patterns among gynecologic oncologists in sentinel lymph node mapping (SLNM) for endometrial cancer (EC) and cervical cancer (CC). Methods A online survey assessing the practice of SLNM, including incidence, patterns of usage, and reasons for non-use was distributed to Society of Gynecologic Oncology candidate and full members in August 2017. Descriptive statistics and univariate analysis was performed. Results The 1,117 members were surveyed and 198 responses (17.7%) were received. Of the 70% (n=139) performing SLNM, the majority reported use for both CC and EC (64.0%) or EC alone (33.1%). In those using SLNM in EC, the majority (86.6%) performed SLNM in >50% of cases for all patients (56.3%), International Federation of Gynecology and Obstetrics grade 1 (43.0%) and 2 (42.2%). Reported benefits of SLNM in EC were reduced surgical morbidity (89.6%), lymphedema (85.2%), and operative time (63.7%). Among those using SLNM for CC, the majority (73.1%) did so in >50% of cases. In EC, 77.2% and 21.3% reported that micro-metastatic disease (0.2–2.0 cm) and isolated tumor cells (ITCs) should be treated as node positive, respectively. In those not using SLNM for EC (n=64) and CC (n=105), concerns were regarding efficacy of SLNM and lack of training. When queried regarding training, 73.7% felt that SLNM would impact skill in full lymphadenectomy (LND). Conclusion The SLNM is utilized frequently among gynecologic oncologists for EC and CC staging. Common reasons for non-uptake include uncertainty of current data, lack of training and technology. Concerns exist regarding impact of SLNM in fellowship training of LND.
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Affiliation(s)
- Laura Moulton Chambers
- Division of Gynecologic Oncology, Ob/Gyn & Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Roberto Vargas
- Division of Gynecologic Oncology, Ob/Gyn & Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Chad M Michener
- Division of Gynecologic Oncology, Ob/Gyn & Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Taşkın S, Altin D, Vatansever D, Tokgozoglu N, Karabük E, Turan H, Takmaz Ö, Kahramanoglu I, Naki MM, Güngör M, Köse F, Ortac F, Arvas M, Ayhan A, Taskiran C. Sentinel lymph node biopsy in early stage endometrial cancer: a Turkish gynecologic oncology group study (TRSGO-SLN-001). Int J Gynecol Cancer 2019; 30:299-304. [PMID: 31857440 DOI: 10.1136/ijgc-2019-000847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this multicenter study was to evaluate the feasibility of sentinel lymph node (SLN) mapping in clinically uterine confined endometrial cancer. METHODS Patients who underwent primary surgery for endometrial cancer with an SLN algorithm were reviewed. Indocyanine green or blue dye was used as a tracer. SLNs and/or suspicious lymph nodes were resected. Side specific lymphadenectomy was performed when mapping was unsuccessful. SLNs were ultrastaged on final pathology. RESULTS 357 eligible patients were analyzed. Median age was 59 years. Median number of resected SLNs was 2 (range 1-12) per patient. Minimal invasive and open surgeries were performed in 264 (73.9%) and 93 (26.1%) patients, respectively. Indocyanine green was used in 231 (64.7%) and blue dye in 126 (35.3%) patients. The dyes were injected into the cervix in 355 (99.4%) patients. The overall and bilateral SLN detection rates were 91.9% and 71.4%, respectively. The mapping rates using indocyanine green or blue dye were comparable (P=0.526). There were 43 (12%) patients with lymphatic metastasis. The SLN algorithm was not able to detect 3 of 43 patients who had isolated paraaortic metastasis. After SLN biopsy, complete pelvic lymphadenectomy was performed in 286 (80.1%) patients. Sensitivity and negative predictive value were both 100% for the detection of pelvic lymph node metastases. In addition, 117 (32.8%) patients underwent completion paraaortic lymphadenectomy after SLN biopsy. In these patients, sensitivity for detecting metastases to pelvic and/or paraaortic lymph nodes was 90.3% with a negative predictive value of 96.6%. The risk of non-SLN involvement in patients with macrometastatic SLNs, micrometastatic SLNs, and isolated tumor cells in SLNs were 61.2%, 14.3% and 0%, respectively. CONCLUSIONS SLN biopsy had good accuracy in detecting lymphatic metastasis. However, one-third of cases with metastatic SLNs also had non-SLN involvement and this risk increased to two-thirds of cases with macrometastatic SLNs. The effect of leaving these nodes in situ on survival should be evaluated in further studies.
