Endometrial Intraepithelial Neoplasia, Concurrent Endometrial Cancer and Risk for Pelvic Sentinel Node Metastases
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Division of Gynaecologic Oncologic Surgery, Department of Obstetrics and Gynaecology, Skåne University Hospital Lund, 22185 Lund, Sweden
2
Department of Clinical Sciences, Obstetrics and Gynaecology, Faculty of Medicine, Lund University, 22185 Lund, Sweden
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(24), 4215; https://doi.org/10.3390/cancers16244215
Submission received: 17 October 2024
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Revised: 12 December 2024
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Accepted: 15 December 2024
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Published: 18 December 2024
(This article belongs to the Special Issue Advancements in Surgical Approaches for Gynecological Cancers)
Simple Summary
The accuracy of the preoperative diagnosis, the risk of concurrent endometrial cancer (EC) and the need for nodal assessment in women with endometrial intraepithelial neoplasia (EIN) remains unclear. The aim of the study was to assess the incidence of concurrent EC at final histology and the presence of metastases in sentinel lymph nodes (SLNs), overall and related to mode of diagnosis and type of endometrial lesion in women with EIN. Overall, 47% of women with EIN had EC at final histology. Women who obtained their diagnosis by an endometrial biopsy had 65% risk of EC. The overall risk of sentinel node metastases was 6.3%; none of these women had clear polypoid lesions and five out of six obtained their diagnosis through endometrial biopsy. SLN detection is recommended in women with general endometrial thickening and/or where EIN has been diagnosed by endometrial biopsy, whereas individual risk evaluation is suggested in women with polypoid lesions.
Abstract
Background/objectives: Given the risk of a progression, or an undiagnosed endometrial cancer (EC), the treatment of choice is hysterectomy in women with endometrial intraepithelial neoplasia (EIN). The risk of metastatic disease and whether sentinel node (SLN) biopsy should be performed remains unclear. The primary aim of this prospective study was to determine the overall incidence of concurrent EC and the impact of the diagnostic tool used and the type of endometrial lesion. The secondary aim was to investigate the risk of metastatic SLNs. Methods: Between July 2019 and May 2024, 98 consecutive women with EIN deemed suitable for robotic surgery and SLN dissection were included in the study. Ultrastaging and immunohistochemistry were performed on all SLNs. Results: In total, 47% of women with preoperative EIN had EC on final histology; 13% of these had metastatic SLNs and the overall risk of metastases was 6.3%. Women who obtained their diagnosis by an endometrial biopsy had 65% risk of EC. All women with metastatic SLNs had non-polypoid lesions and five out of six obtained their diagnosis through endometrial biopsy. Conclusions: The overall risk of SLN metastases was 6.3%, all in women with a general endometrial thickening and/or a diagnosis of EIN by office endometrial biopsy, suggesting that SLN detection should be offered particularly to women with EIN who fulfill these preoperative criteria.
