Predicting lympho-vascular space invasion in endometrial cancers with mucinous carcinomatous components

Association of Tumor Size With Myometrial Invasion, Lymphovascular Space Invasion, Lymph Node Metastasis, and Recurrence in Endometrial Cancer: A Meta-Analysis of 40 Studies With 53,276 Patients

Background

Myometrial invasion (MI), lymphovascular space invasion (LVSI), and lymph node metastasis (LNM) have been found to have independent prognostic factors in endometrial cancer. Tumor size has practical advantages in endometrial cancer. The cutoff values for tumor size conformed with current literature. More and more studies inferred that tumor size >20 mm showed a strong correlation. However, the relationship between tumor size >20 mm and MI, LVSI, LNM, recurrence, and overall survival (OS) remains controversial, and no meta-analysis has been conducted. Therefore, a systematic review and meta-analysis should be performed to discuss this issue later on.

Methods

Relevant articles were collected from PubMed, EMBASE, and Cochrane Library databases from January 1990 to June 2021. The predictive value of tumor size >20 mm in endometrial cancer was studied, and data were pooled for meta-analysis using Review Manager 5.1. Additionally, the odds ratio (OR) was analyzed, and cumulative analyses of hazard ratio (HR) and their corresponding 95% CI were conducted.

Results

A total of 40 articles with 53,276 endometrial cancer patients were included in the meta-analysis. It contained 7 articles for MI, 6 for LVSI, 21 for LNM, 7 for recurrence, and 3 for OS. Primary tumor size >20 mm was significantly associated with depth of MI (OR = 5.59, 95% CI [5.02, 6.23], p < 0.001), positive LVSI (OR = 3.35, 95% CI [2.34, 4.78], p < 0.001), positive LNM (OR = 4.11, 95% CI [3.63, 4.66], p < 0.001), and recurrence (OR = 3.52, 95% CI [2.39, 5.19], p < 0.001). Tumor size >20 mm was also related to OS via meta-synthesis of HR in univariate survival (HR 2.13, 95% CI [1.28, 3.53], p = 0.003). There was no significant publication bias in this study by funnel plot analysis.

Conclusion

Primary tumor size >20 mm was an independent predictive factor for the depth of MI, positive LVSI, positive LNM, recurrence, and poor OS. Therefore, it is more important to take into account the value of tumor size in the clinicopathological staging of endometrial carcinoma. Tumor size >20 mm should be integrated into the intraoperative algorithm for performing a full surgical staging. Well-designed and multicenter studies, with a larger sample size, are still required to verify the findings.

Sentinel Lymph Nodes in Endometrial Cancer Update 2018

There are no established data about lymphadenectomy during treatment of endometrial cancers (ECs) and to what extent lymphadenectomy should be performed. In addition, retroperitoneal lymphadenectomy increases the intraoperative and postoperative complications. Sentinel lymph node (SLN) mapping has the lowest costs and highest quality-adjusted survival. SLN is the most cost-effective strategy in the management of low-risk ECs. Women staged with SLN mapping were more likely to receive adjuvant treatment compared with women staged with systemic lymphadenectomy. This review article designed to evaluate the diagnostic accuracy and the methods of SLN detection in ECs.

Accuracy of Sentinel Node in Detecting Lymph Node Metastasis in Primary Endometrial Carcinoma

BACKGROUND

Endometrial carcinoma is the most common gynecological cancer and its treatment is still controversial, especially in its early stages. There are conflicting data about the efficacy of retroperitoneal lymphadenectomy during abdominal hysterectomy and bilateral salpingoophrectomy treatment. Lymphadenectomy carries a risk of severe complications, especially in women with co-morbidities. Selective lymphadenectomy has been widely employed for staging evaluation of endometrial carcinoma because it is simple and seems to provide reliable data regarding nodal metastasis. This study was designed to evaluate accuracy of sentinel node sampling in detecting lymph node metastasis in primary endometrial carcinoma during staging laparotomy.

MATERIALS AND METHODS

Ninety-three women with endometrial carcinoma at high-risk for nodal metastasis were studied. During laparotomy, methylene blue dye was injected into sub-serosal myometrium, then retroperitoneal spaces were opened and blue lymph nodes within pelvic and para-aortic regions were removed as separate specimens for histopathological examination (sentinel lymph nodes=SLNs). Hysterectomy and selective lymphadenectomy then performed for all women included in this study.

RESULTS

Deposition of methylene dye into at least one lymph node was observed in 73.1% (68/93) of studied cases. 18.3% (17/93) of studied women had positive lymph node metastasis and 94.1% (16/17) of them had positive metastasis in SLNs. In this study, SNLs had 94.4% sensitivity and 100% specificity in prediction of lymph node metastasis. Mean number of lymph nodes removed from each case decreased when SLNs biopsy were taken.

CONCLUSIONS

SLNs are the key lymph nodes in endometrial tumor metastasis and their involvement could be an indicator for whether or not complete systematic lymphadenectomy is needed during staging laparotomy.