title: Is it possible to predict para-aortic lymph node metastasis in endometrial cancer?
abstract: OBJECTIVE
  The purpose of this study was to determine the histopathologic risk factors for pelvic lymph node (PLN) and para-aortic lymph node (PALN) metastasis in endometrial cancer (EC) and to identify in which patients PALN dissection should be performed.
  
  
  METHODS
  A total of 204 consecutive patients, with EC and underwent systematic pelvic and para-aortic lymphadenectomy extending to the renal vessels, were studied retrospectively. Statistical significance between risk factors was examined using multivariant logistic regression analysis.
  
  
  RESULTS
  Cell type, depth of myometrial invasion and tumor size were found to be independently related to PLN metastasis. PLN metastasis in any site and lymphovascular invasion (LVSI) were independent prognostic factors for predicting PALN metastasis. The sensitivity, specificity and the NPV of PLN metastasis for detecting PALN metastasis were 80.8%, 89.3% and 97%, respectively. Furthermore, the 204 patients were divided into two groups according to the presence of one of these following factors: (1) non-endometrioid cell type, (2) PLN metastasis, (3) LVSI, (4) adnexal metastasis and (5) serosal involvement. Among these 204 patients, 104 had one or more of these factors (group A), and 100 patients had none of these factors (group B). PALN metastasis was significantly greater in group A, compared to group B. The sensitivity and the NPV of these combined prognostic factors for predicting PALN metastasis were 96.2% and 99%, respectively.
  
  
  CONCLUSIONS
  Presence of non-endometrioid cell type, PLN metastasis, LVSI, adnexal metastasis or serosal involvement diagnosed by frozen section (FS) seem to be poor prognostic factor for PALN metastasis in EC. Also, PALN dissection should be extended to the level of the renal vessels in all patients who will undergo PALN dissection, due to frequent involvement of the supramesenterial region.
authors.affiliation: Etlik Zübeyde Hanım Women's Health Teaching and Research Hospital, Gynecologic Oncology Division, Ankara, Turkey.
authors.forename: Taner
authors.initials: T
authors.lastname: Turan
authors.forename: Deniz
authors.initials: D
authors.lastname: Hizli
authors.forename: Saynur
authors.initials: S
authors.lastname: Sarici
authors.forename: Nurettin
authors.initials: N
authors.lastname: Boran
authors.forename: Burcu
authors.initials: B
authors.lastname: Gundogdu
authors.forename: Burak
authors.initials: B
authors.lastname: Karadag
authors.forename: Gokhan
authors.initials: G
authors.lastname: Tulunay
authors.forename: M Faruk
authors.initials: MF
authors.lastname: Kose
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010388:Pelvis; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity