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Tutkun Kilinc EC, Korkmaz V, Yalcin HR. Factor affecting lymph node metastasis in uterine papillary serous carcinomas: a retrospective analysis. J OBSTET GYNAECOL 2023; 42:3725-3730. [PMID: 36927276 DOI: 10.1080/01443615.2022.2158311] [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: 03/18/2023]
Abstract
The aim of this study was to investigate the risk factors for lymph node metastasis (LNM) in patients with uterine serous cancer (USC) who underwent systematic staging surgery. Eighty patients who were operated on for pure uterine serous papillary carcinoma between 2008 and 2020 in our clinic were retrospectively analysed. The effects of demographic information and clinicohistopathological characteristics of the included patients on LNM were examined. The median age of the patients included in the study was 64.3 and the tumour diameter was 3.8 cm. At the time of diagnosis, 65.8% of the cases were in the advanced stage, while 34.2% were in the early stage. There was no LNM in 42 (52.5%) of the cases, only pelvic in six (7.5%), only paraaortic LNM in four (5%) patients, and both pelvic and paraaortic LNM in 24 (30%) patients. When factors that may affect LNM were evaluated with multivariate analysis, lymphovascular space invasion (LVSI) and cytology positivity were found to be independent risk factors (p < 0.05). In addition, the rate of isolated paraaortic lymph node involvement in LNM positive patients is 5%, which is 100% associated with LVSI.Impact StatementWhat is already known on this subject? Uterine papillary serous carcinomas (UPSC) are an uncommon and aggressive histological subtype of endometrial cancer. The high risk of recurrence and tendency to migrate into the abdomen of these tumours is not always connected with lymph node and distant organ metastasis, tumour size, LVSI positive and depth of myometrial invasion.What do the results of this study add? Most patients with UPSC are diagnosed at an advanced stage. In this study, in which 80 patients with pure serous histology were evaluated retrospectively, and LVSI and peritoneal cytology positivity were found to be two important prognostic factors for lymph node metastasis.What are the implications of these findings for clinical practice and/or further research? In this study, cytology and LVSI positivity were identified as two predictive markers for LNM, and it is seen that cytology positivity still maintains its importance in these tumours with peritoneal spread. Furthermore, patients with isolated paraaortic lymph node involvement were shown to be LVSI positive, and isolated paraaortic LNM should be investigated in patients with LVSI positivity.
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Affiliation(s)
| | - Vakkas Korkmaz
- Department of Gynecologic Oncology, Faculty of Medicine, Etlik City Hospital, University of Health Sciences, Ankara, Turkey
| | - Hakan Rasit Yalcin
- Department of Gynecologic Oncology, Faculty of Medicine, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Montavon C, Mirza U, Fedier A, Schoetzau A, Zanetti Dällenbach R, Heinzelmann-Schwarz V. Diaphragmatic smears are not of additional benefit in the detection of peritoneal spread in gynecological cancers. Exp Ther Med 2018; 15:4199-4204. [PMID: 29725367 PMCID: PMC5920471 DOI: 10.3892/etm.2018.5957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/09/2018] [Indexed: 11/13/2022] Open
Abstract
Peritoneal biopsies (PB) and peritoneal washing (PW) are routine measures in abdominal staging of gynecological malignancies and are used particularly for the assessment of occult microscopic tumor spread to the peritoneal surface including the diaphragm. Cytological diaphragmatic smears (DS) have been suggested as a supplemental tool; however, they are not routinely taken and their usefulness is still unclear. The present study retrospectively evaluated whether DS provide an additional benefit over PB and PW for the detection of peritoneal malignancies in patients with gynecological cancer. The data from patients who underwent laparotomy for suspected gynecological cancer and had DS and either PB, PW or ascites were reviewed. Sensitivity and specificity, and the number upstaged patients were determined. A total of 43 patients were excluded due to benign diagnosis (those with negative DS or PW) and 2 out of the remaining had 2 carcinomas simultaneously. Among these 41 malignancies, DS were positive in 12, PW in 18 and PB in 19 cases. No case was DS-positive while negative for both PB and PW. Four cases were missed when only PB and 5 when only PW was performed. Notably, no case of peritoneal disease was identified solely on positive DS, indicating that all 23 positive cases (presence of occult peritoneal disease in 56.1%) were identified by PB and PW together (100% sensitivity; 62% specificity). In addition, none of the cases was upstaged solely on positive DS results. Taken together, these data demonstrated that DS do not present an additional benefit to PW and PB in the detection of peritoneal gynecological disease.
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Affiliation(s)
- Celine Montavon
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Uzma Mirza
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Andre Fedier
- Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Andreas Schoetzau
- Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Rosanna Zanetti Dällenbach
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Viola Heinzelmann-Schwarz
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland.,Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
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Türkmen O, Karalok A, Başaran D, Kimyon G, Kul G, Tulunay G, Üreyen I, Turan T. Revaluating the survival effects of International Federation of Gynecology and Obstetrics 1988 stage IIIA criteria for endometrial cancer. J Turk Ger Gynecol Assoc 2017; 18:110-115. [PMID: 28890424 PMCID: PMC5590205 DOI: 10.4274/jtgga.2017.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: This study aimed to define factors that affected survival in the International Federation of Gynecology and Obstetrics (FIGO) 1988 stage IIIA endometrial cancer (EC). Material and Methods: The study included patients with EC who underwent surgery between 1992 and 2013. Patients with adnexal metastases, uterine serosal involvement or positive peritoneal cytology (stage IIIA disease according to the former 1988 FIGO staging system) were selected for further analysis. Clinical and pathologic factors associated with progression-free survival (PFS) were evaluated using univariate and multivariate statistical tests. Results: Seventy-seven patients with stage IIIA disease according to the 1988 FIGO staging system were included. The median follow-up was 37 months (range, 1-175 months) and recurrence was detected in 19 patients. Univariate analysis revealed that the presence of uterine serosal invasion and advanced histologic grade (grade 1-2 vs. grade 3) were associated with diminished PFS (p=0.001, p=0.047). The presence of adnexal involvement and positive peritoneal cytology had no statistically significant influence on PFS (p=0.643 and p=0.795, respectively). Conclusion: In patients with stage IIIA EC according to the FIGO 1988 staging system, only uterine serosal involvement was related with adverse oncologic outcomes, not adnexal involvement or presence of positive cytology.
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Affiliation(s)
- Osman Türkmen
- Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Alper Karalok
- Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Derman Başaran
- Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Günsu Kimyon
- Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Gizem Kul
- Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Gökhan Tulunay
- Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Işın Üreyen
- Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Taner Turan
- Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
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Chen J, Clark LH, Kong WM, Yan Z, Han C, Zhao H, Liu TT, Zhang TQ, Song D, Jiao SM, Zhou C. Does hysteroscopy worsen prognosis in women with type II endometrial carcinoma? PLoS One 2017; 12:e0174226. [PMID: 28334032 PMCID: PMC5363864 DOI: 10.1371/journal.pone.0174226] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/05/2017] [Indexed: 01/07/2023] Open
Abstract
Background Prior studies evaluating the impact of hysteroscopy on outcomes in endometrial cancer have predominantly evaluated type I tumors. We sought to evaluate whether hysteroscopy worsens prognosis in type II endometrial cancer. Methods A retrospective cohort analysis of 140 patients from two institutions with type II endometrial cancer was performed. Women who underwent either diagnostic hysteroscopy (HSC) or dilation and curettage (D&C) for cancer diagnosis from June 2001 until June 2010 were included. The clinical and pathologic characteristics, including peritoneal cytology results were reviewed. The primary endpoint was disease-specific survival (DSS). The exposure of interest was hysteroscopy. Survival curves were projected using the Kaplan-Meier method and compared using the log-rank test. Results There was no difference in age, histology, stage, depth of myometrial invasion, adnexal involvement, or nodal metastasis between HSC and D&C patients. Positive cytology was found in 16/54 (30%) patients following HSC and in 10/86 (12%) following D&C (p = 0.008). Fourteen patients with stage I and II disease had positive peritoneal cytology, with 11/40 (27.5%) patients in the HSC group and 3/59 (5%) patients in the D&C group(p = 0.002). Median DSS was clinically different for the HSC and D&C groups, but statistical significance was not reached (53 versus 63.5 months, p = 0.34). For stage I and II patients, 18/99 (18%) were dead of EC, with a median DSS of 60 months for HSC and 71 months for D&C (p = 0.82). Overall 46 (33%) patients developed a recurrence, with 18/54 (33%) in the HSC group compared to 28/86 (32%) in the D&C group (p = 0.92). There was no difference in recurrence location between groups. Conclusions Diagnostic hysteroscopy significantly increased the rate of positive peritoneal cytology at the time of surgical staging in this cohort of patients with type II EC. However, we were unable to detect a difference in prognosis as measured by DSS.
