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Leite S, Chen YS, Walker A, Riccio K, Taylor N, Zighelboim I, Graul A. Role of sentinel lymph node evaluation during hysterectomy for preoperative pathology diagnosis of endometrial intraepithelial neoplasia in a community hospital setting. Gynecol Oncol 2024; 184:83-88. [PMID: 38301310 DOI: 10.1016/j.ygyno.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To determine the utility of sentinel lymph node (SLN) evaluation during hysterectomy for endometrial intraepithelial neoplasia (EIN) in a community hospital setting and identify descriptive trends among pathology reports from those diagnosed with endometrial cancer (EC). METHODS We reviewed patients who underwent hysterectomy from January 2015 to July 2022 for a pathologically confirmed diagnosis of EIN obtained by endometrial biopsy (EMB) or dilation and curettage. Data was obtained via detailed chart review. Statistical testing was utilized for between-group comparisons and multivariate logistic regression modeling. RESULTS Of the 177 patients with EIN who underwent hysterectomy during the study period, 105 (59.3%) had a final diagnosis of EC. At least stage IB disease was found in 29 of these patients who then underwent adjuvant therapy. Pathology report descriptors suspicious for cancer and initial specimen type obtained by EMB were independently and significantly associated with increased odds of EC diagnosis (aOR 8.192, p < 0.001;3.746, p < 0.001, respectively). Operative times were not increased by performance of SLN sampling while frozen specimen evaluation added an average of 28 min to procedure length. Short-term surgical outcomes were also similar between groups. CONCLUSION Patients treated for EIN at community-based institutions might be more likely to upstage preoperative EIN diagnoses and have an increased risk of later stage disease than previous research suggests. Given no surgical time or short-term outcome differences, SLN evaluation should be more strongly considered in this practice setting, especially for patients diagnosed by EMB or with pathology reports indicating suspicion for EC.
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Affiliation(s)
- Samantha Leite
- Department of Obstetrics and Gynecology, St. Luke's University Health Network, 801 Ostrum St., Bethlehem, PA 18015, United States of America.
| | - Yiting Stefanie Chen
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
| | - Allison Walker
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
| | - Kelly Riccio
- Lewis Katz School of Medicine at Temple University, St. Luke's University Health Network, 3500 N Broad St., Philadelphia, PA 19140, United States of America
| | - Nicholas Taylor
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
| | - Israel Zighelboim
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
| | - Ashley Graul
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
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Mueller JJ, Rios-Doria E, Park KJ, Broach VA, Alektiar KM, Jewell EL, Zivanovic O, Sonoda Y, Abu-Rustum NR, Leitao MM, Gardner GJ. Sentinel lymph node mapping in patients with endometrial hyperplasia: A practice to preserve or abandon? Gynecol Oncol 2023; 168:1-7. [PMID: 36334496 PMCID: PMC10184678 DOI: 10.1016/j.ygyno.2022.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To compare outcomes of patients with premalignant endometrial pathology undergoing hysterectomy with or without sentinel lymph node (SLN) removal. Outcomes of interest included surgical adverse events (AEs), cancer status on final pathology, postoperative treatment, and The Cancer Genome Atlas (TCGA) molecular risk profiles. METHODS We retrospectively identified patients with premalignant pathology on preoperative endometrial biopsy who underwent hysterectomy with or without SLN mapping/excision at our institution from 01/01/2017-12/31/2021. Clinical, pathologic, surgical, and TCGA profiling data were abstracted. Appropriate statistical tests were used. RESULTS Of 221 patients identified, 161 (73%) underwent hysterectomy with SLN excision and 60 (27%) underwent hysterectomy without SLN excision. Median age and body mass index were similar between groups. Median operative time was 130 min for those who underwent SLN mapping/excision versus 136 min for those who did not (p = 0.6). Thirty-day postoperative AE rates were 9% (n = 15/161) and 13% (n = 8/60), respectively (p = 0.9). Ninety-eight (44%) of 221 patients had grade 1-2 endometrioid endometrial cancer on final pathology (4 [4%] were stage IB or higher). Ten (10%) of 98 patients, all within the SLN group, received adjuvant treatment. Among all patients, of 33 (15%) with TCGA molecular classification data, 27 (82%) had copy number-low, 3 (9%) microsatellite instability-high, 2 (6%) POLE-ultramutated, and 1 (3%) copy number-high disease. CONCLUSIONS SLN assessment appears safe, detects a small number of occult nodal metastases for those upstaged, and provides additional staging information that can guide adjuvant treatment. SLN mapping should be discussed in preoperative counseling and offered using a shared decision-making approach.
