The pattern of Myometrial invasion as a predictor of lymph node metastasis or Extrauterine disease in low-grade endometrial carcinoma

Elizabeth Euscher, Patricia Fox, Roland Bassett, Hayma Al-Ghawi, Rouba Ali-Fehmi, Denise Barbuto, Bojana Djordjevic, Elizabeth Frauenhoffer, Insun Kim, Sun Rang Hong, Delia Montiel, Elizabeth Moschiano, Andres Roma, Elvio Silva, Anais Malpica

Research output: Contribution to journalArticle

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Abstract

The purpose of this study was to examine predictors of lymph node (LN) metastases or extrauterine disease (ED) in low-grade (FIGO grade 1 or 2) endometrioid carcinoma (LGEC) in a multi-institutional setting. For LGEC with and without LN metastasis or ED, each of the 9 participating institutions evaluated patients' age, tumor size, myometrial invasion (MI), FIGO grade, % solid component, the presence or absence of papillary architecture, microcystic, elongated, and fragmented glands (MELF), single-cell/cell-cluster invasion (SCI), lymphovascular invasion (LVI), lower uterine segment (LUS) and cervical stromal (CX) involvement, and numbers of pelvic and para-Aortic LNs sampled. A total of 304 cases were reviewed: LN or ED, 96; LN/ED, 208. Patients' ages ranged from 23 to 91 years (median 61 y). Table 1 summarizes the histopathologic variables that were noted for the LN or ED group: tumor size ≥2 cm, 93/96 (97%); MI>50%, 54/96 (56%); MELF, 67/96 (70%); SCI, 33/96 (34%); LVI, 79/96 (82%); >20% solid, 65/96 (68%); papillary architecture present, 68/96 (72%); LUS involved, 64/96 (67%); and CX involved, 41/96 (43%). For the LN/ED group, the results were as follows: tumor size ≥2 cm, 152/208 (73%); MI>50%, 56/208 (27%); MELF, 79/208 (38%); SCI, 19/208 (9%); LVI, 56/208 (27%); >20% solid, 160/208 (77%); papillary architecture present, 122/208 (59%); LUS involved, 77/208 (37%); CX involved, 24/208 (12%). There was no evidence of a difference in the number of pelvic or para-Aortic LNs sampled between groups (P=0.9 and 0.1, respectively). After multivariate analysis, the depth of MI, CX involvement, LVI, and SCI emerged as significant predictors of advanced-stage disease. Although univariate analysis pointed to LUS involvement, MELF pattern of invasion, and papillary architecture as possible predictors of advanced-stage disease, these were not shown to be significant by multivariate analysis. This study validates MI, CX involvement, and LVI as significant predictors of LN or ED. The association of SCI pattern with advanced-stage LGEC is a novel finding.

Original languageEnglish (US)
Pages (from-to)1728-1736
Number of pages9
JournalAmerican Journal of Surgical Pathology
Volume37
Issue number11
DOIs
StatePublished - Nov 1 2013

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Endometrial Neoplasms
Lymph Nodes
Neoplasm Metastasis
Multivariate Analysis
Endometrioid Carcinoma
Neoplasms

