%0 Journal Article
%T Lymph Node Assessment in Endometrial Cancer: Towards Personalized Medicine
%A Fabien Vidal
%A Arash Rafii
%J Obstetrics and Gynecology International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/892465
%X Endometrial cancer (EC) is the most common malignancy of the female reproductive tract and is increasing in incidence. Lymphovascular invasion and lymph node (LN) status are strong predictive factors of recurrence. Therefore, the determination of the nodal status of patients is mandatory to optimally tailor adjuvant therapies and reduce local and distant recurrences. Imaging modalities do not yet allow accurate lymph node staging; thus pelvic and aortic lymphadenectomies remain standard staging procedures. The clinical data accumulated recently allow us to define low- and high-risk patients based on pre- or peroperative findings that will allow the clinician to stratify the patients for their need of lymphadenectomies. More recently, several groups have been introducing sentinel node mapping with promising results as an alternative to complete lymphadenectomy. Finally, the use of peroperative algorithm for risk determination could improve patient's staging with a reduction of lymphadenectomy-related morbidity. 1. Introduction Endometrial cancer (EC) is the most common malignancy of the female reproductive tract with an estimated 47.130 new cases in 2012 in the United States [1]. Most patients are diagnosed with an early-stage disease, and the overall survival for stage I is about 85¨C91% [2]. Nevertheless, patients with advanced disease and unfavorable pathological characteristics have a guarded prognosis [3]. The most significant prognostic factors are histological type and grade, depth of myometrial involvement, lymphovascular invasion, and lymph node (LN) status [4]. 20% of the patients with EC extending outside of the uterus (stages II and IIIA-B) and 10% of the patients with clinical stage I disease have LN metastases (LNM) [2]. Therefore, removal of pelvic and paraaortic LN has been recommended as part of a comprehensive surgical staging including total hysterectomy and bilateral salpingo-oophorectomy [2, 3]. The management of EC has always been heterogeneous across different institutions and countries, in particular regarding LN staging [5¨C8]. Recently, the publication of 2 randomized trials and 1 meta-analysis [9¨C11] increased controversy on LN assessment. Indeed, both trials demonstrated that pelvic lymphadenectomy did not improve disease free and overall survival rates, and therefore should not be recommended as routine procedure. However, several flaws in their design (no randomization for postoperative adjuvant therapy, no systematic paraaortic lymphadenectomy) make the strength of these conclusions questionable [12, 13]. Despite that the
%U http://www.hindawi.com/journals/ogi/2013/892465/