title: Low-Volume Lymph Node Metastasis Discovered During Sentinel Lymph Node Mapping for Endometrial Carcinoma.
abstract: OBJECTIVE
  The aim of this study was to characterize treatment patterns and oncologic outcomes in patients with low-volume lymph node metastasis (isolated tumor cells [ITCs] and micrometastasis [MM]) discovered during sentinel lymph node (SLN) mapping for endometrial carcinoma.
  
  
  METHODS
  We identified endometrial cancer cases treated surgically from September 2005 to April 2013 in which SLN mapping was performed. MM was defined as tumor within a lymph node measuring >0.2 mm but <2.0 mm, and ITCs were those measuring ≤0.2 mm.
  
  
  RESULTS
  Overall, 844 patients, with a median age of 61 years (range 30-90), met the inclusion criteria. Histology was as follows: endometrioid, 724 (85.8 %) patients; serous, 104 (12.3 %) patients; and clear cell, 16 (1.9 %) patients. The median number of lymph nodes resected was six (range 0-60), and the median number of SLNs was two (range 0-15). Overall, 753 (89.2 %) patients were node-negative, 23 (2.7 %) had ITCs only, 21 (2.5 %) had MM only, and 47 (5.6 %) had macrometastasis. Adjuvant chemotherapy was administered to 106 (14 %) of 753 node-negative patients, 19 (83 %) of 23 patients with ITCs, 17 (81 %) of 21 patients with MM, and 42 (89 %) of 47 with macrometastasis. Median follow-up was 26 months (range 0-108). Three-year recurrence-free survival was as follows: node-negative patients, 90 % (±1.5); ITCs only, 86 % (±9.4); MM only, 86 % (±9.7); and macrometastasis, 71 % (±7.2) [p < 0.001].
  
  
  CONCLUSIONS
  Patients with ITCs and MM frequently received adjuvant chemotherapy and had improved oncologic outcomes in comparison to those with macrometastasis to the lymph nodes. Further prospective study is needed to determine optimal post-resection management in patients with ITCs or MM alone.
authors.affiliation: Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Caryn M
authors.initials: CM
authors.lastname: St Clair
authors.affiliation: Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Ane Gerda Z
authors.initials: AG
authors.lastname: Eriksson
authors.affiliation: Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Ducie
authors.affiliation: Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Jewell
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Kaled M
authors.initials: KM
authors.lastname: Alektiar
authors.affiliation: Department of Medicine, Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Martee L
authors.initials: ML
authors.lastname: Hensley
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Soslow
authors.affiliation: Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Nadeem R
authors.initials: NR
authors.lastname: Abu-Rustum
authors.affiliation: Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. leitaom@mskcc.org.|Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA. leitaom@mskcc.org.
authors.forename: Mario M
authors.initials: MM
authors.lastname: Leitao
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018284:Cystadenocarcinoma, Serous / Q000556:secondary* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D061206:Neoplasm Micrometastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D000071036:Sentinel Lymph Node / Q000473:pathology* / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate