Abstract
BackgroundLymphadenectomy is debated in early stages endometrial cancer. Moreover, a new FIGO classification of endometrial cancer, merging stages IA and IB has been recently published. Therefore, the aims of the present study was to evaluate the relevance of the sentinel node (SN) procedure in women with endometrial cancer and to discuss whether the use of the 2009 FIGO classification could modify the indications for SN procedure.MethodsEighty-five patients with endometrial cancer underwent the SN procedure followed by pelvic lymphadenectomy. SNs were detected with a dual or single labelling method in 74 and 11 cases, respectively. All SNs were analysed by both H&E staining and immunohistochemistry. Presumed stage before surgery was assessed for all patients based on MR imaging features using the 1988 FIGO classification and the 2009 FIGO classification.ResultsAn SN was detected in 88.2% of cases (75/85 women). Among the fourteen patients with lymph node metastases one-half were detected by serial sectioning and immunohistochemical analysis. There were no false negative case. Using the 1988 FIGO classification and the 2009 FIGO classification, the correlation between preoperative MRI staging and final histology was moderate with Kappa = 0.24 and Kappa = 0.45, respectively. None of the patients with grade 1 endometrioid carcinoma on biopsy and IA 2009 FIGO stage on MR imaging exhibited positive SN. In patients with grade 2-3 endometrioid carcinoma and stage IA on MR imaging, the rate of positive SN reached 16.6% with an incidence of micrometastases of 50%.ConclusionsThe present study suggests that sentinel node biopsy is an adequate technique to evaluate lymph node status. The use of the 2009 FIGO classification increases the accuracy of MR imaging to stage patients with early stages of endometrial cancer and contributes to clarify the indication of SN biopsy according to tumour grade and histological type.
Highlights
Lymphadenectomy is debated in early stages endometrial cancer
Previous studies attempted to identify patients that could benefit of lymphadenectomy according to presumed Federation International of Gynecology and Obstetrics (FIGO) stage assessed by imaging techniques, histological type and histological grade obtained on biopsy [5]
There is no consensus on sentinel node biopsy neither on the prognostic relevance of micrometastases in endometrial cancer, Yasbushita et al demonstrated the relation between the presence of micrometastases and the risk of recurrence [10]
Summary
Lymphadenectomy is debated in early stages endometrial cancer. a new FIGO classification of endometrial cancer, merging stages IA and IB has been recently published. The scientific community with the support of the Federation International of Gynecology and Obstetrics (FIGO) as well as other international scientific societies and agencies has considered that revision of the classification of endometrial cancer was necessary This was mainly based on data showing that the prognosis of stage IA grade 1-2, and IB grade 1-2, had similar 5-year survival. Recent randomized trials have suggested that lymphadenectomy has little relevance on survival and can be omitted in early stages of endometrial cancer [6] These results were based on routine histology with hematoxylin and eosin staining (H&E) without the use of neither sentinel node procedure nor serial sectioning and immunohistochemical staining. The aims of the present study were to evaluate the relevance of the sentinel node (SN) procedure in women with endometrial cancer and to discuss whether the use of the 2009 FIGO classification could modify the indications for SN procedure
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