Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Gynecol Oncol. 2013 Feb;128(2):294-9. doi: 10.1016/j.ygyno.2012.10.009. Epub 2012 Oct 17.
To determine whether preoperative biopsy (grade and histology) and intraoperative tumor diameter (TD) predict lymph node dissemination (LN+) and lymph node recurrence (LNRec) in endometrial cancer (EC).
Patients who underwent EC surgery from 2004 to 2008 were stratified into risk categories. Cases with preoperative grade 3 or non-endometrioid histology were classified as high risk (HR). Patients with preoperative FIGO grade 1 or 2, endometrioid histology or complex and/or atypical hyperplasia were classified based on intraoperative findings: (a) intraoperative macroscopic extrauterine disease classified as HR; (b) largest TD>2 cm classified as intermediate risk (IR) and (c) TD ≤ 2 cm classified as low risk (LR). LN+ and LNRec rates were determined.
Of 704 patients evaluated, 188 were HR (27%), 350 IR (50%), and 166 LR (23%). P/PA lymphadenectomy was performed in 87% HR, 83% IR and 16% LR patients. LN+ and/or LNRec occurred in 51 HR patients (27%) and 39 IR patients (11%). Only 1 LR patient (0.6%) had LN+ and none had LNRec. Four LR patients (2%) required adjuvant therapy according to permanent section pathology.
Preoperative biopsy and intraoperative TD can be used to effectively stratify patients into LR, IR or HR subgroups to tailor surgery. LR patients have a low probability (<1%) of LN+ and/or LNRec and lymphadenectomy can be omitted in this group. HR and IR patients combined (3/4 of population) have a substantial risk of LN+ or LNRec (17%). Lymphadenectomy is proposed to be advantageous in HR and IR patients if accurate frozen section is lacking.
确定术前活检（分级和组织学）和术中肿瘤直径（TD）是否可预测子宫内膜癌（EC）的淋巴结转移（LN+）和淋巴结复发（LNRec）。
将 2004 年至 2008 年接受 EC 手术的患者分为风险类别。术前分级 3 级或非子宫内膜样组织学的病例被归类为高危（HR）。根据术中发现，将术前国际妇产科联盟（FIGO）分级 1 或 2 级、子宫内膜样组织学或复杂和/或非典型增生的患者分为以下三类：（a）术中发现的肉眼可见的子宫外疾病归类为 HR；（b）最大 TD>2 cm 归类为中危（IR）；（c）TD≤2 cm 归类为低危（LR）。确定 LN+和 LNRec 发生率。
在评估的 704 例患者中，188 例为 HR（27%），350 例为 IR（50%），166 例为 LR（23%）。87%的 HR 患者、83%的 IR 患者和 16%的 LR 患者接受了经腹广泛性淋巴结切除术。51 例 HR 患者（27%）和 39 例 IR 患者（11%）发生 LN+和/或 LNRec。仅 1 例 LR 患者（0.6%）发生 LN+，且无 LNRec。根据石蜡切片病理，4 例 LR 患者（2%）需要辅助治疗。
术前活检和术中 TD 可有效将患者分为 LR、IR 或 HR 亚组，以针对性地进行手术。LR 患者发生 LN+和/或 LNRec 的概率较低（<1%），因此可在该组中省略淋巴结切除术。HR 和 IR 患者（占人群的 3/4）发生 LN+或 LNRec 的风险较大（17%）。如果缺乏准确的冰冻切片，建议对 HR 和 IR 患者进行淋巴结切除术。
