title: Does the use of the 2009 FIGO classification of endometrial cancer impact on indications of the sentinel node biopsy?
abstract: BACKGROUND
  Lymphadenectomy 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.
  
  
  METHODS
  Eighty-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.
  
  
  RESULTS
  An 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%.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Service de Gynécologie-Obstétrique, hôpital Tenon, AP-HP, CancerEst, Université Pierre et Marie Curie, Paris VI, France. emile.darai@tnn.aphp.fr.
authors.forename: Marcos
authors.initials: M
authors.lastname: Ballester
authors.forename: Martin
authors.initials: M
authors.lastname: Koskas
authors.forename: Charles
authors.initials: C
authors.lastname: Coutant
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Chéreau
authors.forename: Jeremy
authors.initials: J
authors.lastname: Seror
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000145:classification / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018196:Carcinoma, Adenosquamous / Q000145:classification / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000145:classification / Q000473:pathology* / Q000601:surgery; D018284:Cystadenocarcinoma, Serous / Q000145:classification / Q000473:pathology* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate
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