Wagar Matthew K, Zinter Allison, McGregor Stephanie M, Williams Makeba, Barroilhet Lisa M, Sampene Katherine
Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
WMJ. 2025;124(3):223-229.
Endometrial cancer is the most common gynecologic cancer in the United States, and endometrial cancer staging historically has included lymph node assessment to inform prognosis and guide recommendations for adjuvant treatment. This study sought to determine the incidence of lymph node involvement in patients undergoing hysterectomy with sentinel lymph node dissection for a preoperative diagnosis of endometrial intraepithelial neoplasia (EIN) to allow for risk stratification and management by general gynecology and gynecologic oncology.
We performed a retrospective chart review of patients diagnosed with EIN who underwent hysterectomy from January 2018 through July 2021. We collected and analyzed patient characteristics, perioperative metrics, and postoperative data. Incidence of lymph node positivity on final pathology was the primary outcome of interest. We analyzed clinical and histologic risk factors for correlation with a final diagnosis of endometrial carcinoma. Chi-square, Fisher exact, and tests were used for comparisons.
One hundred patients met inclusion criteria, 40 of whom had an underlying endometrial cancer. The majority were stage IA grade 1 endometrioid carcinomas (95%). Per institutional protocol, all patients were recommended sentinel lymph node dissection, of which 84 (84%) patients ultimately underwent lymph node dissection. One patient was found to have a positive sentinel lymph node on final pathology (1.2%). Increasing endometrial stripe thickness was positively associated with risk of endometrial carcinoma on final pathology (22.39 mm ± 31.87 vs 11.78 mm ± 5.17, = 0.023).
The incidence of lymph node involvement in patients with a preoperative diagnosis of EIN is low. Sentinel lymph node dissection is unlikely to affect adjuvant treatment recommendations following surgical staging. Standardized risk assessment methods are warranted for patients with a preoperative diagnosis of EIN to delineate the utility of lymph node assessment in this population.
子宫内膜癌是美国最常见的妇科癌症，从历史上看，子宫内膜癌分期包括淋巴结评估，以告知预后并指导辅助治疗建议。本研究旨在确定因术前诊断为子宫内膜上皮内瘤变（EIN）而接受子宫切除术并进行前哨淋巴结清扫的患者中淋巴结受累的发生率，以便进行风险分层，并由普通妇科和妇科肿瘤学进行管理。
我们对2018年1月至2021年7月期间诊断为EIN并接受子宫切除术的患者进行了回顾性病历审查。我们收集并分析了患者特征、围手术期指标和术后数据。最终病理上淋巴结阳性的发生率是主要关注结果。我们分析了临床和组织学风险因素与子宫内膜癌最终诊断的相关性。采用卡方检验、Fisher精确检验和检验进行比较。
100名患者符合纳入标准，其中40名患有潜在的子宫内膜癌。大多数为IA期1级子宫内膜样癌（95%）。根据机构方案，所有患者均被建议进行前哨淋巴结清扫，其中84名（84%）患者最终接受了淋巴结清扫。一名患者在最终病理上被发现前哨淋巴结阳性（1.2%）。子宫内膜条纹厚度增加与最终病理上子宫内膜癌的风险呈正相关（22.39mm±31.87 vs 11.78mm±5.17，P=0.023）。
术前诊断为EIN的患者中淋巴结受累的发生率较低。前哨淋巴结清扫不太可能影响手术分期后的辅助治疗建议。对于术前诊断为EIN的患者，有必要采用标准化的风险评估方法来确定该人群中淋巴结评估的效用。
