Comparison of a sentinel lymph node and a selective lymphadenectomy algorithm in patients with endometrioid endometrial carcinoma and limited myometrial invasion

Ane Gerda Zahl Eriksson, Jen Ducie, Narisha Ali, Michaela E. McGree, Amy L. Weaver, Giorgio Bogani, William Arthur Cliby, Sean Christopher Dowdy, Jamie N Bakkum-Gamez, Nadeem R. Abu-Rustum, Andrea Mariani, Mario M. Leitao

Research output: Contribution to journalArticle

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Abstract

Objectives To assess clinicopathologic outcomes between two nodal assessment approaches in patients with endometrioid endometrial carcinoma and limited myoinvasion. Methods Patients with endometrial cancer at two institutions were reviewed. At one institution, a complete pelvic and para-aortic lymphadenectomy to the renal veins was performed in select cases deemed at risk for nodal metastasis due to grade 3 cancer and/or primary tumor diameter > 2 cm (LND cohort). This is a historic approach at this institution. At the other institution, a sentinel lymph node mapping algorithm was used per institutional protocol (SLN cohort). Low risk was defined as endometrioid adenocarcinoma with myometrial invasion <50%. Macrometastasis, micrometastasis, and isolated tumor cells were all considered node-positive. Results Of 1135 cases identified, 642 (57%) were managed with an SLN approach and 493 (43%) with an LND approach. Pelvic nodes (PLNs) were removed in 93% and 58% of patients, respectively (P <0.001); para-aortic nodes (PANs) were removed in 14.5% and 50% of patients, respectively (P <0.001). Median number of PLNs removed was 6 and 34, respectively; median number of PANs removed was 5 and 16, respectively (both P <0.001). Metastasis to PLNs was detected in 5.1% and 2.6% of patients, respectively (P = 0.03), and to PANs in 0.8% and 1.0%, respectively (P = 0.75). The 3-year disease-free survival rates were 94.9% (95% CI, 92.4-97.5) and 96.8% (95% CI, 95.2-98.5), respectively. Conclusions Our findings support the use of either strategy for endometrial cancer staging, with no apparent detriment in adhering to the SLN algorithm. The clinical significance of disease detected on ultrastaging and the role of adjuvant therapy is yet to be determined.

Original languageEnglish (US)
Pages (from-to)394-399
Number of pages6
JournalGynecologic Oncology
Volume140
Issue number3
DOIs
StatePublished - Mar 1 2016

Fingerprint

Endometrioid Carcinoma
Endometrial Neoplasms
Lymph Node Excision
Neoplasm Metastasis
Neoplasms
Neoplasm Micrometastasis
Renal Veins
Neoplasm Staging
Disease-Free Survival
Survival Rate
Sentinel Lymph Node

Keywords

  • Comprehensive lymphadenectomy
  • Endometrial carcinoma
  • Sentinel lymph node
  • Sentinel lymph node algorithm
  • SLN algorithm
  • Ultrastaging

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Comparison of a sentinel lymph node and a selective lymphadenectomy algorithm in patients with endometrioid endometrial carcinoma and limited myometrial invasion. / Eriksson, Ane Gerda Zahl; Ducie, Jen; Ali, Narisha; McGree, Michaela E.; Weaver, Amy L.; Bogani, Giorgio; Cliby, William Arthur; Dowdy, Sean Christopher; Bakkum-Gamez, Jamie N; Abu-Rustum, Nadeem R.; Mariani, Andrea; Leitao, Mario M.

In: Gynecologic Oncology, Vol. 140, No. 3, 01.03.2016, p. 394-399.

Research output: Contribution to journalArticle

Eriksson, Ane Gerda Zahl ; Ducie, Jen ; Ali, Narisha ; McGree, Michaela E. ; Weaver, Amy L. ; Bogani, Giorgio ; Cliby, William Arthur ; Dowdy, Sean Christopher ; Bakkum-Gamez, Jamie N ; Abu-Rustum, Nadeem R. ; Mariani, Andrea ; Leitao, Mario M. / Comparison of a sentinel lymph node and a selective lymphadenectomy algorithm in patients with endometrioid endometrial carcinoma and limited myometrial invasion. In: Gynecologic Oncology. 2016 ; Vol. 140, No. 3. pp. 394-399.
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abstract = "Objectives To assess clinicopathologic outcomes between two nodal assessment approaches in patients with endometrioid endometrial carcinoma and limited myoinvasion. Methods Patients with endometrial cancer at two institutions were reviewed. At one institution, a complete pelvic and para-aortic lymphadenectomy to the renal veins was performed in select cases deemed at risk for nodal metastasis due to grade 3 cancer and/or primary tumor diameter > 2 cm (LND cohort). This is a historic approach at this institution. At the other institution, a sentinel lymph node mapping algorithm was used per institutional protocol (SLN cohort). Low risk was defined as endometrioid adenocarcinoma with myometrial invasion <50{\%}. Macrometastasis, micrometastasis, and isolated tumor cells were all considered node-positive. Results Of 1135 cases identified, 642 (57{\%}) were managed with an SLN approach and 493 (43{\%}) with an LND approach. Pelvic nodes (PLNs) were removed in 93{\%} and 58{\%} of patients, respectively (P <0.001); para-aortic nodes (PANs) were removed in 14.5{\%} and 50{\%} of patients, respectively (P <0.001). Median number of PLNs removed was 6 and 34, respectively; median number of PANs removed was 5 and 16, respectively (both P <0.001). Metastasis to PLNs was detected in 5.1{\%} and 2.6{\%} of patients, respectively (P = 0.03), and to PANs in 0.8{\%} and 1.0{\%}, respectively (P = 0.75). The 3-year disease-free survival rates were 94.9{\%} (95{\%} CI, 92.4-97.5) and 96.8{\%} (95{\%} CI, 95.2-98.5), respectively. Conclusions Our findings support the use of either strategy for endometrial cancer staging, with no apparent detriment in adhering to the SLN algorithm. The clinical significance of disease detected on ultrastaging and the role of adjuvant therapy is yet to be determined.",
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AU - Eriksson, Ane Gerda Zahl

AU - Ducie, Jen

AU - Ali, Narisha

AU - McGree, Michaela E.

AU - Weaver, Amy L.

AU - Bogani, Giorgio

AU - Cliby, William Arthur

AU - Dowdy, Sean Christopher

AU - Bakkum-Gamez, Jamie N

AU - Abu-Rustum, Nadeem R.

AU - Mariani, Andrea

AU - Leitao, Mario M.

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N2 - Objectives To assess clinicopathologic outcomes between two nodal assessment approaches in patients with endometrioid endometrial carcinoma and limited myoinvasion. Methods Patients with endometrial cancer at two institutions were reviewed. At one institution, a complete pelvic and para-aortic lymphadenectomy to the renal veins was performed in select cases deemed at risk for nodal metastasis due to grade 3 cancer and/or primary tumor diameter > 2 cm (LND cohort). This is a historic approach at this institution. At the other institution, a sentinel lymph node mapping algorithm was used per institutional protocol (SLN cohort). Low risk was defined as endometrioid adenocarcinoma with myometrial invasion <50%. Macrometastasis, micrometastasis, and isolated tumor cells were all considered node-positive. Results Of 1135 cases identified, 642 (57%) were managed with an SLN approach and 493 (43%) with an LND approach. Pelvic nodes (PLNs) were removed in 93% and 58% of patients, respectively (P <0.001); para-aortic nodes (PANs) were removed in 14.5% and 50% of patients, respectively (P <0.001). Median number of PLNs removed was 6 and 34, respectively; median number of PANs removed was 5 and 16, respectively (both P <0.001). Metastasis to PLNs was detected in 5.1% and 2.6% of patients, respectively (P = 0.03), and to PANs in 0.8% and 1.0%, respectively (P = 0.75). The 3-year disease-free survival rates were 94.9% (95% CI, 92.4-97.5) and 96.8% (95% CI, 95.2-98.5), respectively. Conclusions Our findings support the use of either strategy for endometrial cancer staging, with no apparent detriment in adhering to the SLN algorithm. The clinical significance of disease detected on ultrastaging and the role of adjuvant therapy is yet to be determined.

AB - Objectives To assess clinicopathologic outcomes between two nodal assessment approaches in patients with endometrioid endometrial carcinoma and limited myoinvasion. Methods Patients with endometrial cancer at two institutions were reviewed. At one institution, a complete pelvic and para-aortic lymphadenectomy to the renal veins was performed in select cases deemed at risk for nodal metastasis due to grade 3 cancer and/or primary tumor diameter > 2 cm (LND cohort). This is a historic approach at this institution. At the other institution, a sentinel lymph node mapping algorithm was used per institutional protocol (SLN cohort). Low risk was defined as endometrioid adenocarcinoma with myometrial invasion <50%. Macrometastasis, micrometastasis, and isolated tumor cells were all considered node-positive. Results Of 1135 cases identified, 642 (57%) were managed with an SLN approach and 493 (43%) with an LND approach. Pelvic nodes (PLNs) were removed in 93% and 58% of patients, respectively (P <0.001); para-aortic nodes (PANs) were removed in 14.5% and 50% of patients, respectively (P <0.001). Median number of PLNs removed was 6 and 34, respectively; median number of PANs removed was 5 and 16, respectively (both P <0.001). Metastasis to PLNs was detected in 5.1% and 2.6% of patients, respectively (P = 0.03), and to PANs in 0.8% and 1.0%, respectively (P = 0.75). The 3-year disease-free survival rates were 94.9% (95% CI, 92.4-97.5) and 96.8% (95% CI, 95.2-98.5), respectively. Conclusions Our findings support the use of either strategy for endometrial cancer staging, with no apparent detriment in adhering to the SLN algorithm. The clinical significance of disease detected on ultrastaging and the role of adjuvant therapy is yet to be determined.

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