title: Microcystic, elongated, and fragmented pattern invasion is mainly associated with isolated tumor cell pattern metastases in International Federation of Gynecology and Obstetrics grade I endometrioid endometrial cancer.
abstract: Although many studies have evaluated the impact of mismatch repair protein loss of expression (MMR LOE) or microcystic, elongated, and fragmented (MELF) pattern of myometrial invasion as individual factors in endometrial cancer, we analyzed the combined impact of both. We reviewed every case of International Federation of Gynecology and Obstetrics (FIGO) grade 1 endometrioid endometrial cancers (EECs) from our institution, between 2011 and 2015, that had a sentinel lymph node biopsy and/or a lymphadenectomy, and examined the following data: age, myometrial infiltration, MELF infiltration, lymphovascular space invasion, and lymph node status. These cases were then grouped according to the absence of lymph node metastases, the presence of isolated tumor cell (ITC) lymph node metastases, or the presence of non-ITC metastases. Among the 127 cases that were in our study, 105 patients did not have nodal metastases, whereas 22 patients showed metastases, of which 11 were ITC. MMR LOE was only significantly associated with a higher odds ratio (OR) of metastases (OR, 7.44; P < .001). MELF was only associated with a higher OR of ITC-pattern metastases (OR, 32.3; P < .001). This study distinguished the effects of MELF and MMR LOE on the risk of metastases in FIGO grade 1 EEC. Further research on the clinical impact of MELF and ITC-pattern metastases is warranted to better guide clinicians on the management of patients with FIGO grade 1 EEC harboring such characteristics, which are still considered low-risk cancer.
authors.affiliation: Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada H2L 4M1; Department of Pathology and Cellular Biology, Université de Montréal, Montreal, Quebec, Canada H3T 1J4.
authors.forename: Mathieu P
authors.initials: MP
authors.lastname: Pelletier
authors.affiliation: Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada H2L 4M1; Department of Pathology and Cellular Biology, Université de Montréal, Montreal, Quebec, Canada H3T 1J4; Centre de Recherche du Centre Hospitalier de l'Université de Montréal and Institut du Cancer de Montréal, Montreal, Quebec, Canada H2X 0A9.
authors.forename: Vincent Q
authors.initials: VQ
authors.lastname: Trinh
authors.affiliation: Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada H2L 4M1.
authors.forename: Philippe
authors.initials: P
authors.lastname: Stephenson
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal and Institut du Cancer de Montréal, Montreal, Quebec, Canada H2X 0A9; Department of Medicine, Université de Montréal, Montreal, Quebec, Canada H3T 1J4.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Mes-Masson
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal and Institut du Cancer de Montréal, Montreal, Quebec, Canada H2X 0A9; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Quebec, Canada H2L 4M1.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Samouelian
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal and Institut du Cancer de Montréal, Montreal, Quebec, Canada H2X 0A9; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Quebec, Canada H2L 4M1.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Provencher
authors.affiliation: Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada H2L 4M1; Department of Pathology and Cellular Biology, Université de Montréal, Montreal, Quebec, Canada H3T 1J4; Centre de Recherche du Centre Hospitalier de l'Université de Montréal and Institut du Cancer de Montréal, Montreal, Quebec, Canada H2X 0A9. Electronic address: kurosh.rahimi.chum@gouv.ssss.qc.ca.
authors.forename: Kurosh
authors.initials: K
authors.lastname: Rahimi
mesh_terms: D020137:Base Pair Mismatch; D018269:Carcinoma, Endometrioid / Q000737:chemistry / Q000556:secondary* / Q000601:surgery; D002465:Cell Movement; D045643:DNA Repair Enzymes / Q000032:analysis; D016889:Endometrial Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007150:Immunohistochemistry; D016015:Logistic Models; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009215:Myometrium / Q000473:pathology*; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011792:Quebec; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy
chemical_list: D045643:DNA Repair Enzymes
keywords: Endometrioid endometrial carcinoma; Isolated tumor cell; Lymph node metastasis; Microcystic elongated and fragmented; Microsatellite instability