Abt Devon, Macharia Annliz, Hacker Michele R, Baig Rasha, Esselen Katharine McKinley, Ducie Jennifer
Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA.
Int J Gynecol Cancer. 2022 Sep 6;32(9):1091-1097. doi: 10.1136/ijgc-2022-003521.
The goal of our study was to identify preoperative factors in patients with endometrial intraepithelial neoplasia that are associated with concurrent endometrial cancer to select patients who may benefit from sentinel lymph node (SLN) assessment at the time of hysterectomy.
Retrospective single institution cohort study of patients with a preoperative diagnosis of endometrial intraepithelial neoplasia who underwent hysterectomy with or without staging from January 2010 to July 2020. Modified Poisson regression was used to calculate risk ratios (RR) and 95% confidence intervals (CI).
Of 378 patients with a preoperative diagnosis of endometrial intraepithelial neoplasia, 275 (73%) had endometrial intraepithelial neoplasia and 103 (27%) had invasive cancer on final pathology. Age (p=0.003), race (p=0.02), and hypertension (p=0.02) were significantly associated with concurrent endometrial cancer. The median preoperative endometrial stripe was significantly greater in the endometrial cancer group (14 mm (range 10-19)) than in the endometrial intraepithelial neoplasia group (11 mm (range 8-16); p=0.002). A preoperative endometrial stripe ≥20 mm was associated with double the risk of endometrial cancer on final pathology (crude RR 2.0, 95% CI 1.3 to 2.9) and preoperative endometrial stripe ≥15 mm was 2.5 times more likely to be associated with high risk Mayo criteria on final pathology (crude RR 2.5, 95% CI 1.2 to 5.2). Of those with concurrent endometrial cancer, 5% were stage IB, 29% had tumors >2 cm, and 1% had grade 3 histology. Only 3% of all patients underwent lymph node evaluation.
In a large cohort of patients with a preoperative diagnosis of endometrial intraepithelial neoplasia, less than a third had invasive cancer and even fewer had pathologic features considered high risk for nodal metastasis, arguing against the use of routine SLN dissection in these patients. Endometrial stripe ≥15 mm may be a useful preoperative marker to identify patients at higher risk for concurrent endometrial cancer and may be an important criterion for use of selective SLN dissection in carefully selected patients with endometrial intraepithelial neoplasia.
我们研究的目的是确定子宫内膜上皮内瘤变患者中与同时存在的子宫内膜癌相关的术前因素，以选择可能在子宫切除时从前哨淋巴结（SLN）评估中获益的患者。
对2010年1月至2020年7月期间术前诊断为子宫内膜上皮内瘤变且接受了子宫切除及分期或未分期手术的患者进行回顾性单机构队列研究。采用修正泊松回归计算风险比（RR）和95%置信区间（CI）。
在378例术前诊断为子宫内膜上皮内瘤变的患者中，275例（73%）最终病理诊断为子宫内膜上皮内瘤变，103例（27%）为浸润性癌。年龄（p=0.003）、种族（p=0.02）和高血压（p=0.02）与同时存在的子宫内膜癌显著相关。子宫内膜癌组术前子宫内膜厚度中位数（14mm（范围10 - 19））显著大于子宫内膜上皮内瘤变组（11mm（范围8 - 16）；p=0.002）。术前子宫内膜厚度≥20mm与最终病理诊断为子宫内膜癌的风险增加一倍相关（粗RR 2.0，95%CI 1.3至2.9），术前子宫内膜厚度≥15mm在最终病理诊断时与梅奥高危标准相关的可能性高2.5倍（粗RR 2.5，95%CI 1.2至5.2）。在同时患有子宫内膜癌的患者中，5%为IB期，29%肿瘤>2cm，1%为3级组织学类型。所有患者中仅3%接受了淋巴结评估。
在一大组术前诊断为子宫内膜上皮内瘤变的患者中，不到三分之一患有浸润性癌，甚至更少患者具有被认为有淋巴结转移高危病理特征，这表明在这些患者中不主张常规进行SLN清扫。子宫内膜厚度≥15mm可能是识别同时患有子宫内膜癌高风险患者的有用术前标志物，并且可能是在精心挑选的子宫内膜上皮内瘤变患者中使用选择性SLN清扫的重要标准。
