Cytokeratin staining of resected lymph nodes may improve the sensitivity of surgical staging for endometrial cancer

Jesus Gonzalez Bosquet, Gary Keeney, Andrea Mariani, Maurice J. Webb, William Arthur Cliby

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Objectives The presence of metastases to regional lymph nodes (LN) is the single most important risk factor in endometrial cancer. Advances in molecular biology have provided more sensitive methods for detecting micrometastasis. This was a pilot study to determine whether cytokeratin staining of LN from endometrial cancer patients is more sensitive than traditional histopathologic evaluation for the detection of micrometastasis. Methods The inclusion criteria included patients with surgical stage I-II endometrial cancer having >50% myometrial invasion, lesions >2 cm, and negative LN together with one of the following: FIGO grade 3 or cervical or lymph-vascular involvement. A matched control group included patients with LN metastasis. The evaluation of the LN at the time of initial surgery consisted of a frozen section and a reevaluation on permanent sections with H&E. In the study, lymphadenectomy specimens were cut, stained again with H&E and with cytokeratin, and examined. Cytokeratin staining was performed with AE1/AE3 antibodies. There were 16 LN-negative cases and 9 LN-positive controls. Results There was complete agreement between the LN assessment at time of surgery and the study H&E review prior to the staining for cytokeratin. However, 2 LN-negative cases (12.5%) had micrometastasis by cytokeratin staining. One of these patients developed recurrent disease in the para-aortic LN and died of disease at 2.8 years. Conclusion Cytokeratin staining may improve the sensitivity for detection of metastasis compared to traditional evaluation. This study strongly suggests that these micrometastasis are clinically significant. An approach incorporating cytokeratin analysis could improve the risk assessment of specific patients.

Original languageEnglish (US)
Pages (from-to)518-525
Number of pages8
JournalGynecologic Oncology
Volume91
Issue number3
DOIs
StatePublished - Dec 2003

Fingerprint

Endometrial Neoplasms
Keratins
Lymph Nodes
Staining and Labeling
Neoplasm Micrometastasis
Neoplasm Metastasis
Frozen Sections
Lymph
Lymph Node Excision
Blood Vessels
Molecular Biology
Research Design
Control Groups
Antibodies

Keywords

  • AE1/AE3
  • Cytokeratin
  • Endometrial cancer
  • Micrometastasis

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Cytokeratin staining of resected lymph nodes may improve the sensitivity of surgical staging for endometrial cancer. / Bosquet, Jesus Gonzalez; Keeney, Gary; Mariani, Andrea; Webb, Maurice J.; Cliby, William Arthur.

In: Gynecologic Oncology, Vol. 91, No. 3, 12.2003, p. 518-525.

Research output: Contribution to journalArticle

@article{657a858ada7d47e0973690684a7627fb,
title = "Cytokeratin staining of resected lymph nodes may improve the sensitivity of surgical staging for endometrial cancer",
abstract = "Objectives The presence of metastases to regional lymph nodes (LN) is the single most important risk factor in endometrial cancer. Advances in molecular biology have provided more sensitive methods for detecting micrometastasis. This was a pilot study to determine whether cytokeratin staining of LN from endometrial cancer patients is more sensitive than traditional histopathologic evaluation for the detection of micrometastasis. Methods The inclusion criteria included patients with surgical stage I-II endometrial cancer having >50{\%} myometrial invasion, lesions >2 cm, and negative LN together with one of the following: FIGO grade 3 or cervical or lymph-vascular involvement. A matched control group included patients with LN metastasis. The evaluation of the LN at the time of initial surgery consisted of a frozen section and a reevaluation on permanent sections with H&E. In the study, lymphadenectomy specimens were cut, stained again with H&E and with cytokeratin, and examined. Cytokeratin staining was performed with AE1/AE3 antibodies. There were 16 LN-negative cases and 9 LN-positive controls. Results There was complete agreement between the LN assessment at time of surgery and the study H&E review prior to the staining for cytokeratin. However, 2 LN-negative cases (12.5{\%}) had micrometastasis by cytokeratin staining. One of these patients developed recurrent disease in the para-aortic LN and died of disease at 2.8 years. Conclusion Cytokeratin staining may improve the sensitivity for detection of metastasis compared to traditional evaluation. This study strongly suggests that these micrometastasis are clinically significant. An approach incorporating cytokeratin analysis could improve the risk assessment of specific patients.",
keywords = "AE1/AE3, Cytokeratin, Endometrial cancer, Micrometastasis",
author = "Bosquet, {Jesus Gonzalez} and Gary Keeney and Andrea Mariani and Webb, {Maurice J.} and Cliby, {William Arthur}",
year = "2003",
month = "12",
doi = "10.1016/j.ygyno.2003.08.026",
language = "English (US)",
volume = "91",
pages = "518--525",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",
number = "3",

