Lymph Node Counts in Endometrial Cancer: Expectations Versus Reality.
Elizabeth Euscher, Roland Bassett, Anais Malpica. MD Anderson Cancer Center, Houston, TX
Background: It has been proposed that a thorough lymph node dissection (LND) should yield a median of 35 pelvic LNs (PLNs) and a median of 17 para aortic LNs (PALNs).This resulted in a discrepancy between the expected and reported LN counts at our institution.To address this issue, we began submitting the residual adipose tissue (AT) following routine processing of LNDs to determine if this discrepancy was due to undetected LNs.This study seeks to evaluate whether this approach significantly increases the reported number of LNs in a cohort of patients (pts) treated for EC at our institution.Additionally, we evaluated the association of procedure type, body mass index (BMI) and EC subtype to the number of LNs obtained.
Design: The number of LNs from all hysterectomies for EC with LNDs performed at MDACC from 2006 to the present was recorded and divided into regions as specified in the pathology report.H&E slides from cases in which residual AT was submitted were reviewed to determine the number and size of any additional LNs.Procedure type, histology of the EC, and BMI were also noted.
Results: 1-38 PLNs (median, 11) and 1-25 PALNs (median, 6) were obtained in 258 pts. 47 of 79 cases (59.5%) in which residual AT was submitted were found to have additional LNs (median size 4.0 mm): PLN, median=2; PALN, median=3.There was no significant association between the number of LNs obtained and whether or not residual AT was submitted (PLN, p=0.2; PALN, p=0.78; total LNs, p=0.19).Furthermore, there were no cases in which metastatic EC was present exclusively in the additional LNs.Compared to open hysterectomy, laparoscopically and robotically obtained LNDs had an average of 3 and 0.8 more PALNs respectively (p=0.002).No similar association was found for PLNs or total LNs.No evidence of an association between BMI and total PALNs (p=0.4) or total PLNs (p=0.2) was identified.The same was true for histologic subtype.
Conclusions: Open surgical procedures do not increase the number of LNs obtained compared to minimally invasive techniques.There is no significant difference in numbers of LNs obtained between obese and non obese pts.The median number of PLNs and PALNs in a cohort of EC cases from a tertiary care center fell short of the proposed recommendation for median numbers of PLNs and PALNs.Submitting residual AT did not significantly increase the numbers of reported LNs.These results validate that standard processing of LNDs adequately reflects the actual number of LNs present.The current definition of a thorough LND may be unrealistic and should be revisited.
Category: Gynecologic & Obstetrics
Monday, February 28, 2011 2:45 PM
Platform Session: Section C, Monday Afternoon