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

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

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: To determine if a sentinel lymph node (SLN) mapping algorithm will detect metastatic nodal disease in patients with intermediate. -/high-risk endometrial carcinoma. Methods: Patients were identified and surgically staged at two collaborating institutions. The historical cohort (2004-2008) at one institution included patients undergoing complete pelvic and paraaortic lymphadenectomy to the renal veins (LND cohort). At the second institution an SLN mapping algorithm, including pathologic ultra-staging, was performed (2006-2013) (SLN cohort). Intermediate-risk was defined as endometrioid histology (any grade), ≥. 50% myometrial invasion; high-risk as serous or clear cell histology (any myometrial invasion). Patients with gross peritoneal disease were excluded. Isolated tumor cells, micro-metastases, and macro-metastases were considered node-positive. Results: We identified 210 patients in the LND cohort, 202 in the SLN cohort. Nodal assessment was performed for most patients. In the intermediate-risk group, stage IIIC disease was diagnosed in 30/107 (28.0%) (LND), 29/82 (35.4%) (SLN) (P = 0.28). In the high-risk group, stage IIIC disease was diagnosed in 20/103 (19.4%) (LND), 26 (21.7%) (SLN) (P = 0.68). Paraaortic lymph node (LN) assessment was performed significantly more often in intermediate. -/high-risk groups in the LND cohort (P <. 0.001). In the intermediate-risk group, paraaortic LN metastases were detected in 20/96 (20.8%) (LND) vs. 3/28 (10.7%) (SLN) (P = 0.23). In the high-risk group, paraaortic LN metastases were detected in 13/82 (15.9%) (LND) and 10/56 (17.9%) (SLN) (%, P = 0.76). Conclusions: SLN mapping algorithm provides similar detection rates of stage IIIC endometrial cancer. The SLN algorithm does not compromise overall detection compared to standard LND.

Original languageEnglish (US)
JournalGynecologic Oncology
DOIs
StateAccepted/In press - 2017

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Endometrial Neoplasms
Lymph Node Excision
Neoplasm Metastasis
Lymph Nodes
Histology
Peritoneal Diseases
Sentinel Lymph Node
Renal Veins

Keywords

  • Endometrial carcinoma
  • Lymphadenectomy
  • Sentinel node mapping

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

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

In: Gynecologic Oncology, 2017.

Research output: Contribution to journalArticle

Ducie, Jennifer A. ; Eriksson, Ane Gerda Zahl ; Ali, Narisha ; McGree, Michaela E. ; Weaver, Amy L. ; Bogani, Giorgio ; Cliby, William Arthur ; Dowdy, Sean Christopher ; Bakkum-Gamez, Jamie N ; Soslow, Robert A. ; Keeney, Gary ; Abu-Rustum, Nadeem R. ; Mariani, Andrea ; Leitao, Mario M. / 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. In: Gynecologic Oncology. 2017.
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title = "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",
abstract = "Objective: To determine if a sentinel lymph node (SLN) mapping algorithm will detect metastatic nodal disease in patients with intermediate. -/high-risk endometrial carcinoma. Methods: Patients were identified and surgically staged at two collaborating institutions. The historical cohort (2004-2008) at one institution included patients undergoing complete pelvic and paraaortic lymphadenectomy to the renal veins (LND cohort). At the second institution an SLN mapping algorithm, including pathologic ultra-staging, was performed (2006-2013) (SLN cohort). Intermediate-risk was defined as endometrioid histology (any grade), ≥. 50{\%} myometrial invasion; high-risk as serous or clear cell histology (any myometrial invasion). Patients with gross peritoneal disease were excluded. Isolated tumor cells, micro-metastases, and macro-metastases were considered node-positive. Results: We identified 210 patients in the LND cohort, 202 in the SLN cohort. Nodal assessment was performed for most patients. In the intermediate-risk group, stage IIIC disease was diagnosed in 30/107 (28.0{\%}) (LND), 29/82 (35.4{\%}) (SLN) (P = 0.28). In the high-risk group, stage IIIC disease was diagnosed in 20/103 (19.4{\%}) (LND), 26 (21.7{\%}) (SLN) (P = 0.68). Paraaortic lymph node (LN) assessment was performed significantly more often in intermediate. -/high-risk groups in the LND cohort (P <. 0.001). In the intermediate-risk group, paraaortic LN metastases were detected in 20/96 (20.8{\%}) (LND) vs. 3/28 (10.7{\%}) (SLN) (P = 0.23). In the high-risk group, paraaortic LN metastases were detected in 13/82 (15.9{\%}) (LND) and 10/56 (17.9{\%}) (SLN) ({\%}, P = 0.76). Conclusions: SLN mapping algorithm provides similar detection rates of stage IIIC endometrial cancer. The SLN algorithm does not compromise overall detection compared to standard LND.",
keywords = "Endometrial carcinoma, Lymphadenectomy, Sentinel node mapping",
author = "Ducie, {Jennifer A.} and Eriksson, {Ane Gerda Zahl} and Narisha Ali and McGree, {Michaela E.} and Weaver, {Amy L.} and Giorgio Bogani and Cliby, {William Arthur} and Dowdy, {Sean Christopher} and Bakkum-Gamez, {Jamie N} and Soslow, {Robert A.} and Gary Keeney and Abu-Rustum, {Nadeem R.} and Andrea Mariani and Leitao, {Mario M.}",
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T1 - 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

AU - Ducie, Jennifer A.

