Adequacy of Lymphadenectomy in Endometrial Cancer: A Threshold Change Is Needed
Gitika Aggarwal, Anais Malpica, Elizabeth D Euscher, Preetha Ramalingam. Georgia Health Sciences University, Augusta; UT MD Anderson Cancer Center, Houston
Background: Adequate pelvic lymph node (PLN) dissection has been arbitrarily determined, by some authors, as yielding >10 LNs and paraaortic (PALN) dissection as yielding >5LNs. Others have suggested that thorough PLN and PALN dissection should yield a median of 35 and 17 LNs respectively. Recent studies from a large institution have shown that the median yield is 11 for PLN and 6 for PALN in completely submitted tissue. The aim of this study is to assess if this was consistent among a cohort of cases in which LNs and adipose tissue were entirely submitted for histologic evaluation.
Design: We reviewed endometrial carcinomas (EC) from 2007 to present, in which pelvic and/or para-aortic lymph node sampling was performed, including the submission of remaining adipose tissue in entirety, if present. The histologic subtype, FIGO grade and pathologic stage were evaluated for all cases. Total number of LNs in entirely submitted cases as well as presence of additional LNs when the remaining adipose tissue was submitted was recorded. The presence of metastasis if any, in LNs in remaining adipose tissue was determined.
Results: 45 EC with entirely submitted LNs were identified. The patients' age ranged from 34-83 yrs (median 64yrs) and tumor size from 1.0 -8.0cm (median 7.25cm). 32 were endometrioid carcinomas, and 13 were non-endometrioid carcinomas (2 serous carcinomas, 9 mixed carcinomas, 1 clear cell carcinoma and 1 sarcomatoid carcinoma). 29 were FIGO grade 1-2 and 16 were grade 3. Pathologic stage was as follows: 31 pT1, 8 pT2, and 6 pT3. Total number of PLN ranged from 0-22 (median 5) and PALN 1-11 (median 4). Remainder of adipose tissue was submitted in 1-9 cassettes (median 2). Additional LNs were identified 21/45 (47%) cases in which remainder of adipose tissue was submitted and numbers ranged from 1-13 (median 3) for PLN and 1-7 (median 2) for PALN. Size of additional LNs ranged from 0.1-1.3 cm (median 0.3 cm). No metastatic carcinoma was identified in any of the additional LNs.
Conclusions: The median number of LNs obtained after complete submission of LNs and remainder of adipose tissue is 5 for PLN and 4 for PALN. Additional LNs were identified in less than half the cases and were subcentimeter in all but one case. The one case in which a large LN was not grossly identified was likely prosector dependent. No metastatic disease was identified in additional LNs detected in the remainder of adipose tissue. Given that these results are from 2 different institutions the expectation for "adequate" pelvic and paraaortic LN dissection must be re-examined.
Category: Gynecologic & Obstetrics
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 180, Tuesday Morning