Reducing overtreatment: A comparison of lymph node assessment strategies for endometrial cancer

Abdulrahman K. Sinno, Elizabeth Peijnenburg, Amanda Nickles Nickles Fader, Sarah M. Temkin, Rebecca Stone, Kimberly Levinson, Tricia Murdock, Edward J. Tanner

Research output: Contribution to journalArticle

Abstract

Objectives To compare the utility of three lymph node (LN) assessment strategies to identify lymphatic metastases while minimizing complete lymphadenectomy rates in women with low-grade endometrial cancer (EC). Methods: Using our institutional standard protocol (SP), patients with complex atypical hyperplasia (CAH) or grade 1/2 EC underwent sentinel lymph node (SLN) mapping, hysterectomy, and intraoperative frozen section (FS). Lymphadenectomy was performed if high-risk uterine features were identified on FS. Utilizing SP data, two alternative strategies were applied: a Universal FS Strategy (UFS), omitting SLN mapping and performing lymphadenectomy based on FS results, and a SLN-Restrictive FS Strategy (SLN-RFS) in which FS and lymphadenectomy are performed only if bilateral SLN mapping fails. Results Of 114 patients managed on the SP, SLNs were identified in 86%, with lymphatic metastases detected in eight patients. Six patients recurred after a median follow up of 15 months. Most (83%) developed in those who had a negative systematic lymphadenectomy (n = 4; mean LNs: 18) or no lymphadenectomy indication. When applying the alternative lymphatic assessment strategies, the SLN-RFS approach would theoretically result in lower lymphadenectomy rates compared to both the SP and the alternative UFS strategies (9.2% versus 36.8% and 36.8%, respectively; p = 0.004), without a reduction in detection of LN metastases (8/8 versus 8/8 and 5/8, respectively). Conclusion In this modeling analysis, an operative strategy omitting universal frozen section and restricting its use to cases with failed SLN mapping may result in lower lymphadenectomy rates and reduce the risk of overtreatment without compromising oncologic outcome for patients with EC.

Original languageEnglish (US)
Pages (from-to)281-286
Number of pages6
JournalGynecologic Oncology
Volume143
Issue number2
DOIs
StatePublished - Nov 1 2016

Fingerprint

Endometrial Neoplasms
Lymph Node Excision
Frozen Sections
Lymph Nodes
Lymphatic Metastasis
Medical Overuse
Hysterectomy
Hyperplasia
Sentinel Lymph Node
Neoplasm Metastasis

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Reducing overtreatment : A comparison of lymph node assessment strategies for endometrial cancer. / Sinno, Abdulrahman K.; Peijnenburg, Elizabeth; Nickles Fader, Amanda Nickles; Temkin, Sarah M.; Stone, Rebecca; Levinson, Kimberly; Murdock, Tricia; Tanner, Edward J.

In: Gynecologic Oncology, Vol. 143, No. 2, 01.11.2016, p. 281-286.

Research output: Contribution to journalArticle

@article{c9981d98215f4f108fed69ece4264afb,
title = "Reducing overtreatment: A comparison of lymph node assessment strategies for endometrial cancer",
abstract = "Objectives To compare the utility of three lymph node (LN) assessment strategies to identify lymphatic metastases while minimizing complete lymphadenectomy rates in women with low-grade endometrial cancer (EC). Methods: Using our institutional standard protocol (SP), patients with complex atypical hyperplasia (CAH) or grade 1/2 EC underwent sentinel lymph node (SLN) mapping, hysterectomy, and intraoperative frozen section (FS). Lymphadenectomy was performed if high-risk uterine features were identified on FS. Utilizing SP data, two alternative strategies were applied: a Universal FS Strategy (UFS), omitting SLN mapping and performing lymphadenectomy based on FS results, and a SLN-Restrictive FS Strategy (SLN-RFS) in which FS and lymphadenectomy are performed only if bilateral SLN mapping fails. Results Of 114 patients managed on the SP, SLNs were identified in 86{\%}, with lymphatic metastases detected in eight patients. Six patients recurred after a median follow up of 15 months. Most (83{\%}) developed in those who had a negative systematic lymphadenectomy (n = 4; mean LNs: 18) or no lymphadenectomy indication. When applying the alternative lymphatic assessment strategies, the SLN-RFS approach would theoretically result in lower lymphadenectomy rates compared to both the SP and the alternative UFS strategies (9.2{\%} versus 36.8{\%} and 36.8{\%}, respectively; p = 0.004), without a reduction in detection of LN metastases (8/8 versus 8/8 and 5/8, respectively). Conclusion In this modeling analysis, an operative strategy omitting universal frozen section and restricting its use to cases with failed SLN mapping may result in lower lymphadenectomy rates and reduce the risk of overtreatment without compromising oncologic outcome for patients with EC.",
author = "Sinno, {Abdulrahman K.} and Elizabeth Peijnenburg and {Nickles Fader}, {Amanda Nickles} and Temkin, {Sarah M.} and Rebecca Stone and Kimberly Levinson and Tricia Murdock and Tanner, {Edward J.}",
year = "2016",
month = "11",
day = "1",
doi = "10.1016/j.ygyno.2016.08.323",
language = "English (US)",
volume = "143",
pages = "281--286",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",
number = "2",

