Sentinal Lymph Node Biopsy Upstages Patients with Presumed Low- and Intermediate-Risk Endometrial Cancer
“Our study confirms that, because of discrepancies between preoperative staging and definitive histology, lymph node status should be assessed in patients with presumed low- and intermediate risk endometrial cancer,” reported Marcos Ballester, MD, of the Tenon University Hospital in Paris, France, and coauthors. “Ultrastaging detected metastases undiagnosed by conventional histology in 6 (42.8%) of 14 patients with positive SLNs.”
The team's retrospective multicenter study of 103 women with presumed low- or intermediate-risk endometrial cancer who underwent SLN biopsy and ultrastaging between 2007 and 2011, found that 15.7% of patients had pelvic metastasis, suggesting “that these patients were undertreated and exposed to a risk of recurrence,” the authors reported.
Only 1 of 14 women with no SLN-positive findings was subsequently found to have metastatic lymph nodes, the authors reported. Positive SLN findings were significantly associated with definitive endometrial cancer risk status (P=0.047), lympho-vascular space involvement (P=0.01), and definitive depth of myometrial invasion ≥50% (P=0.01).
Among 56 patients with presumed low-risk tumors based on preoperative staging, 9 patients (16%) were found after definitive histology to have intermediate-risk tumors; 3 patients (5.4%) were found to have high risk cancers.
“Hence, 12 (21.4%) of the 56 patients were upstaged by definitive histology, among whom 3 (25%) had pelvic positive SLNs corresponding to definitive IIIC1 FIGO stage,” they reported.
“Although it has been demonstrated that lymphadenectomy has no benefit for these subgroup(s) of patients, SLN biopsy is a trade-off to adequately stage patients and tailor adjuvant therapies,” the authors concluded.