Touhami Omar, Trinh Xuan-Bich, Gregoire Jean, Sebastianelli Alexandra, Renaud Marie-Claude, Grondin Katherine, Plante Marie
*Gynecologic Oncology Division and †Pathology Department, Centre Hospitalier Universitaire de Québec, L'Hôtel-Dieu de Québec, Laval University, Quebec City, Quebec, Canada.
Int J Gynecol Cancer. 2015 Sep;25(7):1266-70. doi: 10.1097/IGC.0000000000000488.
Uterine serous carcinoma (USC) is an aggressive histologic subtype of endometrial cancer that shares similarities to serous ovarian cancer, with a propensity for spread to the upper abdomen, a high recurrence rate, and a poor prognosis. The aim of this study was to determine whether the traditional surgical staging procedure for endometrial cancer was adequate for USC or whether a more extensive surgery, similar to the staging procedure for ovarian cancer, needs to be performed. Specifically, the roles of omentectomy and sentinel lymph node (SLN) mapping were evaluated.
We retrospectively identified cases of presumed clinical stage I USC at our institution from April 2005 to March 2014. Medical records were reviewed for the following information: age at diagnosis, preoperative imaging, operative findings, surgical procedure, and final histology with definitive International Federation of Gynecology and Obstetrics stage.
A total of 39 patients with presumed clinical stage I USC were identified. According to the final pathology report, the surgical stage was as follows: 17 stage IA (44%), 8 stage IB (20%), 3 stage II (8%), 2 stage IIIA (5%), 6 stage IIIC1 (15%), 1 IIIC2 (3%), and 2 stage IVB (5%). Therefore, 14 patients (36%) were surgically upstaged, but none of the patients had their clinical disease upstaged by virtue of finding microscopic metastatic disease in an otherwise normal-looking omentum. Sentinel lymph node mapping was performed in 19 patients (42%). Sensitivity and negative predictive value of SLN mapping were 100% when at least 1 SLN was identified.
The detection of microscopic disease in radiologically and clinically normal-appearing omentum seems to be rare in USC. Sentinel lymph node mapping seems to be valuable in the serous subtype of endometrial cancer. A less extensive surgery may be possible in patients with USC as it seems to provide the same information as a more extensive surgery.
子宫浆液性癌（USC）是子宫内膜癌的一种侵袭性组织学亚型，与浆液性卵巢癌有相似之处，易于扩散至上腹部，复发率高，预后差。本研究的目的是确定子宫内膜癌的传统手术分期程序对USC是否足够，或者是否需要进行更广泛的手术，类似于卵巢癌的分期程序。具体而言，评估了大网膜切除术和前哨淋巴结（SLN）定位的作用。
我们回顾性地确定了2005年4月至2014年3月在本机构疑似临床I期USC的病例。查阅病历以获取以下信息：诊断时的年龄、术前影像学检查、手术发现、手术程序以及最终组织学检查和明确的国际妇产科联盟分期。
共确定了39例疑似临床I期USC患者。根据最终病理报告，手术分期如下：17例IA期（44%），8例IB期（20%），3例II期（8%），2例IIIA期（5%），6例IIIC1期（15%），1例IIIC2期（3%），2例IVB期（5%）。因此，14例患者（36%）手术分期上调，但没有患者因在外观正常的大网膜中发现微小转移病灶而使临床疾病分期上调。19例患者（42%）进行了前哨淋巴结定位。当至少识别出1个SLN时，SLN定位的敏感性和阴性预测值为100%。
在USC中，在影像学和临床上外观正常的大网膜中检测到微小病灶似乎很少见。前哨淋巴结定位在子宫内膜癌的浆液性亚型中似乎很有价值。对于USC患者，可能可以进行范围较小的手术，因为它似乎能提供与范围更广的手术相同的信息。
