Associate professor of obstetrics and gynecology, Alexandria university, Egypt
Background:. The present study compares between superficial and deep myometrial invasion in type 1 endometrial cancer in relation to regional lymph nodes metastasis, so we can answer the question to do or not do lymphadenectomy, this life-threatening procedure in both superficial and deep myometrial invasion with type 1, clinically and radiologically stage 1 endometrial cancer.
Patients and methods: Patients were divided into 2 groups distributed as follows: group I includes 50 patients type 1 endometrial cancer with superficial myometrial invasion and group II includes 50 patients type 1 endometrial cancer with deep myometrial invasion. Total abdominal hysterectomy with bilateral salpingo-opherectomy with pelvic and lower para-aortic lymphadenectomy to all patients included in the study from both groups. Histopathological examinations were done to all the specimen from both groups to confirm diagnosis of type 1 endometrial cancer, depth of myometrial invasion, pathological grading and metastasis to the regional lymph nodes.
Result: Considering regional lymph nodes metastasis in both groups, there is a statistical difference between group I and group II in relation to relation to regional lymph nodes metastasis as group II (cases with deep myometrial invasion) are associated with more regional lymph nodes metastasis (p= 0.0001)).
Conclusion: deep myometrial invasion in type 1 endometrial cancer is associated with significant increase in regional lymph nodes metastases.
- 1-Zhang S, Gong TT, Liu FH, et al. Global, Regional, and National Burden of Endometrial Cancer, 1990-2017: Results From the Global Burden of Disease Study, 2017. Front Oncol. 2019;9:1440. Published 2019 Dec 19. doi:10.3389/fonc.2019.01440. 2-Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. (2018) 68:394–424. 10.3322/caac.21492 3- Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol. 1983;15:10–17. 4- Moore KN, Fader AN. Uterine papillary serous carcinoma. Clin Obstet Gynecol. 2011;54:278–291. 5-Bakkum-Gamez JN, Gonzalez-Bosquet J, Laack NN, et al. Current issues in the management of endometrial cancer. Mayo Clin Proc 2008 Jan;83:97-112. 6- American College of Obstetricians and Gynecologists. ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer. Obstet Gynecol 2005;106:413-425. 7-Galaal K, Bryant A, Fisher AD, et al. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. The Cochrane Database of Systematic Reviews 2012, Issue 9 8- Chan JK, Cheung MK, Huh WK et al: Therapeutic role of lymph node resection in endometrioid corpus cancer: a studyof 12,333 patients. Cancer. 2006 Oct 15;107(8):1823-30. 9- rost JA, Webster KE, Bryant A, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev. 2017;10(10):CD007585. Published 2017 Oct 2. doi:10.1002/14651858.CD007585.pub4 10- Zhang, G., Chen, H., Liu, Y. et al. Is lymph node dissection mandatory among early stage endometrial cancer patients? A retrospective study. BMC Women's Health 20, 258 (2020). https://doi.org/10.1186/s12905-020-01128-w 11- Abu-Rustum NR, Khoury-Collado F, Pandit-Taskar N, et al. Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma? Gynecol Oncol 2009;113:163-169. 12- Setiawan VW, Yang HP, Pike MC, McCann SE, Yu H, Xiang YB, et al: Type I and II endometrial cancers: have they different risk factors? J Clin Oncol 2013; 31: 2607–2618 13- Seracchioli R, Solfrini S, Mabrouk M, et al. Controversies in surgical staging of endometrial cancer. Obstet Gynecol Int. 2010;2010:181963. doi:10.1155/2010/181963 14- May K, Bryant A, Dickinson HO, Kehoe S, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev. 2010;(1):CD007585. Published 2010 Jan 20. doi:10.1002/14651858.CD007585.pub2. 15- Ignatov A , Lebius C , Ignatov T , et al . Lymph node micrometastases and outcome of endometrial cancer. Gynecol Oncol 2019;154:475–9. doi:10.1016/j.ygyno.2019.07.018. 16- Euscher E, Fox P, Bassett R, et al. The pattern of myometrial invasion as a predictor of lymph node metastasis or extrauterine disease in low-grade endometrial carcinoma. Am J Surg Pathol. 2013;37(11):1728-1736. doi:10.1097/PAS.0b013e318299f2ab. 17- Essmat, A. (2021) Correlation between Depth of Myometrial Invasion and Degree of Lymph Node Affection in Cases of Endometrial Cancer. Open Journal of Obstetrics and Gynecology, 11, 360-368. doi: 10.4236/ojog.2021.114036. 18- Bandala-Jacques, A., Cantú-de-León, D., Pérez-Montiel, D. et al. Diagnostic performance of intraoperative assessment in grade 2 endometrioid endometrial carcinoma. World J Surg Onc 18, 284 (2020). https://doi.org/10.1186/s12957-020-02056-7. 19- Ahmet Taner TURAN1, Burcu AYKAN YILDIRIM, Işın ÜREYEN, Deniz HIZLI, Mustafa Alper KARALÖK, Ömer Lütfi TAPISIZ, Hakkı Gökhan TULUNAY, Nurettin BORAN, Nejat ÖZGÜL, Mehmet Faruk KÖSE. Creating a risk model to determine paraaortic lymph node involvement in endometrial carcinoma. Turk J Med Sci 2012; 42 (Sup.1): 1259-1267. © TÜBİTAK E-mail: [email protected]:10.3906/sag-1201-27.