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Affiliation(s)
- Jiao Chen
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Leslie H. Clark
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Wei-Min Kong
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- * E-mail: (WMK); (CZ)
| | - Zhen Yan
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Chao Han
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Hui Zhao
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Ting-Ting Liu
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Tong-Qing Zhang
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Dan Song
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Si-Meng Jiao
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Chunxiao Zhou
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
- * E-mail: (WMK); (CZ)
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Damiani D, Suciu V, Genestie C, Vielh P. Cytomorphology of ovarian clear cell carcinomas in peritoneal effusions. Cytopathology 2016; 27:427-432. [DOI: 10.1111/cyt.12297] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2015] [Indexed: 12/25/2022]
Affiliation(s)
- D. Damiani
- Department of Biopathology; Gustave Roussy Comprehensive Cancer Center; Villejuif Cedex France
| | - V. Suciu
- Department of Biopathology; Gustave Roussy Comprehensive Cancer Center; Villejuif Cedex France
| | - C. Genestie
- Department of Biopathology; Gustave Roussy Comprehensive Cancer Center; Villejuif Cedex France
| | - P. Vielh
- Department of Biopathology; Gustave Roussy Comprehensive Cancer Center; Villejuif Cedex France
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Karabagli P, Ugras S, Yilmaz BS, Celik C. The evaluation of reliability and contribution of frozen section pathology to staging endometrioid adenocarcinomas. Arch Gynecol Obstet 2015; 292:391-7. [PMID: 25608758 DOI: 10.1007/s00404-015-3621-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 01/12/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the reliability and accuracy of intraoperative pathological findings, compared to permanent section (PS) and to understand contributions of frozen section (FS) to final staging in patients with endometrioid carcinomas. METHODS This is a retrospective analysis of 79 patients undergoing intraoperative FS and with endometrioid adenocarcinomas. Intraoperative pathological findings were compared with final results as to grade, depth of myometrial invasion (MI), cervical involvement, lymphovascular space invasion (LVSI) and stage. We also analyzed whether staging procedures like pelvic or para-aortic lymph node metastasis, peritoneal cytology and extension beyond of uterus were related to FS findings. Staging was based on the FIGO 2009. RESULTS FS results were agreement in 89.9 % for grade, 88.6 % for depth of MI, 100 % for cervical invasion, and 92.4 % for LVSI, compared with PS. On FS, 12, 16.6 and 44.4 % of specimens in stages of IA, IB and II became upstaged in final pathology, respectively. Of 79 cases, 5 (6.3 %) were upstaged to IIIC1, and 3 (3.8 %) were upstaged to IIIC2 because of lymph node metastasis. A significant relationship was detected between lymph node metastasis, and FS grades (p = 0.001), LVSI (p = 0.000), cervical invasion (p = 0.006) and MI (p = 0.001). CONCLUSION We consider that intraoperative FS is a useful procedure to identify poor prognostic pathological factors. While grading, depth of MI, cervical stromal invasion and LVSI on FS are significant in predicting lymph node metastasis, the existence of cervical stromal invasion and LVSI should be considered more effective parameters in the identification of metastatic endometrial cancer risks.
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Affiliation(s)
- Pinar Karabagli
- Department of Pathology, Medical School of Selcuk University, Alaeddin Keykubad Campus, 42075, Selcuklu, Konya, Turkey,
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Han KH, Park NH, Kim HS, Chung HH, Kim JW, Song YS. Peritoneal cytology: A risk factor of recurrence for non-endometrioid endometrial cancer. Gynecol Oncol 2014; 134:293-6. [DOI: 10.1016/j.ygyno.2014.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 03/23/2014] [Accepted: 05/13/2014] [Indexed: 11/29/2022]
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Gilani S, Anderson I, Fathallah L, Mazzara P. Factors predicting nodal metastasis in endometrial cancer. Arch Gynecol Obstet 2014; 290:1187-93. [PMID: 24981050 DOI: 10.1007/s00404-014-3330-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Evaluation of lymph node (LN) metastases in endometrial carcinoma (EC) is an important prognostic factor and a required element of cancer staging. The purpose of this study is to analyze what factors might predict the likelihood of nodal involvement in EC. METHODS A retrospective search of our institutional database for hysterectomies with associated LN dissection in women with EC revealed 207 cases between 2005 and 2012. Cases with primary EC, irrespective of histologic subtype, including carcinosarcomas were included in the study, but pure sarcomas were excluded. We evaluated various factors including tumor size (TS; ≤2.0 cm and >2.0 cm), depth of myometrial invasion (DMI; absent, ≤50 %, >50 %), positive pelvic cytology (PPC), cervical stromal invasion (CSI), and lymph-vascular invasion (LVI), to determine which factors correlated with the presence of LN metastasis. RESULTS Of the 207 (age = 62.29 ± 10.9, mean ± SD) cases of EC with LN dissection in our study group, 34 (16.42 %) had positive LNs. On univariate analysis, we found that TS (p = 0.04), tumor grade (Grade I and II versus grade III, p < 0.0001), DMI (p < 0.0001), CSI (p < 0.0001), LVI (p < 0.0001), and PPC (p = 0.001) showed statistically significant correlation with LN metastasis. However, on multivariate analysis, only DMI (p = 0.002) and LVI (p = 0.004) independently showed statistically significant correlation with LN metastasis. In addition, 18 (8.7 %) grade I and II (well/moderately differentiated) tumors with TS ≤2.0 cm and <50 % DMI showed no LN metastasis, LVI, CSI, or PPC. CONCLUSION We concluded that DMI and LVI were independent factors predictive of LN metastasis.
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Affiliation(s)
- Syed Gilani
- Department of Pathology, St. John Hospital and Medical Center, 22101 Moross Road, Detroit, MI, 48236, USA,
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Mount SL, Horton M. Changes in staging and advances in treatment for gynecological malignancies: the impact on cytopathology. Cancer Cytopathol 2014; 122:317-21. [PMID: 24436143 DOI: 10.1002/cncy.21394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/04/2013] [Accepted: 12/17/2013] [Indexed: 01/12/2023]
Affiliation(s)
- Sharon L Mount
- Pathology Department, Fletcher Allen Health Care and University of Vermont, Burlington, Vermont
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Gonçalves E, Figueiredo O, Costa F. Sentinel lymph node in endometrial cancer: an overview. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s10397-013-0796-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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