}

TY - JOUR

T1 - Reducing overtreatment

T2 - A comparison of lymph node assessment strategies for endometrial cancer

AU - Sinno, Abdulrahman K.

AU - Peijnenburg, Elizabeth

AU - Nickles Fader, Amanda Nickles

AU - Temkin, Sarah M.

AU - Stone, Rebecca

AU - Levinson, Kimberly

AU - Murdock, Tricia

AU - Tanner, Edward J.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Objectives To compare the utility of three lymph node (LN) assessment strategies to identify lymphatic metastases while minimizing complete lymphadenectomy rates in women with low-grade endometrial cancer (EC). Methods: Using our institutional standard protocol (SP), patients with complex atypical hyperplasia (CAH) or grade 1/2 EC underwent sentinel lymph node (SLN) mapping, hysterectomy, and intraoperative frozen section (FS). Lymphadenectomy was performed if high-risk uterine features were identified on FS. Utilizing SP data, two alternative strategies were applied: a Universal FS Strategy (UFS), omitting SLN mapping and performing lymphadenectomy based on FS results, and a SLN-Restrictive FS Strategy (SLN-RFS) in which FS and lymphadenectomy are performed only if bilateral SLN mapping fails. Results Of 114 patients managed on the SP, SLNs were identified in 86%, with lymphatic metastases detected in eight patients. Six patients recurred after a median follow up of 15 months. Most (83%) developed in those who had a negative systematic lymphadenectomy (n = 4; mean LNs: 18) or no lymphadenectomy indication. When applying the alternative lymphatic assessment strategies, the SLN-RFS approach would theoretically result in lower lymphadenectomy rates compared to both the SP and the alternative UFS strategies (9.2% versus 36.8% and 36.8%, respectively; p = 0.004), without a reduction in detection of LN metastases (8/8 versus 8/8 and 5/8, respectively). Conclusion In this modeling analysis, an operative strategy omitting universal frozen section and restricting its use to cases with failed SLN mapping may result in lower lymphadenectomy rates and reduce the risk of overtreatment without compromising oncologic outcome for patients with EC.

AB - Objectives To compare the utility of three lymph node (LN) assessment strategies to identify lymphatic metastases while minimizing complete lymphadenectomy rates in women with low-grade endometrial cancer (EC). Methods: Using our institutional standard protocol (SP), patients with complex atypical hyperplasia (CAH) or grade 1/2 EC underwent sentinel lymph node (SLN) mapping, hysterectomy, and intraoperative frozen section (FS). Lymphadenectomy was performed if high-risk uterine features were identified on FS. Utilizing SP data, two alternative strategies were applied: a Universal FS Strategy (UFS), omitting SLN mapping and performing lymphadenectomy based on FS results, and a SLN-Restrictive FS Strategy (SLN-RFS) in which FS and lymphadenectomy are performed only if bilateral SLN mapping fails. Results Of 114 patients managed on the SP, SLNs were identified in 86%, with lymphatic metastases detected in eight patients. Six patients recurred after a median follow up of 15 months. Most (83%) developed in those who had a negative systematic lymphadenectomy (n = 4; mean LNs: 18) or no lymphadenectomy indication. When applying the alternative lymphatic assessment strategies, the SLN-RFS approach would theoretically result in lower lymphadenectomy rates compared to both the SP and the alternative UFS strategies (9.2% versus 36.8% and 36.8%, respectively; p = 0.004), without a reduction in detection of LN metastases (8/8 versus 8/8 and 5/8, respectively). Conclusion In this modeling analysis, an operative strategy omitting universal frozen section and restricting its use to cases with failed SLN mapping may result in lower lymphadenectomy rates and reduce the risk of overtreatment without compromising oncologic outcome for patients with EC.

UR - http://www.scopus.com/inward/record.url?scp=84994115535&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994115535&partnerID=8YFLogxK

U2 - 10.1016/j.ygyno.2016.08.323

DO - 10.1016/j.ygyno.2016.08.323

M3 - Article

C2 - 27568279

AN - SCOPUS:84994115535

VL - 143

SP - 281

EP - 286

JO - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

IS - 2

ER -