title: Ultrastaging of para-aortic lymph nodes in stage IIIC1 endometrial cancer: a preliminary report.
abstract: OBJECTIVE
  The aim of this study was to determine the rate of occult metastasis, including isolated tumor cells, in para-aortic lymph nodes of patients with stage IIIC1 endometrial cancer who underwent pelvic and para-aortic lymphadenectomy.
  
  
  METHODS
  A series of 15 patients who had undergone combined pelvic and para-aortic lymphadenectomy during the period from 2004 to 2010 and who were diagnosed as being positive for pelvic node metastasis but negative for para-aortic node metastasis were included in this study. Ultra-staging by multiple slicing, staining with hematoxylin/eosin and cytokeratin, and microscopic inspection was performed on a total of 242 para-aortic lymph nodes.
  
  
  RESULTS
  Eleven (73.3%) of the 15 patients had occult para-aortic lymph node metastasis. Two patients (13.3%) had macrometastasis and nine patients (60.0%) had isolated tumor cells. Type 2 endometrial cancer tended to have a higher rate of occult metastasis than that of type 1 cancer (90% vs. 40%, P=0.07). The rate of occult para-aortic node metastasis was not related to the number of metastatic pelvic nodes. Five patients suffered recurrence in the lung or in the intraabdomen, but lymph node recurrence was not found in any case.
  
  
  CONCLUSIONS
  Patients with stage IIIC1 endometrial cancer have a potentially high rate of occult para-aortic node metastasis. Local treatment of the para-aortic region should be considered in patients with stage IIIC1 endometrial cancer until effective adjuvant therapy is established.
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan. yukiharu@sap-cc.go.jp
authors.forename: Yukiharu
authors.initials: Y
authors.lastname: Todo
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Manabu
authors.initials: M
authors.lastname: Azuma
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hatanaka
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Konno
authors.forename: Hidemichi
authors.initials: H
authors.lastname: Watari
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kato
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Matsuno
authors.forename: Katsushige
authors.initials: K
authors.lastname: Yamashiro
authors.forename: Noriaki
authors.initials: N
authors.lastname: Sakuragi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D061206:Neoplasm Micrometastasis / Q000175:diagnosis; D009367:Neoplasm Staging