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Annals of Surgical Oncology

, Volume 25, Issue 12, pp 3692–3698 | Cite as

Frozen Section for Detection of Lymph Nodes After Cervical Injection with Indocyanine Green (ICG) for Sentinel Lymph Node Technique in Endometrial Cancer Staging

  • Jvan Casarin
  • Francesco Multinu
  • Kalyan Pasupathy
  • Amy Weaver
  • Michaela McGree
  • Lucia Tortorella
  • Diogo Torres
  • Amanika Kumar
  • Carrie Langstraat
  • Yajue Huang
  • Fabio Ghezzi
  • Andrea Mariani
  • Gretchen Glaser
Gynecologic Oncology

Abstract

Objective

The aim of this study was to assess the role of frozen section (FS) in identifying an absence of lymph nodes during sentinel lymph node (SLN) biopsy for apparent early-stage endometrial cancer (EC).

Methods

Consecutive apparent early-stage EC patients who had SLNs removed after cervical injection with indocyanine green (ICG) from 1 June 2014 to 30 June 2016 were analyzed. An empty node (EN) was defined as an SLN specimen without evidence of lymph node(s). The association of tumor and patient characteristics with an EN was evaluated, and trend analysis to compare the rate of ENs over calendar quarters was performed. A decision-tree model was then created to compare the use of FS versus no FS for SLN evaluation in the hypothetical cohort affected by early-stage EC in the US each year.

Results

Over the study period, 300 patients met the inclusion criteria. FS revealed ENs in 24 (8%) patients. No association between patient demographic characteristics (age, body mass index, prior abdominopelvic surgery, international federation of gynecology and obstetrics (FIGO) stage, histology, myometrial invasion, cervical stromal invasion) and presence of ENs was observed. The rate of ENs at FS did not change over time (p = 0.68). The hypothetical analysis showed a 4.3% decrease of inappropriately staged patients with the use of FS on the SLN (95% confidence interval 4.1–4.5).

Conclusions

ENs during SLN biopsy for EC staging is not a rare event and can be easily detected with FS. The implementation of FS of SLN might reduce inadequate staging of EC. Individual institutions may want to examine their own EN rates and determine if this would assist them in their SLN practices for EC.

Notes

Funding

Dr. Casarin is a research fellow supported by the University of Insubria, Varese, Italy, and Fondo Miglierina, Provincia di Varese, Italy.

Disclosures

The authors have nothing to disclose.

Supplementary material

10434_2018_6698_MOESM1_ESM.docx (230 kb)
Supplementary material 1 (DOCX 229 kb)

References

  1. 1.
    Rossi EC, Kowalski LD, Scalici J et al. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol 2017; 18: 384–392.CrossRefGoogle Scholar
  2. 2.
    Achouri A, Huchon C, Bats AS et al. Complications of lymphadenectomy for gynecologic cancer. Eur J Surg Oncol 2013; 39: 81–86.CrossRefGoogle Scholar
  3. 3.
    Abu-Rustum NR. Sentinel lymph node mapping for endometrial cancer: a modern approach to surgical staging. J Natl Compr Canc Netw 2014; 12: 288–297.CrossRefGoogle Scholar
  4. 4.
    Mariani A, Dowdy SC, Cliby WA et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol 2008; 109: 11–18.CrossRefGoogle Scholar
  5. 5.
    Ross JG, Hamner JJ, Alston W et al. Preoperative risk factors to predict lymph node metastasis in early stage endometrial cancer. Gynecologic Oncology 2015. 137 Suppl 1:159.CrossRefGoogle Scholar
  6. 6.
    Weaver DL. Pathology evaluation of sentinel lymph nodes in breast cancer: protocol recommendations and rationale. Mod Pathol 2010; 23 Suppl 2: S26–32.CrossRefGoogle Scholar
  7. 7.
    Jorns JM, Visscher D, Sabel M et al. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center. Am J Clin Pathol 2012; 138: 657–669.CrossRefGoogle Scholar
  8. 8.
    Goel V. Decision analysis: applications and limitations. The Health Services Research Group. CMAJ 1992; 147: 413–417.PubMedGoogle Scholar
  9. 9.
    Wahlster P, Goetghebeur M, Kriza C et al. Balancing costs and benefits at different stages of medical innovation: a systematic review of Multi-criteria decision analysis (MCDA). BMC Health Serv Res 2015; 15: 262.CrossRefGoogle Scholar
  10. 10.
    Broekhuizen H, Groothuis-Oudshoorn CG, Hauber AB et al. Estimating the value of medical treatments to patients using probabilistic multi criteria decision analysis. BMC Med Inform Decis Mak 2015; 15: 102.CrossRefGoogle Scholar
  11. 11.
    Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67: 7–30.CrossRefGoogle Scholar
  12. 12.
    National Comprehensive Cancer Network. Uterine Neoplasms. Version 1.2017. National Comprehensive Cancer Network; 2016.Google Scholar
  13. 13.
    Bodurtha Smith AJ, Fader AN, Tanner EJ. Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol 2017; 216: 459–476.e410.Google Scholar
  14. 14.
    Barlin JN, Zhou Q, St Clair CM et al. Classification and regression tree (CART) analysis of endometrial carcinoma: seeing the forest for the trees. Gynecol Oncol 2013; 130: 452–456.CrossRefGoogle Scholar
  15. 15.
    He S, Gill BS, Heron DE et al. Long-term outcomes using adjuvant pelvic intensity modulated radiation therapy (IMRT) for endometrial carcinoma. Pract Radiat Oncol 2017; 7: 19–25.CrossRefGoogle Scholar
  16. 16.
    Connolly JL, Schnitt SJ, Wang HH, Longtine JA, Dvorak A, Dvorak HF. Role of the Surgical Pathologist in the Diagnosis and Management of the Cancer Patient. In: Kufe DW, Pollock RE, Weichselbaum RR, Bast RC Jr, Gansler TS, Holland JF, et al. (eds). Holland-Frei Cancer Medicine. 6th ed. Hamilton (ON): BC Decker; 2003.Google Scholar
  17. 17.
    Wright JD, Cham S, Chen L et al. Utilization of sentinel lymph node biopsy for uterine cancer. Am J Obstet Gynecol 2017; 216: 594.e1–594.e13.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Jvan Casarin
    • 1
    • 2
  • Francesco Multinu
    • 1
    • 3
  • Kalyan Pasupathy
    • 4
  • Amy Weaver
    • 1
  • Michaela McGree
    • 1
  • Lucia Tortorella
    • 1
  • Diogo Torres
    • 1
  • Amanika Kumar
    • 1
  • Carrie Langstraat
    • 1
  • Yajue Huang
    • 5
  • Fabio Ghezzi
    • 2
  • Andrea Mariani
    • 1
  • Gretchen Glaser
    • 1
  1. 1.Division of Gynecologic SurgeryMayo ClinicRochesterUSA
  2. 2.Department of Obstetrics and GynecologyUniversity of InsubriaVareseItaly
  3. 3.Department of Gynecology, Division of Gynecologic OncologyEuropean Institute of Oncology, University of MilanMilanItaly
  4. 4.Health Care Systems EngineeringMayo ClinicRochesterUSA
  5. 5.Division of Anatomic PathologyMayo ClinicRochesterUSA

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