title: Lymphatic spread of endometriosis to pelvic sentinel lymph nodes: a prospective clinical study.
abstract: OBJECTIVE
  To establish the prevalence of endometriosis metastatic to pelvic sentinel lymph nodes (PSLN) in women with ovarian and/or peritoneal endometriosis.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  Academic research institution.
  
  
  METHODS
  Women with a laparoscopic diagnosis of ovarian and/or peritoneal endometriosis verified by intraoperative frozen section analysis.
  
  
  METHODS
  Resection of endometriotic lesions and PSLN after cervical blue dye injection.
  
  
  METHODS
  Histologic analysis of PSLN for the presence of endometriosis and immunohistochemical analysis of estrogen receptor (ER), progesterone receptor (PR), cytokeratin (CK), and CD-10 expression.
  
  
  RESULTS
  The study enrolled 26 women with suspected endometriosis; endometriosis was confirmed in 23 women, and a PSLN was identified in 19 women. A total of 37 (right side: 20; left side: 17) lymph nodes were removed. The prevalence of endometriotic lesions in PSLN was 11% (2 of 19). Both lesions were positive for ER, PR, CK, and CD-10. Isolated endometriotic-like cells (IELCs) staining positive for ER and PR were identified in the peripheral sinus of 16 (80%) of 20 and 14 (70%) of 20 PSLN, respectively. All IELCs lacked CK staining, whereas CD-10 staining was present in 16 (80%) of 20 cases, indicating a stromal origin of IELCs. Intraoperative and/or postoperative complications were observed in 1 (5%) of 19 women.
  
  
  CONCLUSIONS
  Spread of IELCs to PSLN is common in ovarian and/or peritoneal endometriosis. Metastatic lesions in PSLN are present in 11% of women. Further studies to evaluate the prognostic and predictive value of endometriotic spread to PSLN are warranted.
authors: Department of Obstetrics and Gynecology, Ruhr University of Bochum, Bochum, Germany. clemens.tempfer@marienhospital-herne.de
authors: Clemens B
authors: CB
authors: Tempfer
authors: René
authors: R
authors: Wenzl
authors: Reinhard
authors: R
authors: Horvat
authors: Christoph
authors: C
authors: Grimm
authors: Stephan
authors: S
authors: Polterauer
authors: Bernd
authors: B
authors: Buerkle
authors: Alexander
authors: A
authors: Reinthaller
authors: Johannes C
authors: JC
authors: Huber
mesh_terms: D000328:Adult; D004396:Coloring Agents / Q000493:pharmacokinetics; D004715:Endometriosis / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D005629:Frozen Sections; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D010049:Ovarian Diseases / Q000453:epidemiology* / Q000473:pathology*; D010532:Peritoneal Diseases / Q000453:epidemiology / Q000473:pathology; D015995:Prevalence; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data; D012720:Severity of Illness Index
chemical_list: D004396:Coloring Agents