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Affiliation(s)
- Salih Taşkın
- Obstetrics and Gynecology, Ankara University Medical Faculty, Ankara, Turkey
| | - Duygu Altin
- Obstetrics and Gynecology, Ankara University Medical Faculty, Ankara, Turkey
| | - Dogan Vatansever
- Obstetrics and Gynecology, Koc University Medical Faculty, Istanbul, Turkey
| | - Nedim Tokgozoglu
- Obstetrics and Gynecology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Emine Karabük
- Gynecology and Obstetrics, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Hasan Turan
- Obstetrics and Gynecology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Özgüç Takmaz
- Gynecology and Obstetrics, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Ilker Kahramanoglu
- Obstetrics and Gynecology, Diyarbakır Education and Research Hospital, Diyarbakır, Turkey
| | - Mehmet Murat Naki
- Gynecology and Obstetrics, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Mete Güngör
- Gynecology and Obstetrics, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Faruk Köse
- Gynecology and Obstetrics, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Firat Ortac
- Obstetrics and Gynecology, Ankara University Medical Faculty, Ankara, Turkey
| | - Macit Arvas
- Obstetrics and Gynecology, Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ali Ayhan
- Gynecology and Obstetrics, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Cagatay Taskiran
- Obstetrics and Gynecology, Koc University Medical Faculty, Istanbul, Turkey
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Liu MJ, Liu ZF, Yin WH, Chen XR, Gao LY, Sun HJ. Application of transvaginal three-dimensional power Doppler ultrasound in benign and malignant endometrial diseases. Medicine (Baltimore) 2019; 98:e17965. [PMID: 31725659 PMCID: PMC6867744 DOI: 10.1097/md.0000000000017965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To investigate the value of transvaginal three-dimensional (3D) power Doppler ultrasound in the diagnosis of benign and malignant endometrial diseases.A total of 144 patients with endometrial thickness ≥4 mm were enrolled. Endometrial thickness was measured by transvaginal 3D B-mode ultrasound, while blood signals were detected by 3D power Doppler ultrasound. Endometrial volume (EV), vascularization index (VI), blood flow index (FI), and vascularization flow index (VFI) were calculated. All histopathological diagnoses of endometrium were obtained.There were 86 benign and 58 malignant cases. There were statistically significant differences between two groups in endometrial thickness [1.50 (1.30, 1.80) vs 2.30 (1.80, 3.20), P < .001], EV [10.62 (7.14, 17.36) vs 28.94 (9.59, 67.96), P < .001], VI [6.07 (3.61, 10.33) vs 12.01 (7.50, 19.87), P = .001], FI [27.42 (24.45, 31.33) vs 32.98 (30.22, 35.40), P < .001], and VFI [1.58 (0.92, 3.32) vs 4.28 (2.24, 6.41), P < 0.001]. Sensitivity and specificity of endometrial thickness were relatively high [endometrial thickness (86.2%, 76.1%), EV (48.3%, 97.7%), VI (72.4%, 69.8%), FI (72.4%, 74.4%), and VFI (72.4%, 74.4%)]. There was no significant difference in any parameters of the endometrium between different stages (Ia, Ib, II, and above) or phases (G1, G2, and G3) of Ia phase of endometrial cancer (all P > .05).Transvaginal 3D power Doppler ultrasound is valuable in the differentiating benign and malignant endometrial lesions.
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Affiliation(s)
- Mei-juan Liu
- Department of Ultrasound, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Zhong-feng Liu
- Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University
| | - Wei-hong Yin
- Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University
| | - Xiao-ran Chen
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Ling-Yun Gao
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Hong-jun Sun
- Department of Ultrasound, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan
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Sánchez M, Causa Andrieu P, Latapie C, Saez Perrotta M, Napoli N, Perrotta M, Chacón C, Wernicke A. Diagnostic yield of magnetic resonance imaging and intraoperative frozen section in the determination of deep myometrial invasion in endometrial cancer. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Sánchez M, Causa Andrieu P, Latapie C, Saez Perrotta M, Napoli N, Perrotta M, Chacón C, Wernicke A. Rédito diagnóstico de la resonancia magnética y el estudio por congelación intraoperatorio en la determinación de la invasión miometrial profunda en cáncer de endometrio. RADIOLOGIA 2019; 61:315-323. [DOI: 10.1016/j.rx.2019.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/08/2019] [Accepted: 01/29/2019] [Indexed: 12/24/2022]
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Gitas G, Proppe L, Alkatout I, Rody A, Kotanidis C, Tsolakidis D, Baum S. Accuracy of frozen section at early clinical stage of endometrioid endometrial cancer: a retrospective analysis in Germany. Arch Gynecol Obstet 2019; 300:169-174. [DOI: 10.1007/s00404-019-05158-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/06/2019] [Indexed: 11/24/2022]
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Sentinel Lymph Node Ultra-staging as a Supplement for Endometrial Cancer Intraoperative Frozen Section Deficiencies. Int J Gynecol Pathol 2019; 38:52-58. [PMID: 28968296 DOI: 10.1097/pgp.0000000000000463] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For endometrial cancer (EC), most surgeons rely on intraoperative frozen section (IFS) to determine the risk of nodal metastasis and necessity of lymphadenectomy. IFS remains a weak link in this practice due to its susceptibility to diagnostic errors. As a less invasive alternative, sentinel lymph node (SLN) mapping and ultra-staging have gradually gained acceptance for EC. We aimed to establish the SLN success rate, negative predictive value, and whether SLNs provide useful information for cases misdiagnosed on IFS. From 2013 to 2017, 100 patients (63 low-risk and 37 high-risk EC) underwent hysterectomy, bilateral salpingo-oophorectomy, and SLN. Among them, 56 had additional pelvic lymphadenectomy. A total of 337 SLNs were obtained in 86 cases: 55 bilaterally and 31 unilaterally. The remaining 14 cases failed because of patient obesity or leiomyoma. Pathology ultra-staging detected 2 positive SLNs from 2 patients (1 with isolated tumor cells, 1 with micrometastases). One of 773 nonsentinel pelvic nodes was positive on the contralateral hemi-pelvis in a patient who was mapped unilaterally, resulting in negative predictive value of 100%. During IFS, tumor grade and/or depth of myometrial invasion was misdiagnosed in 22 cases (22%). These errors would have resulted in under-staging in 10 high-risk patients or over-staging in 4 low-risk patients. SLNs were mapped in these misestimated patients, with one revealing metastases. SLN provides invaluable information on nodal status while detecting occult metastases in cases misdiagnosed on IFS. Our findings justify the incorporation of SLN in initial surgery for EC as an offset to IFS diagnostic errors, minimizing their negative impact on patient care.
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Günakan E, Atan S, Haberal AN, Küçükyıldız İA, Gökçe E, Ayhan A. A novel prediction method for lymph node involvement in endometrial cancer: machine learning. Int J Gynecol Cancer 2018; 29:320-324. [PMID: 30718313 DOI: 10.1136/ijgc-2018-000033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/28/2018] [Accepted: 08/30/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The necessity of lymphadenectomy and the prediction of lymph node involvement (LNI) in endometrial cancer (EC) have been hotly-debated questions in recent years. Machine learning is a broad field that can produce results and estimations. In this study we constructed prediction models for EC patients using the Naïve Bayes machine learning algorithm for LNI prediction. METHODS The study assessed 762 patients with EC. Algorithm models were based on the following histopathological factors: V1: final histology; V2: presence of lymphovascular space invasion (LVSI); V3: grade; V4: tumor diameter; V5: depth of myometrial invasion (MI); V6: cervical glandular stromal invasion (CGSI); V7: tubal or ovarian involvement; and V8: pelvic LNI. Logistic regression analysis was also used to evaluate the independent factors affecting LNI. RESULTS The mean age of patients was 59.1 years. LNI was detected in 102 (13.4%) patients. Para-aortic LNI (PaLNI) was detected in 54 (7.1%) patients, of which four patients had isolated PaLNI. The accuracy rate of the algorithm models was found to be between 84.2% and 88.9% and 85.0% and 97.6% for LNI and PaLNI, respectively. In multivariate analysis, the histologic type, LVSI, depth of MI, and CGSI were independently and significantly associated with LNI (p<0.001 for all). CONCLUSIONS Machine learning may have a place in the decision tree for the management of EC. This is a preliminary report about the use of a new statistical technique. Larger studies with the addition of sentinel lymph node status, laboratory findings, or imaging results with machine learning algorithms may herald a new era in the management of EC.
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Affiliation(s)
- Emre Günakan
- Department of Obstetrics and Gynecology, University of Medical Sciences, Keçioren Training and Research Hospital, Ankara, Turkey
| | | | | | | | - Ehad Gökçe
- Department of Obstetrics and Gynecology, Başkent University, School of Medicine, Ankara, Turkey
| | - Ali Ayhan
- Department of Obstetrics and Gynecology, Başkent University, School of Medicine, Ankara, Turkey
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Gasparri ML, Caserta D, Benedetti Panici P, Papadia A, Mueller MD. Surgical staging in endometrial cancer. J Cancer Res Clin Oncol 2018; 145:213-221. [PMID: 30460411 DOI: 10.1007/s00432-018-2792-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/12/2018] [Indexed: 01/17/2023]
Abstract
In several malignancies, it has been demonstrated that the lymph nodal status is the most important pathologic factor affecting prognosis and giving the indication to further adjuvant treatment. The surgical assessment of the lymph nodal status in endometrial cancer is debated since 30 years. Recently, the sentinel lymph node mapping is rapidly gaining clinical acceptance in endometrial cancer. The adoption of Indocyanine Green as a safe and user friendly tracer for sentinel lymph node mapping increased the speed to which this procedure is getting applied in clinical practice. As a consequence of this rapid growth, several fundamental questions have been raised and are still debatable. In this manuscript, we discuss the importance of a known pathological lymph nodal status, the technique of the sentinel lymph node mapping with the reported false negative rates and detection rates according to the different tracers adopted, and the clinical scenarios in which a sentinel lymph node mapping could be employed.
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Affiliation(s)
- Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland.
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Rome, Italy.
- Department of Gynecological-Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy.
| | - Donatella Caserta
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecological-Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
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Papadia A, Gasparri ML, Wang J, Radan AP, Mueller MD. Sentinel node biopsy for treatment of endometrial cancer: current perspectives. ACTA ACUST UNITED AC 2018; 71:25-35. [PMID: 30318882 DOI: 10.23736/s0026-4784.18.04337-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The risk of lymph nodal metastases in endometrial cancer varies greatly according to the characteristics of the primary tumor. Surgical staging with a systematic lymphadenectomy in endometrial cancer is debated since three decades. On one hand, it provides important pathological information on the spread of the tumor allowing for an appropriate decision making on adjuvant treatment but on the other side it is characterized by a non-negligible short and long-term morbidity. In the past decade, various efforts have been made in the attempt to apply the concept of the sentinel lymph node mapping in endometrial cancer. The sentinel lymph node mapping has the potential to provide the necessary pathological lymph nodal information at a reasonable cost in terms of morbidity. In this review, the most relevant aspects of the sentinel lymph node mapping in endometrial cancer are summarized. Furthermore, the performance in terms of false negative rates and detection rates, the clinical value of the pathological ultrastaging, its clinical applicability in different scenarios including patients preoperatively considered to be at low or at high risk are discussed. Oncological outcome of the patients who have been submitted to a sentinel lymph node mapping as compared to a full lymhadenectomy are presented as well as technical aspects to improve the performance of the surgical technique.
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Affiliation(s)
- Andrea Papadia
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, Bern, Switzerland -
| | - Maria L Gasparri
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, Bern, Switzerland.,Department of Gynecology and Obstetrics, Sapienza University, Rome, Italy
| | - Junjie Wang
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, Bern, Switzerland.,Department of Gynecological Oncology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Anda P Radan
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, Bern, Switzerland
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Tanaka T, Terai Y, Yamamoto K, Yamada T, Ohmichi M. The diagnostic accuracy of fluorodeoxyglucose-positron emission tomography/computed tomography and sentinel node biopsy in the prediction of pelvic lymph node metastasis in patients with endometrial cancer: A retrospective observational study. Medicine (Baltimore) 2018; 97:e12522. [PMID: 30235772 PMCID: PMC6160259 DOI: 10.1097/md.0000000000012522] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
According to the sentinel node biopsy (SNB), systematic pelvic lymph node dissection (PLND) may not be needed for patients with early-stage endometrial cancer. On the other hand, imaging technology including fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) has been developing worldwide. The aim of this study was to evaluate the combined diagnostic accuracy of FDG PET/CT and SNB in the prediction of pelvic lymph node metastasis in endometrial cancer patients.One hundred twenty-one patients with endometrial cancer underwent FDG PET/CT before hysterectomy and received SNB followed by systematic PLND. Univariate and multivariate analyses were performed to compare the diagnostic accuracy of FDG PET/CT and SNB in the prediction of pelvic node metastasis to the ultimate histologic status.FDG PET/CT had lower sensitivity (36.8% versus 57.9%, P = .1) and a higher specificity (96.4% versus 84.8%, P < .01) than SNB. The kappa statistics of FDG PET/CT and SNB were 0.37 (95% CI, 0.15-0.59) and 0.72 (95% CI, 0.53-0.90), respectively. The sensitivity of SNB was significantly higher than that of FDG PET/CT in all hemi-pelvises (HPs) in which the short axis of the largest metastatic lymph node was <5 mm in diameter (72.7% versus 18.2%, P = .01). In contrast, the sensitivity of FDG PET/CT was higher than that of SNB in all HPs in which the short axis of the largest metastatic lymph node was ≥5 mm in diameter (62.5% versus 37.5%, P = .2); however, the difference was not statistically significant. When the combined diagnosis of FDG PET/CT and SNB was made, the sensitivity and specificity were 84.2% and 82.1%, respectively.SNB was more useful for detecting lymph node metastasis than FDG PET/CT, especially in patients with small metastatic lymph nodes. The combined diagnosis of FDG PET/CT and SNB improves the sensitivity; PET-positive nodes should be dissected regardless of SNB status and HPs in which SNB was not detected should be dissected systematically regardless of FDG PET/CT status.
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Affiliation(s)
| | | | | | - Takashi Yamada
- Department of Pathology, Osaka Medical College, Takatsuki, Japan
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27
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Papadia A, Buda A, Gasparri ML, Di Martino G, Bussi B, Verri D, Mueller MD. The impact of different doses of indocyanine green on the sentinel lymph-node mapping in early stage endometrial cancer. J Cancer Res Clin Oncol 2018; 144:2187-2191. [DOI: 10.1007/s00432-018-2716-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/19/2018] [Indexed: 11/24/2022]
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28
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Erdem B, Aşıcıoğlu O, Seyhan NA, Peker N, Ülker V, Akbayır Ö. Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia? Int J Surg 2018; 53:350-353. [DOI: 10.1016/j.ijsu.2018.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/22/2018] [Accepted: 04/10/2018] [Indexed: 11/29/2022]
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Papadia A, Gasparri ML, Radan AP, Stämpfli CAL, Rau TT, Mueller MD. Retrospective validation of the laparoscopic ICG SLN mapping in patients with grade 3 endometrial cancer. J Cancer Res Clin Oncol 2018; 144:1385-1393. [PMID: 29691646 DOI: 10.1007/s00432-018-2648-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/19/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the sensitivity, negative predictive value (NPV) and false-negative (FN) rate of the near infrared (NIR) indocyanine green (ICG) sentinel lymph node (SLN) mapping in patients with poorly differentiated endometrial cancer who have undergone a full pelvic and para-aortic lymphadenectomy after SLN mapping. METHODS We performed a retrospective analysis of patients with endometrial cancer undergoing a laparoscopic NIR-ICG SLN mapping followed by a systematic pelvic and para-aortic lymphadenectomy. Inclusion criteria were a grade 3 endometrial cancer or a high-risk histology (papillary serous, clear cell carcinoma, carcinosarcoma, and neuroendocrine carcinoma) and a completion pelvic and para-aortic lymphadenectomy to the renal vessels after SLN mapping. Overall and bilateral detection rates, sensitivity, NPV, and FN rates were calculated. RESULTS From December 2012 until January 2017, 42 patients fulfilled inclusion criteria. Overall and bilateral detection rates were 100 and 90.5%, respectively. Overall, 23.8% of the patients had lymph node metastases. In one patient, despite negative bilateral pelvic SLNs, a metastatic non-SLN-isolated para-aortic metastasis was detected. This NSLN was clinically suspicious and sent to frozen section analysis during the surgery. FN rate, sensitivity, and NPV were 10, 90, and 97.1%, respectively. For the SLN mapping algorithm, FN rate, sensitivity, and NPV were 0, 100, and 100%, respectively. CONCLUSIONS Laparoscopic NIR-ICG SLN mapping in high-risk endometrial cancer patients has acceptable sensitivity, FN rate, and NPV.
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Affiliation(s)
- Andrea Papadia
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Effingerstrasse 102, 3010, Bern, Switzerland.
| | - Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Effingerstrasse 102, 3010, Bern, Switzerland.,Dipartimento Assistenziale Integrato Ostetricia e Ginecologia, Perinatologia e Puericultura, "Sapienza" University of Rome, Rome, Italy.,Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Anda P Radan
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Effingerstrasse 102, 3010, Bern, Switzerland
| | - Chantal A L Stämpfli
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Effingerstrasse 102, 3010, Bern, Switzerland
| | - Tilman T Rau
- Institute of Pathology, University of Bern, Murtenstrasse 31, 3008, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Effingerstrasse 102, 3010, Bern, Switzerland
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Dos Santos Siufi DF, Neto JS, Abrão MS, Favero G. Lymphadenectomy in Early Stage Endometrial Cancer: A Critical Review of the Current Literature. TUMORI JOURNAL 2018. [DOI: 10.1177/1660.18154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - João Siufi Neto
- Research fellow, Gynecology Department, Mayo Clinic Arizona, Phoenix, AZ, United States of America
| | - Mauricio Simões Abrão
- Department of Obstetrics and Gynecology, University of São Paulo, São Paulo, SP, Brazil
| | - Giovanni Favero
- Department of Obstetrics and Gynecology, University of São Paulo, São Paulo, SP, Brazil
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Burnett AF, Stone RL, Jeffreys MA, Zorn KK, Quick CM. A Quick and Inexpensive Alternative to Frozen Section for Diagnosing Myometrial Invasion in Endometrial Cancer. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander F. Burnett
- Division of Gynecologic Oncology, Winthrop P. Rockefeller Cancer Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Rebecca L. Stone
- Division of Gynecologic Oncology, The Johns Hopkins University, Baltimore, MD
| | - Mathew A. Jeffreys
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Kristin K. Zorn
- Division of Gynecologic Oncology, Winthrop P. Rockefeller Cancer Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | - C. Mathew Quick
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR
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Is Tumor Size Really Important for Prediction of Lymphatic Dissemination in Grade 1 Endometrial Carcinoma With Superficial Myometrial Invasion? Int J Gynecol Cancer 2018; 27:1393-1398. [PMID: 28604451 DOI: 10.1097/igc.0000000000001025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Selection of patients with endometrioid endometrial cancer (EEC), in whom systematic lymph node dissection (LND) is indicated, is an important part of management to maintain optimal oncological outcomes, while avoiding unnecessary morbidities. According to the current approach, LND is recommended for the patients with International Federation of Gynecology and Obstetrics (FIGO) grade 1 to 2 tumors and a primary tumor diameter (PTD) greater than 2 cm, even with myometrial invasion (MMI) of less than 50%. We aimed to determine incidence of LN metastasis in this particular group of patients with grade 1 tumors, superficial MMI, and a PTD greater than 2 cm. MATERIALS AND METHODS This study only focused on women with FIGO grade 1 EEC having less than 50% MMI. Therefore, women with grade 2 or 3 tumors were excluded, as well as patients with 50% or greater MMI. We also excluded women with macroscopic extrauterine disease, as well as patients with cervical stromal involvement. Patients were divided into subgroups with regard to PTD; group 1 was composed of patients with PTD of 20 mm or less, whereas group 2 was composed of patients with PTD greater than 20 mm. All clinical and pathological variables were compared between the groups. RESULTS Final pathology reports of 484 women with EEC who underwent surgical staging were analyzed. Among these women, there were 123 women in group 1 (PTD ≤ 20 mm) and 120 women in group 2 (PTD > 20 mm), with FIGO grade 1 tumors and superficial MMI. The median number of total LNs removed was 54 (range, 20-151). There were no women with pelvic and/or para-aortic LN metastasis in group 2, as well as in group 1. CONCLUSIONS Our results suggest that lymphadenectomy may be omitted in women with FIGO grade 1 EEC having superficial MMI regardless of PTD. Deferral of systematic LND in this subgroup of patients may lead to reductions in costs and surgical morbidity.
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Does Obesity Affect Pathologic Agreement of Initial and Final Tumor Grade of Disease in Endometrial Cancer Patients? Int J Gynecol Cancer 2018; 27:714-719. [PMID: 28333843 DOI: 10.1097/igc.0000000000000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The objectives of this study were to compare preoperative and postoperative tumor grade to determine if surgical staging decisions for endometrial cancer based on preoperative biopsy are feasible and whether obesity affects the agreement. METHODS A retrospective cohort study of women with endometrial cancer between January 2010 and December 2011 was performed. Demographics, stage of final pathology, biopsy method, preoperative and postoperative tissue grade, and histology were abstracted and stratified by patient body mass index (obese ≥30 kg/m and nonobese <30 kg/m). Patients with incomplete records or uterine sarcoma were excluded. The agreement between preoperative and postoperative tumor grade for all patients and in obese and nonobese patients was determined using weighted κ statistics. RESULTS Four hindered forty-five patients were included: 161 nonobese patients and 284 obese patients. The proportion of preoperative sampling via office biopsy and dilation and curettage was similar in each cohort. Overall, the agreement between preoperative and postoperative pathology was only fair (weighted κ = 0.21). Stratified by body mass index, the agreement between preoperative and postoperative grade remains fair in obese and slight in nonobese patients (weighted κ = 0.21 and 0.19, respectively). Substantial increases in tumor grade from preoperative to postoperative pathologic specimens occurred in both cohorts. CONCLUSIONS Obesity does not appear to significantly alter the correlation between preoperative biopsy and final tumor grade. With only fair correlation between preoperative and postoperative pathologic evaluation, utilization of preoperative biopsy pathology results as a triage tool for surgical staging should be avoided. However, the discordance between preoperative and postoperative pathology in favor of a higher grade on final pathology in both groups may cause some surgeons to favor staging.
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Ducie JA, Eriksson AGZ, Ali N, McGree ME, Weaver AL, Bogani G, Cliby WA, Dowdy SC, Bakkum-Gamez JN, Soslow RA, Keeney GL, Abu-Rustum NR, Mariani A, Leitao MM. Comparison of a sentinel lymph node mapping algorithm and comprehensive lymphadenectomy in the detection of stage IIIC endometrial carcinoma at higher risk for nodal disease. Gynecol Oncol 2017; 147:541-548. [DOI: 10.1016/j.ygyno.2017.09.030] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 11/15/2022]
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Bartosch C, Pires M, Jerónimo C, Lopes JM. The role of pathology in the management of patients with endometrial carcinoma. Future Oncol 2017; 13:1003-1020. [PMID: 28481146 DOI: 10.2217/fon-2016-0570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Pathology plays a critical role in every step in the management of endometrial carcinoma patients. In this review, we describe the state of the art of pathological examination, including examination of endometrium biopsy; intra-operative evaluation with gross examination and frozen section; and grossing of hysterectomy specimen and its histological and immunohistochemistry study. The main pathologic findings in each step are described, as well as limitations and difficulties that may ensue. We highlight the important pathologic parameters that determine treatment options and prognosis of endometrial cancer patients.
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Affiliation(s)
- Carla Bartosch
- Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal.,Department of Pathology and Oncology, Medical Faculty, University of Porto, Porto, Portugal.,Cancer Biology & Epigenetics Group, Research Center, Portuguese Oncology Institute of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (PCCC), Porto, Portugal
| | - Mónica Pires
- Porto Comprehensive Cancer Center (PCCC), Porto, Portugal.,Department of Gynecology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Carmen Jerónimo
- Cancer Biology & Epigenetics Group, Research Center, Portuguese Oncology Institute of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (PCCC), Porto, Portugal.,Department of Pathology & Molecular Immunology, Institute of Biomedical Sciences Abel Salazar-ICBAS, University of Porto, Porto, Portugal
| | - José Manuel Lopes
- Department of Pathology and Oncology, Medical Faculty, University of Porto, Porto, Portugal.,Department of Pathology, Centro Hospitalar de São João, Porto, Portugal.,IPATIMUP (Institute of Molecular Pathology & Immunology, University of Porto) & I3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Portugal
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The detection of sentinel lymph nodes in laparoscopic surgery can eliminate systemic lymphadenectomy for patients with early stage endometrial cancer. Int J Clin Oncol 2017; 23:305-313. [PMID: 29098518 PMCID: PMC5882620 DOI: 10.1007/s10147-017-1196-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 09/21/2017] [Indexed: 01/19/2023]
Abstract
Background The examination of a sentinel lymph node (SLN), where lymph node metastasis first occurs, may be advocated as an alternative staging technique. The aim of this study was to evaluate the feasibility and detection rates of an SLN biopsy in patients with endometrial cancer. Study design Two hundred and eleven patients with endometrial cancer underwent an SLN biopsy at hysterectomy using three kinds of tracers including 99m-technetium-labeled tin colloid (99mTc), indigo carmine and indocyanine green. Factors related to the side-specific detection rate, sensitivity and false negative rate were analyzed. Results The detection rates of the SLN biopsy using 99mTc, indigo carmine and indocyanine green were 77.9, 17.0 and 73.4%, respectively. The detection rate was lower in elderly patients (≥60 years) (67.9 vs 89.2%, p < 0.01), patients with >50% myometrial invasion (68.3 vs 85.2%, p < 0.01), patients with high-grade tumors (69.5 vs 84.9%, p < 0.01) and patients who underwent laparotomy (71.2 vs 84.9%, p < 0.01). There were no significant differences in body mass index. The sensitivity was not significantly different in any factor. However, the false negative rate was higher in patients with > 50% myometrial invasion (11.5 vs 1.2%, p < 0.01), high-grade tumors (13.3 vs 0.8%, p < 0.01) and who underwent laparotomy (12.2 vs 0.4%, p < 0.01). Conclusion Patients who underwent laparoscopy with < 50% myometrial invasion and low-grade tumors not only have higher detection rates, but also have lower false negative rates. These patients may avoid systemic lymphadenectomy according to the status of the SLN biopsy.
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Wisner KPA, Ahmad S, Holloway RW. Indications and techniques for robotic pelvic and para-aortic lymphadenectomy with sentinel lymph node mapping in gynecologic oncology. Best Pract Res Clin Obstet Gynaecol 2017; 45:83-93. [DOI: 10.1016/j.bpobgyn.2017.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/17/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
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Desouki MM, Li Z, Hameed O, Fadare O. Intraoperative Pathologic Consultation on Hysterectomy Specimens for Endometrial Cancer: An Assessment of the Accuracy of Frozen Sections, "Gross-Only" Evaluations, and Obtaining Random Sections of a Grossly "Normal" Endometrium. Am J Clin Pathol 2017; 148:345-353. [PMID: 28967955 DOI: 10.1093/ajcp/aqx076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pathologic intraoperative consultation (IOC) is a common approach for segregating the subset of patients with endometrial cancer who likely require a lymphadenectomy. METHODS We evaluate factors related to the performance and value of IOC, including the accuracy of frozen sections, "gross-only examinations," and obtaining random sections when a gross lesion is not apparent. RESULTS IOC was performed by gross examination only in 17 (8%) of 250 cases, the specificity and negative predictive value of which in diagnosing cancer were 100% and 85%, respectively. Among the 64 cases wherein a gross lesion was not apparent and random sections were examined, a final diagnosis of carcinoma was rendered in 20, of which only three (15%) had a diagnosable malignancy on the random section. The frozen-section/final diagnosis concordance was 80% for tumor grade. Determining the depth of myometrial invasion was problematic, with 36% underestimation and 2.6% overestimation. CONCLUSIONS Obtaining random sections in the absence of a gross lesion has no significant benefit, and a negative result is likely to provide inaccurate data to the surgeon. Frozen-section analyses are a generally reliable tool to determine "low-risk" pathologic parameters that were evaluated herein when a gross lesion is present.
