title: Value of additional level sections in the evaluation of lymph nodes for endometrial carcinoma staging.
abstract: OBJECTIVE
  To evaluate the value of deeper sections for conventional (non-sentinel) lymph node dissections in high-risk endometrial carcinoma (EC).
  
  
  METHODS
  We conducted a retrospective review of all ECs with high-grade or serous histology, more than 50% myometrial invasion or International Federation of Gynecology and Obstetrics (FIGO) pathologic stage greater than 2, and conventional complete pelvic lymph node dissections. No sentinel lymph node (SLN) biopsies were performed. Nodes were originally processed entirely in 3-mm slices, with residual fatty tissue submitted separately. When lymph nodes were negative on original H&E sections, paraffin blocks were sectioned to produce 1 additional H&E slide at approximately 0.8 mm deep. With positive nodes, we examined the relationship between micrometastases, staging parameters, and recurrence.
  
  
  RESULTS
  Fifty-one high-risk cases were identified, with a median of 15 pelvic lymph nodes per case. Fifteen (29%) cases contained positive nodes. Review of the original slides and additional sections of all blocks from the remaining 36 cases failed to reveal metastases. Statistically significant associations were found between node status and depth of myometrial invasion, lymphovascular invasion, and FIGO stage. We found no significant relationship between lymph node status and serous histology.
  
  
  CONCLUSIONS
  Our results suggest that enhanced detection of metastasis by SLN biopsies may be related to targeted lymph node selection rather than additional histologic sectioning.
authors.affiliation: Dept of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; e-mail: jlhecht@BIDMC.harvard.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schmolze
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Awtrey
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Hecht
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary*; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009215:Myometrium; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy
keywords: Endometrial carcinoma; Level sections; Microstaging; Sentinel lymph node