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Affiliation(s)
- Jennifer J Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA.
| | - Eric Rios-Doria
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vance A Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth L Jewell
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
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Ferrero A, Novara L, Perotto S, Capece R, Petey F, Perrini G, Mariani LL, DE Rosa G, Biglia N, Fuso L. Could a 2D/3D US based model be helpful in the assessment of myometrial invasion at time of intraoperative frozen section? A pilot study. Minerva Obstet Gynecol 2021; 73:362-368. [PMID: 34008391 DOI: 10.23736/s2724-606x.21.04777-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The assessment of myometrial invasion is a pivotal step in the preoperative staging of endometrial cancer. Intraoperative frozen section (FS) represents a reliable tool in directing surgeon's choices. Preoperative transvaginal ultrasound (US) showed high accuracy in evaluating myometrial invasion. This study aimed to understand if the application of a standardized ultrasonographic protocol for the pre-operative evaluation of myometrial invasion can help pathologists in improving the accuracy of FS. Furthermore, the agreement between US and FS in the assessment of myometrial invasion was assessed. METHODS Sixty-six patients who underwent surgery for endometrial cancer were analyzed. Preoperative 2D/3D ultrasound was performed in all the patients. Myometrial invasion was estimated by subjective assessment and objective measurement techniques. Data from US were reported to pathologists through a prefilled form with depth and site of the maximum myometrial invasion. Diagnostic performance of US and FS were compared having the definitive histological examination as the gold standard. RESULTS Influenced by the information given by our 3D US-model, FS showed a 90% sensitivity and a 93% specificity, with a 93% PPV and an 89% NPV. The agreement with histology was strong (K=0.824). Myometrial invasion was missed at the level of the isthmus by FS just in one case. Subjective assessment was confirmed as the most reliable ultrasonographic technique in assessing myometrial invasion, with 90% sensitivity, 78% specificity, 80% PPV and 89% NPV. The agreement with histology was substantial (K=0.68). CONCLUSIONS The application of a preoperative 2D/3D US assessment would seem to help pathologists in detecting myometrial invasion in difficult areas of the uterus such as the isthmus, reducing downstaging and overtreatment.
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Affiliation(s)
- Annamaria Ferrero
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
| | - Lorenzo Novara
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
| | - Stefania Perotto
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
| | - Roberto Capece
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
| | - Francesca Petey
- Department of Obstetrics and Gynecology SC2U, Sant'Anna Hospital, Turin, Italy
| | - Gaetano Perrini
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
| | - Luca L Mariani
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
| | | | - Nicoletta Biglia
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy -
| | - Luca Fuso
- Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
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Jose T, Singh A, Vardhan S. Pre-surgical staging in endometrial cancer: An opportunity for risk stratification and triage? Med J Armed Forces India 2021; 77:205-213. [PMID: 33867639 PMCID: PMC8042510 DOI: 10.1016/j.mjafi.2020.09.009] [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: 08/05/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Endometrial cancer (EC) is treated by comprehensive surgical staging that includes a systematic lymphadenectomy. The low rates of lymph node metastasis (LNM) in early stages question the benefit of routine lymphadenectomy in low-risk disease, but the absence of a reliable method to identify these patients in whom lymphadenectomy could be omitted makes complete staging the standard of care. This study evaluated a method of preoperative staging in EC to identify patients at low risk of LNM and adjuvant treatment. METHODS This prospective observational study compared the presurgical staging and risk triage based on endometrial biopsy (EB) and imaging (magnetic resonance imaging [MRI], Positron Emission Tomography [PET] scan) in 94 cases of EC with the final surgicopathological staging and evaluated the role of each modality in presurgical evaluation and triage. RESULTS Ninety-four cases were triaged into 42 low-risk and 52 non-low-risk cases preoperatively. EB showed a sensitivity, specificity, and accuracy of 51.55%, 89.83%, and 75.53%, respectively, in identifying high-risk grade and histology. MRI was effective for local staging and identified tumor size, myometrial invasion, and cervical involvement with accuracy ranging from 82.20% to 97.78% for these parameters. MRI detected LNM with an accuracy of 85.11%, whereas PET exhibited an accuracy of 86.17%. The combined presurgical staging could identify low-risk disease with a sensitivity, specificity, and accuracy of 85.37%, 86.79%, and 86.17%, respectively. CONCLUSION Preoperative staging may triage patients into low-risk and non-low-risk cases, thereby facilitating a conscious decision to omit lymphadenectomy in low-risk cases, thus avoiding unnecessary morbidity without compromising oncological safety.
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Affiliation(s)
- Tony Jose
- Professor & Senior Adviser (Obs & Gyn) and Gyn Oncologist, Command Hospital (Eastern Command), Kolkata, India
| | - Amarinder Singh
- Classified Specialist (Obs & Gyn) and Gyn Oncologist, Command Hospital (Western Command), India
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