Nízkoobjemové metastatické postižení lymfatických uzlin u karcinomu endometria

Czech version

Authors: J. Hambálek ¹; M. Maděrka ¹; M. Kolečková ²; R. Pilka ¹
Authors‘ workplace: Porodnicko-gynekologická klinika LF UP a FN, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D. ¹; Ústav klinické a molekulární patologie LF UP a FN, Olomouc, přednosta prof. MUDr. Z. Kolář, Ph. D. ²
Published in: Ceska Gynekol 2019; 84(6): 458-462
Category: Review Article

Overview

Aim: To review contemporary knowledge of the low volume metastatic disease in patients with endometrial cancer.

Type of study: A literatue review.

Settings: Department of Obstetrics and Gynecology, University Hospital Olomouc; Department of Clinical and Molecular Pathology, University Hospital Olomouc.

Introduction: The presence of micrometastases or isolated tumor cells in the sentinel node detected by ultrastaging leads to the change of tumor stage. Low volume lymph node involvement represents up to 30% of the affected lymph nodes in patients with endometrial cancer. The enhanced sentinel lymph node investigation aims to more accurately determine the extent of illness from stage I to stage IIIC. Particularly important is the detection of low-volume metastatic nodal involvement in low-risk tumors, because compared with macrometastases, micrometastases may occure earlier in tumours with lower carcinologic aggressiveness.

Conclusion: Detection of low volume metastatic disease decrease the false negativity of nodal involvement and is helpful for adjuvant treatment planning.

Keywords:

endometrial cancer – low-volume disease – metastatic lymphonode involvement – pathological ultrastaging

Sources

1. Practice Bulletin No. 149: Endometrial cancer. Obstet Gynecol, 2015, 125(4), p. 1006–1026.

2. Altgassen, C., Muller, N., Hornemann, A., et al. Immunohistochemical workup of sentinel nodes in endometrial cancer improves diagnostic accuracy. Gynecol Oncol, 2009, 114(2), p. 284–287.

3. Benedetti Panici, P., Basile, S., Maneschi, F., et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 2008, 100(23), p. 1707–1716.

4. Bogani, G., Dowdy, SC., Cliby, WA., et al. Management of endometrial cancer: issues and controversies. Eur J Gynaecol Oncol, 2016, 37(1), p. 6–12.

5. Bogani, G., Dowdy, SC., Cliby, WA., et al. Role of pelvic and para-aortic lymphadenectomy in endometrial cancer: current evidence. J Obstet Gynaecol Res, 2014, 40(2), p. 301–311.

6. Buda, A., Di Martino, G., Restaino, S., et al. The impact on survival of two different staging strategies in apparent early stage endometrial cancer comparing sentinel lymph nodes mapping algorithm and selective lymphadenectomy: An Italian retrospective analysis of two reference centers. Gynecol Oncol, 2017, 147(3), p. 528–534.

7. Burke, TW., Levenback, C., Tornos, C., et al. Intraabdominal lymphatic mapping to direct selective pelvic and paraaortic lymphadenectomy in women with high-risk endometrial cancer: results of a pilot study. Gynecol Oncol, 1996, 62(2), p. 169–173.

8. Clinton, LK., Kondo, J., Carney, ME., et al. Low-volume lymph node metastases in endometrial carcinoma. Int J Gynecol Cancer, 2017, 27(6), p. 1165–1170.

9. Cormier, B., Rozenholc, AT., Gotlieb, W., et al. Sentinel lymph node procedure in endometrial cancer: A systematic review and proposal for standardization of future research. Gynecol Oncol, 2015, 138(2), p. 478–485.

10. Creasman, WT., Morrow, CP., Bundy, BN., et al. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer, 1987, 60(8), Suppl., p. 2035–2041.

11. Doll, KM., Tseng, J., Denslow, SA., et al. High-grade endometrial cancer: revisiting the impact of tumor size and location on outcomes. Gynecol Oncol, 2014, 132(1), p. 44–49.

12. Ducie, JA., Eriksson, AGZ., Ali, N., et al. 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. Gynecol Oncol, 2017, 147(3), p. 541–548.

13. European Cancer Information System. Estimates of cancer incidence and mortality in 2018. In: https://ecis.jrc.ec.europa.eu/explorer.php?$0-0$1-AEE$4-2$3-All$6-0,14$5-2008,2008$7-7$2-All$CEstByCancer$X0_8-3$CEstRelativeCanc$X1_8-3$X1_9-AE28; 2019.

14. European Society of Gynaecological Oncology. Endometrial Cancer Guidelines based on ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer. In: https://www.esgo.org/media/2015/12/Endometrial_broz_A6_b.pdf: European Society of Gynaecological Oncology. p.

15. Geppert, B., Lonnerfors, C., Bollino, M., et al. A study on uterine lymphatic anatomy for standardization of pelvic sentinel lymph node detection in endometrial cancer. Gynecol Oncol, 2017, 145(2), p. 256–261.

16. Henley, SJ., Miller, JW., Dowling, NF., et al. Uterine cancer incidence and mortality – United States, 1999–2016. MMWR Morb Mortal Wkly Rep, 2018, 67(48), p. 1333–1338.

17. James, D., Brierley, MKG., Wittekind, C. TNM Klasifikace zhoubných novotvarů. 8.ed. Praha: Ústav zdravotnických informací a statistiky České republiky, 2018, 266 s.

18. Kim, CH., Soslow, RA., Park, KJ., et al. Pathologic ultrastaging improves micrometastasis detection in sentinel lymph nodes during endometrial cancer staging. Int J Gynecol Cancer, 2013, 23(5), p. 964–970.

19. Kitchener, H., Swart, AM., Qian, Q., et al. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet, 2009, 373(9658), p. 125–136.

20. Koskas, M., Chereau, E., Ballester, M., et al. Accuracy of a nomogram for prediction of lymph-node metastasis detected with conventional histopathology and ultrastaging in endometrial cancer. Br J Cancer, 2013, 108(6), p. 1267–1272.

21. McCready, DR., Yong, WS., Ng, AK., et al. Influence of the new AJCC breast cancer staging system on sentinel lymph node positivity and false-negative rates. J Natl Cancer Inst, 2004, 96(11), p. 873–875.

22. Multinu, F., Casarin, J., Mariani, A. Point/Counterpoint: Is lymphadenectomy required in endometrial cancer for adequate surgical staging? Oncology (Williston Park), 2017, 31(5), p. 390–391, 401.

23. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Version 4.2019. Uterine Neoplasms. In: https://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf; 2019.

24. Niikura, H., Okamoto, S., Yoshinaga, K., et al. Detection of micrometastases in the sentinel lymph nodes of patients with endometrial cancer. Gynecol Oncol, 2007, 105(3), p. 683–686.

25. European Society of Gynaecological Oncology. Endometrial Cancer Guidelines based on ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer. In: https://www.esgo.org/media/2015/12/Endometrial_broz_A6_b.pdf: European Society of Gynaecological Oncology.

26. Plante, M., Stanleigh, J., Renaud, MC., et al. Isolated tumor cells identified by sentinel lymph node mapping in endometrial cancer: Does adjuvant treatment matter? Gynecol Oncol, 2017, 146(2), p. 240–246.

27. Rossi, EC., Kowalski, LD., Scalici, J., et al. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol, 2017, 18(3), p. 384–392.

28. Schlappe, BA., Weaver, AL., Ducie, JA., et al. Multicenter study comparing oncologic outcomes between two nodal assessment methods in patients with deeply invasive endometrioid endometrial carcinoma: A sentinel lymph node algorithm versus a comprehensive pelvic and paraaortic lymphadenectomy. Gynecol Oncol, 2018, 151(2), p. 235–242.

29. St Clair, CM., Eriksson, AG., Ducie, JA., et al. Low-volume lymph node metastasis discovered during sentinel lymph node mapping for endometrial carcinoma. Ann Surg Oncol, 2016, 23(5), p. 1653–1659.

30. Ústav zdravotnických informací a stastistiky ČR. Novotvary 2016, komplet. In: www.uzis.cz/system/files/novotvary2016.pdf. Ústav zdravotnických informací a stastistiky ČR.

31. Yabushita, H., Shimazu, M., Yamada, H., et al. Occult lymph node metastases detected by cytokeratin immunohistochemistry predict recurrence in node-negative endometrial cancer. Gynecol Oncol, 2001, 80(2), p. 139–144.

32. Zahl Eriksson, AG., Ducie, J., Ali, N., et al. Comparison of a sentinel lymph node and a selective lymphadenectomy algorithm in patients with endometrioid endometrial carcinoma and limited myometrial invasion. Gynecol Oncol, 2016, 140(3), p. 394–399.