}

TY - JOUR

T1 - Cytokeratin staining of resected lymph nodes may improve the sensitivity of surgical staging for endometrial cancer

AU - Bosquet, Jesus Gonzalez

AU - Keeney, Gary

AU - Mariani, Andrea

AU - Webb, Maurice J.

AU - Cliby, William Arthur

PY - 2003/12

Y1 - 2003/12

N2 - Objectives The presence of metastases to regional lymph nodes (LN) is the single most important risk factor in endometrial cancer. Advances in molecular biology have provided more sensitive methods for detecting micrometastasis. This was a pilot study to determine whether cytokeratin staining of LN from endometrial cancer patients is more sensitive than traditional histopathologic evaluation for the detection of micrometastasis. Methods The inclusion criteria included patients with surgical stage I-II endometrial cancer having >50% myometrial invasion, lesions >2 cm, and negative LN together with one of the following: FIGO grade 3 or cervical or lymph-vascular involvement. A matched control group included patients with LN metastasis. The evaluation of the LN at the time of initial surgery consisted of a frozen section and a reevaluation on permanent sections with H&E. In the study, lymphadenectomy specimens were cut, stained again with H&E and with cytokeratin, and examined. Cytokeratin staining was performed with AE1/AE3 antibodies. There were 16 LN-negative cases and 9 LN-positive controls. Results There was complete agreement between the LN assessment at time of surgery and the study H&E review prior to the staining for cytokeratin. However, 2 LN-negative cases (12.5%) had micrometastasis by cytokeratin staining. One of these patients developed recurrent disease in the para-aortic LN and died of disease at 2.8 years. Conclusion Cytokeratin staining may improve the sensitivity for detection of metastasis compared to traditional evaluation. This study strongly suggests that these micrometastasis are clinically significant. An approach incorporating cytokeratin analysis could improve the risk assessment of specific patients.

AB - Objectives The presence of metastases to regional lymph nodes (LN) is the single most important risk factor in endometrial cancer. Advances in molecular biology have provided more sensitive methods for detecting micrometastasis. This was a pilot study to determine whether cytokeratin staining of LN from endometrial cancer patients is more sensitive than traditional histopathologic evaluation for the detection of micrometastasis. Methods The inclusion criteria included patients with surgical stage I-II endometrial cancer having >50% myometrial invasion, lesions >2 cm, and negative LN together with one of the following: FIGO grade 3 or cervical or lymph-vascular involvement. A matched control group included patients with LN metastasis. The evaluation of the LN at the time of initial surgery consisted of a frozen section and a reevaluation on permanent sections with H&E. In the study, lymphadenectomy specimens were cut, stained again with H&E and with cytokeratin, and examined. Cytokeratin staining was performed with AE1/AE3 antibodies. There were 16 LN-negative cases and 9 LN-positive controls. Results There was complete agreement between the LN assessment at time of surgery and the study H&E review prior to the staining for cytokeratin. However, 2 LN-negative cases (12.5%) had micrometastasis by cytokeratin staining. One of these patients developed recurrent disease in the para-aortic LN and died of disease at 2.8 years. Conclusion Cytokeratin staining may improve the sensitivity for detection of metastasis compared to traditional evaluation. This study strongly suggests that these micrometastasis are clinically significant. An approach incorporating cytokeratin analysis could improve the risk assessment of specific patients.

KW - AE1/AE3

KW - Cytokeratin

KW - Endometrial cancer

KW - Micrometastasis

UR - http://www.scopus.com/inward/record.url?scp=1642393110&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=1642393110&partnerID=8YFLogxK

U2 - 10.1016/j.ygyno.2003.08.026

DO - 10.1016/j.ygyno.2003.08.026

M3 - Article

C2 - 14675670

AN - SCOPUS:1642393110

VL - 91

SP - 518

EP - 525

JO - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

IS - 3

ER -