The pattern of myometrial invasion as a predictor of lymph node metastasis or extrauterine disease in low-grade endometrial carcinoma.
The purpose of this study was to examine predictors of lymph node (LN) metastases or extrauterine disease (ED) in low-grade (FIGO grade 1 or 2) endometrioid carcinoma (LGEC) in a multi-institutional setting. For LGEC with and without LN metastasis or ED, each of the 9 participating institutions evaluated patients' age, tumor size, myometrial invasion (MI), FIGO grade, % solid component, the presence or absence of papillary architecture, microcystic, elongated, and fragmented glands (MELF), single-cell/cell-cluster invasion (SCI), lymphovascular invasion (LVI), lower uterine segment (LUS) and cervical stromal (CX) involvement, and numbers of pelvic and para-aortic LNs sampled. A total of 304 cases were reviewed: LN(+) or ED(+), 96; LN(-)/ED(-), 208. Patients' ages ranged from 23 to 91 years (median 61 y). Table 1 summarizes the histopathologic variables that were noted for the LN(+) or ED(+) group: tumor size ≥2 cm, 93/96 (97%); MI>50%, 54/96 (56%); MELF, 67/96 (70%); SCI, 33/96 (34%); LVI, 79/96 (82%); >20% solid, 65/96 (68%); papillary architecture present, 68/96 (72%); LUS involved, 64/96 (67%); and CX involved, 41/96 (43%). For the LN(-)/ED(-) group, the results were as follows: tumor size ≥2 cm, 152/208 (73%); MI>50%, 56/208 (27%); MELF, 79/208 (38%); SCI, 19/208 (9%); LVI, 56/208 (27%); >20% solid, 160/208 (77%); papillary architecture present, 122/208 (59%); LUS involved, 77/208 (37%); CX involved, 24/208 (12%). There was no evidence of a difference in the number of pelvic or para-aortic LNs sampled between groups (P=0.9 and 0.1, respectively). After multivariate analysis, the depth of MI, CX involvement, LVI, and SCI emerged as significant predictors of advanced-stage disease. Although univariate analysis pointed to LUS involvement, MELF pattern of invasion, and papillary architecture as possible predictors of advanced-stage disease, these were not shown to be significant by multivariate analysis. This study validates MI, CX involvement, and LVI as significant predictors of LN(+) or ED(+). The association of SCI pattern with advanced-stage LGEC is a novel finding.
*The University of Texas, MD Anderson Cancer Center, Houston, TX †Wayne State University, Detroit, MI ‡Cedars-Sinai Medical Center, Los Angeles, CA ∥Penn State University, Hershey, PA ††Cleveland Clinic, Cleveland, OH §The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada ¶Korea University Anam Hospital #Kwandong Hospital, Seoul, Republic of Korea **Instituto Nacional de Cancerologia, Mexico City, Mexico.
Elizabeth
E
Euscher
Patricia
P
Fox
Roland
R
Bassett
Hayma
H
Al-Ghawi
Rouba
R
Ali-Fehmi
Denise
D
Barbuto
Bojana
B
Djordjevic
Elizabeth
E
Frauenhoffer
Insun
I
Kim
Sun Rang
SR
Hong
Delia
D
Montiel
Elizabeth
E
Moschiano
Andres
A
Roma
Elvio
E
Silva
Anais
A
Malpica
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D018269:Carcinoma, Endometrioid / Q000556:secondary*; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008800:Mexico; D008875:Middle Aged; D015999:Multivariate Analysis; D009215:Myometrium / Q000473:pathology*; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009864:Ontario; D011237:Predictive Value of Tests; D011379:Prognosis; D056910:Republic of Korea; D012307:Risk Factors; D014481:United States; D055815:Young Adult