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Affiliation(s)
- Mohamed Mokhtar Desouki
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Zaibo Li
- Department of Pathology,Ohio State University, Cincinnati
| | - Omar Hameed
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Oluwole Fadare
- Department of Pathology,University of California, San Diego
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Comparing Single-Site and Multiport Robotic Hysterectomy with Sentinel Lymph Node Mapping for Endometrial Cancer: Surgical Outcomes and Cost Analysis. J Minim Invasive Gynecol 2017; 24:977-983. [DOI: 10.1016/j.jmig.2017.05.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 12/19/2022]
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Role of Intraoperative Frozen Section in Defining the Extent of Surgery in Endometrial Carcinoma: An Indian Experience. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2017. [DOI: 10.1007/s40944-017-0140-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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Taşkın S, Kan Ö, Dai Ö, Taşkın EA, Koyuncu K, Alkılıç A, Güngör M, Ortaç F. Lymph node dissection in atypical endometrial hyperplasia. J Turk Ger Gynecol Assoc 2017; 18:127-132. [PMID: 28890426 PMCID: PMC5590208 DOI: 10.4274/jtgga.2017.0043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective: The rate of concomitant endometrial carcinoma in patients with atypical endometrial hyperplasia is high. We aimed to investigate the role of lymphadenectomy in deciding adjuvant treatment in patients with concomitant atypical endometrial hyperplasia and endometrial carcinoma. Material and Methods: Women with atypical endometrial hyperplasia were enrolled in this retrospective study. Lymph node dissection was performed in only some patients who gave informed consent if their surgeon elected to do so, or if the intraoperative findings necessitated. The final histopathologic evaluations of surgical specimens were compared with endometrial biopsy results. Results: Eighty eligible patients were evaluated. Seventy-two (90%) patients had complex hyperplasia with atypia, and 8 (10%) patients had simple hyperplasia with atypia. Hysterectomy and bilateral salpingo-oophorectomy were performed to all patients; 37 also underwent lymph node dissection. Lymph node dissection was extended to the paraaortic region in 9 of 37 patients. The concomitant endometrial carcinoma rate was 50%. Two patients had lymph node metastasis. Among 40 cases of carcinoma, 17 had deep myometrial invasion and/or cervical or ovarian involvement or grade 2 tumors with superficial myometrial invasion on hysterectomy specimens; 27.5% of all carcinomas were stage Ib or higher. Conclusion: The concomitant endometrial carcinoma rate was high in patients with atypical endometrial hyperplasia. Nearly half of these patients had risk factors for extrauterine spread. Lymph node dissection might be helpful to decide adjuvant treatment.
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Affiliation(s)
- Salih Taşkın
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Özgür Kan
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Ömer Dai
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Elif A Taşkın
- Department of Obstetrics and Gynecology, Losante Hospital, Ankara, Turkey
| | - Kazibe Koyuncu
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Ayşegül Alkılıç
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Mete Güngör
- Department of Obstetrics and Gynecology, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Fırat Ortaç
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
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Baiocchi G, Faloppa CC, Mantoan H, Camarço WR, Badiglian-Filho L, Kumagai LY, De Brot L, da Costa AABA. Para-aortic lymphadenectomy can be omitted in most endometrial cancer patients at risk of lymph node metastasis. J Surg Oncol 2017; 116:220-226. [DOI: 10.1002/jso.24651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/27/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Glauco Baiocchi
- Department of Gynecologic Oncology; AC Camargo Cancer Center; Sao Paulo Brazil
| | | | - Henrique Mantoan
- Department of Gynecologic Oncology; AC Camargo Cancer Center; Sao Paulo Brazil
| | | | | | | | - Louise De Brot
- Department of Anatomic Pathology; AC Camargo Cancer Center; Sao Paulo Brazil
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Prediction of lymphatic dissemination in endometrioid endometrial cancer: Comparison of three risk-stratification models in a single-institution cohort. Gynecol Oncol 2017; 144:510-514. [DOI: 10.1016/j.ygyno.2017.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/26/2016] [Accepted: 01/03/2017] [Indexed: 12/23/2022]
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Khalifa MA, Salama S, Vogel RI, Klein ME, Richter J, Pulver T, Mullany SA, Winterhoff B. Assessment of the Intraoperative Consultation Service Rendered by General Pathologists in a Scenario Where a Well-Defined Decision Algorithm Is Followed. Am J Clin Pathol 2017; 147:322-326. [PMID: 28395052 DOI: 10.1093/ajcp/aqw223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Intraoperative consultation (IOC) remains an area of general practice even within subspecialized pathology departments. This study assesses the IOCs rendered in a general pathology setting where surgeons integrate these results in a well-defined algorithm, developed with the input of specialized pathologists. METHODS The surgical decisions to perform lymphadenectomy in patients with endometrial adenocarcinoma operated on at our institution between January 2003 and June 2015 as a result of the IOC assessment of tumor size, histologic grade, and depth of invasion in the hysterectomy specimen were analyzed. RESULTS Frozen section (FS) was examined in 801 cases. In comparison to permanent section analysis, FS International Federation of Gynecology and Obstetrics (FIGO) grade had an overall accuracy of 0.95 (95% confidence interval [CI], 0.93-0.98). The FS depth of invasion had an overall accuracy of 0.92 (95% CI, 0.89-0.94). FIGO grade was not documented in 47.8%, the depth of myometrial invasion in 45.2%, and tumor size in 41.8% of the pathology reports. CONCLUSIONS The high omission rate of the needed parameters by the general pathologists would question their overall understanding of the paradigm shift intended by this algorithm. Possible explanations of this phenomenon and potential solutions are discussed.
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Affiliation(s)
| | - Sherine Salama
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Rachel I Vogel
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis
| | - Molly E Klein
- From the Department of Laboratory Medicine and Pathology
| | - James Richter
- From the Department of Laboratory Medicine and Pathology
| | - Tanya Pulver
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis
| | - Sally A Mullany
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis
| | - Boris Winterhoff
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis
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FIGO stage IIIC endometrial cancer identification among patients with complex atypical hyperplasia, grade 1 and 2 endometrioid endometrial cancer: laparoscopic indocyanine green sentinel lymph node mapping versus frozen section of the uterus, why get around the problem? J Cancer Res Clin Oncol 2016; 143:491-497. [DOI: 10.1007/s00432-016-2303-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/05/2016] [Indexed: 10/20/2022]
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Intraoperative Ex Vivo High-Resolution Sonography: A Novel Technique for the Assessment of Myometrial Invasion in Endometrial Cancer. Int J Gynecol Cancer 2016; 25:1639-44. [PMID: 26332388 DOI: 10.1097/igc.0000000000000531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aims to assess the diagnostic performance of a novel intraoperative ex vivo ultrasonography technique in determining deep myometrial invasion (MI) in patients with apparently low-risk endometrial cancer (EC). METHODS This prospective study included patients with type I EC who underwent staging laparotomy at Hacettepe University Hospital from December 2011 to September 2014. After hysterectomy, a radiologist with special training in gynecology examined the uterus ex vivo using a 12-MHz superficial linear probe. The specimen was sent for intraoperative frozen section (FS) analysis. The results were compared with permanent section reports. RESULTS In total, 45 female patients were eligible for analysis. Intraoperative ex vivo high-resolution sonography (IEVHS) correctly assessed depth of MI in 39 of 45 cases (86.6%) and overestimated it in 5 cases (11.1%). Only 1 case with deep infiltration was underestimated by IEVHS as invasion of less than one half of the myometrium. Frozen section correctly identified depth of MI in 41 of 46 cases (91.1%), overestimated it in 1 case (2.2%), and underestimated it in 3 cases (6.6%). The sensitivity, specificity, positive predictive value, and negative predictive value of IEVHS and FS for assessment of deep MI were 87.5%, 86.4%, 58.3%, and 96.9%, and 62.5%, 97.3%, 83.3%, and 92.3%, respectively. CONCLUSIONS Intraoperative ex vivo high-resolution sonography is a novel technique for assessing MI in EC. Its high sensitivity for deep MI could be useful as an adjunct to FS (enabling pathologists to obtain targeted FS slices) and could improve the accuracy of FS.
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Endometrial and cervical cancer patients with multiple sentinel lymph nodes at laparoscopic ICG mapping: How many are enough? J Cancer Res Clin Oncol 2016; 142:1831-6. [PMID: 27318493 DOI: 10.1007/s00432-016-2193-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/13/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE The adoption of a sentinel lymph node (SLN) algorithm and the presence of high bilateral detection rates have been associated with increased accuracy of SLN mapping in cervical and endometrial cancer patients. In this context, the significance of the number of SLNs removed has not yet been investigated. The aim of this study was to evaluate (a) whether or not a higher SLN removal count is associated with a reduced false-negative rate and (b) which clinical factors correlate with the number of SLNs removed. METHODS Patients with cervical or endometrial cancer who underwent SLN mapping with bilateral SLN detection followed by lymphadenectomy were evaluated retrospectively. On the basis of the mean number of the SLNs removed, the patients were divided in two groups: Group 1 included patients with up to 3 SLNs removed and Group 2 included patients with more than 3 SLNs removed. Factors predicting a higher SLN count were evaluated using univariate and multivariate analysis. RESULTS Eighty-four patients met the inclusion criteria. The two groups consisted of 42 patients each and differed only by the median SLN count. Two endometrial cancer patients in Group 1 had false-negative pelvic SLNs and isolated para-aortic metastases; no false-negative SLNs were recorded in Group 2 (p = n.s.). The results of multivariate analysis indicted that the number of SLNs removed was influenced only in cases where the operating surgeon had performed more than 20 laparoscopic ICG SLN mappings. CONCLUSIONS A higher SLN count does not seem to increase the accuracy of SLN mapping in cervical and endometrial cancer patients.
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Assessment of the Role of Intraoperative Frozen Section in Guiding Surgical Staging for Endometrial Cancer. Int J Gynecol Cancer 2016; 26:918-23. [DOI: 10.1097/igc.0000000000000692] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe aim of this study was to assess the role of intraoperative frozen section (FS) in guiding decision making for surgical staging of endometrioid endometrial cancer (EC).MethodsMedical records were collected retrospectively on 112 patients with endometrioid EC, who underwent total hysterectomy and bilateral salpingo-oophorectomy at the University of Arizona Medical Center from January 1, 2010, to December 31, 2014. Only patients with endometrioid adenocarcinoma, grade 1, less than 50% myometrial invasion, and tumor size less than 2 cm determined by intraoperative FS omitted lymphadenectomy; otherwise, surgical staging was performed with lymph node dissection. The FS results were compared with the permanent paraffin sections (PSs) to assess the diagnostic accuracy.ResultsThe concordance rate of different variables between FS and PS in EC was 100%, 89.3% (100/112), 97.3% (109/112), and 95.5% (107/112), respectively, with respecting to histological subtype, grade, myometrial invasion, and tumor size. Diagnostic accurate rate of combined risk factors deciding surgical staging at the time of FS was 95.5% (107/112), and the discordance rate of all risk factors considered between FS and PS was 4.5%, resulting 3 cases (2.7%) undertreated and 2 cases (1.8%) overtreated.ConclusionsDespite nonideal FS evaluation, intraoperative FS diagnosis for EC is highly reliable by providing guidance for the intraoperative decisions of surgical staging at our institution, and such guidelines may be referenced by the institutions with sufficient gynecologic pathology expertise.
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