Low-Risk Uterine Endometrioid Carcinoma: The Necessity of Intraoperative Histopathological Assessment and Lymphadenectomy
Nguyen HQ, Elshaikh MA, Tsolakian IG, Naaman JD, Chaugle S, Khalil R, Bandyopadhyay S, Morris RT, and Ali-Fehmi R. Low-Risk Uterine Endometrioid Carcinoma: The Necessity of Intraoperative Histopathological Assessment and Lymphadenectomy. Gynecol Oncol 2019; 154:180.
Objective: Current practice of surgical management of low-risk uterine endometrioid carcinoma (EEC) and based on Mayo criteria FIGO grade 1 or 2, greatest tumor dimension (GTD) ≤2 cm, and myometrial invasion ≤50%) is hysterectomy without lymphadenectomy. Lymphadenectomy is considered for patients whose tumor does satisfy all 3 criteria and requires intraoperative histopathological assessment. The use of frozen section diagnosis can significantly prolong the surgery and is not always available in all health care facilities. This study investigates the use of preoperative histologic grade with intraoperative greatest tumor dimension measurement, bypassing the intraoperative assessment of myometrial invasion, to determine the indication of lymphadenectomy. Method: This is a retrospective database collection of patients who underwent hysterectomy with or without comprehensive surgical staging for EEC between 1995 and 2016. All high-risk histologic types, such as clear cell, serous, or carcinosarcoma, are excluded. This investigation compared those with preoperative FIGO grade 1 or 2 and GTD ≤2 cm to patients with preoperative FIGO grade 3 or GTD >2 cm. Lymph node metastasis (LNM) and recurrence were compared in these groups. This study also compared the use of 2 criteria (preoperative FIGO grade 1 or 2 and GTD ≤2 cm), bypassing frozen section diagnosis, to the use of Mayo criteria in predicting LNM. Results: This study reviewed 1,325 cases. Overall, LNM occurred in 7.6% of patients. Patients with GTD >2 cm have higher rate of LNM (10.1%) and recurrence (10.4%) compared to those with GTD ≤2 cm (LNM = 2.7%, recurrence = 5%; P= 0.000 and P = 0.001 respectively). When combining preoperative FIGO grade 1-2 with GTD ≤2 cm, the rate of LNM is 2.3%, while the rate of LNM when using Mayo criteria is 1.1%. Fisher exact test to compare the rate of LNM in 2 groups of criteria couldn’t find any statistical difference regarding LNM detection (P = 0.126). See Table 1. Conclusion: The results indicate that combined preoperative FIGO and GTD can detect LNM as well as Mayo criteria; therefore, the intraoperative histopathological assessment may be not necessary and could be eliminated in selected women with low-risk uterine endometrioid carcinoma.