AU - Eriksson, Ane Gerda Zahl

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 - Soslow, Robert A.

AU - Keeney, Gary

AU - Abu-Rustum, Nadeem R.

AU - Mariani, Andrea

AU - Leitao, Mario M.

PY - 2017

Y1 - 2017

N2 - Objective: To determine if a sentinel lymph node (SLN) mapping algorithm will detect metastatic nodal disease in patients with intermediate. -/high-risk endometrial carcinoma. Methods: Patients were identified and surgically staged at two collaborating institutions. The historical cohort (2004-2008) at one institution included patients undergoing complete pelvic and paraaortic lymphadenectomy to the renal veins (LND cohort). At the second institution an SLN mapping algorithm, including pathologic ultra-staging, was performed (2006-2013) (SLN cohort). Intermediate-risk was defined as endometrioid histology (any grade), ≥. 50% myometrial invasion; high-risk as serous or clear cell histology (any myometrial invasion). Patients with gross peritoneal disease were excluded. Isolated tumor cells, micro-metastases, and macro-metastases were considered node-positive. Results: We identified 210 patients in the LND cohort, 202 in the SLN cohort. Nodal assessment was performed for most patients. In the intermediate-risk group, stage IIIC disease was diagnosed in 30/107 (28.0%) (LND), 29/82 (35.4%) (SLN) (P = 0.28). In the high-risk group, stage IIIC disease was diagnosed in 20/103 (19.4%) (LND), 26 (21.7%) (SLN) (P = 0.68). Paraaortic lymph node (LN) assessment was performed significantly more often in intermediate. -/high-risk groups in the LND cohort (P <. 0.001). In the intermediate-risk group, paraaortic LN metastases were detected in 20/96 (20.8%) (LND) vs. 3/28 (10.7%) (SLN) (P = 0.23). In the high-risk group, paraaortic LN metastases were detected in 13/82 (15.9%) (LND) and 10/56 (17.9%) (SLN) (%, P = 0.76). Conclusions: SLN mapping algorithm provides similar detection rates of stage IIIC endometrial cancer. The SLN algorithm does not compromise overall detection compared to standard LND.

AB - Objective: To determine if a sentinel lymph node (SLN) mapping algorithm will detect metastatic nodal disease in patients with intermediate. -/high-risk endometrial carcinoma. Methods: Patients were identified and surgically staged at two collaborating institutions. The historical cohort (2004-2008) at one institution included patients undergoing complete pelvic and paraaortic lymphadenectomy to the renal veins (LND cohort). At the second institution an SLN mapping algorithm, including pathologic ultra-staging, was performed (2006-2013) (SLN cohort). Intermediate-risk was defined as endometrioid histology (any grade), ≥. 50% myometrial invasion; high-risk as serous or clear cell histology (any myometrial invasion). Patients with gross peritoneal disease were excluded. Isolated tumor cells, micro-metastases, and macro-metastases were considered node-positive. Results: We identified 210 patients in the LND cohort, 202 in the SLN cohort. Nodal assessment was performed for most patients. In the intermediate-risk group, stage IIIC disease was diagnosed in 30/107 (28.0%) (LND), 29/82 (35.4%) (SLN) (P = 0.28). In the high-risk group, stage IIIC disease was diagnosed in 20/103 (19.4%) (LND), 26 (21.7%) (SLN) (P = 0.68). Paraaortic lymph node (LN) assessment was performed significantly more often in intermediate. -/high-risk groups in the LND cohort (P <. 0.001). In the intermediate-risk group, paraaortic LN metastases were detected in 20/96 (20.8%) (LND) vs. 3/28 (10.7%) (SLN) (P = 0.23). In the high-risk group, paraaortic LN metastases were detected in 13/82 (15.9%) (LND) and 10/56 (17.9%) (SLN) (%, P = 0.76). Conclusions: SLN mapping algorithm provides similar detection rates of stage IIIC endometrial cancer. The SLN algorithm does not compromise overall detection compared to standard LND.

KW - Endometrial carcinoma

KW - Lymphadenectomy

KW - Sentinel node mapping

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