All Science Journal Classification (ASJC) codes

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

Euscher, Elizabeth ; Fox, Patricia ; Bassett, Roland ; Al-Ghawi, Hayma ; Ali-Fehmi, Rouba ; Barbuto, Denise ; Djordjevic, Bojana ; Frauenhoffer, Elizabeth ; Kim, Insun ; Hong, Sun Rang ; Montiel, Delia ; Moschiano, Elizabeth ; Roma, Andres ; Silva, Elvio ; Malpica, Anais. / The pattern of Myometrial invasion as a predictor of lymph node metastasis or Extrauterine disease in low-grade endometrial carcinoma. In: American Journal of Surgical Pathology. 2013 ; Vol. 37, No. 11. pp. 1728-1736.
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abstract = "The purpose of this study was to examine predictors of lymph node (LN) metastases or extrauterine disease (ED) in low-grade (FIGO grade 1 or 2) endometrioid carcinoma (LGEC) in a multi-institutional setting. For LGEC with and without LN metastasis or ED, each of the 9 participating institutions evaluated patients' age, tumor size, myometrial invasion (MI), FIGO grade, {\%} solid component, the presence or absence of papillary architecture, microcystic, elongated, and fragmented glands (MELF), single-cell/cell-cluster invasion (SCI), lymphovascular invasion (LVI), lower uterine segment (LUS) and cervical stromal (CX) involvement, and numbers of pelvic and para-Aortic LNs sampled. A total of 304 cases were reviewed: LN or ED, 96; LN/ED, 208. Patients' ages ranged from 23 to 91 years (median 61 y). Table 1 summarizes the histopathologic variables that were noted for the LN or ED group: tumor size ≥2 cm, 93/96 (97{\%}); MI>50{\%}, 54/96 (56{\%}); MELF, 67/96 (70{\%}); SCI, 33/96 (34{\%}); LVI, 79/96 (82{\%}); >20{\%} solid, 65/96 (68{\%}); papillary architecture present, 68/96 (72{\%}); LUS involved, 64/96 (67{\%}); and CX involved, 41/96 (43{\%}). For the LN/ED group, the results were as follows: tumor size ≥2 cm, 152/208 (73{\%}); MI>50{\%}, 56/208 (27{\%}); MELF, 79/208 (38{\%}); SCI, 19/208 (9{\%}); LVI, 56/208 (27{\%}); >20{\%} solid, 160/208 (77{\%}); papillary architecture present, 122/208 (59{\%}); LUS involved, 77/208 (37{\%}); CX involved, 24/208 (12{\%}). There was no evidence of a difference in the number of pelvic or para-Aortic LNs sampled between groups (P=0.9 and 0.1, respectively). After multivariate analysis, the depth of MI, CX involvement, LVI, and SCI emerged as significant predictors of advanced-stage disease. Although univariate analysis pointed to LUS involvement, MELF pattern of invasion, and papillary architecture as possible predictors of advanced-stage disease, these were not shown to be significant by multivariate analysis. This study validates MI, CX involvement, and LVI as significant predictors of LN or ED. The association of SCI pattern with advanced-stage LGEC is a novel finding.",
author = "Elizabeth Euscher and Patricia Fox and Roland Bassett and Hayma Al-Ghawi and Rouba Ali-Fehmi and Denise Barbuto and Bojana Djordjevic and Elizabeth Frauenhoffer and Insun Kim and Hong, {Sun Rang} and Delia Montiel and Elizabeth Moschiano and Andres Roma and Elvio Silva and Anais Malpica",
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Euscher, E, Fox, P, Bassett, R, Al-Ghawi, H, Ali-Fehmi, R, Barbuto, D, Djordjevic, B, Frauenhoffer, E, Kim, I, Hong, SR, Montiel, D, Moschiano, E, Roma, A, Silva, E & Malpica, A 2013, 'The pattern of Myometrial invasion as a predictor of lymph node metastasis or Extrauterine disease in low-grade endometrial carcinoma', American Journal of Surgical Pathology, vol. 37, no. 11, pp. 1728-1736. https://doi.org/10.1097/PAS.0b013e318299f2ab

The pattern of Myometrial invasion as a predictor of lymph node metastasis or Extrauterine disease in low-grade endometrial carcinoma. / Euscher, Elizabeth; Fox, Patricia; Bassett, Roland; Al-Ghawi, Hayma; Ali-Fehmi, Rouba; Barbuto, Denise; Djordjevic, Bojana; Frauenhoffer, Elizabeth; Kim, Insun; Hong, Sun Rang; Montiel, Delia; Moschiano, Elizabeth; Roma, Andres; Silva, Elvio; Malpica, Anais.

In: American Journal of Surgical Pathology, Vol. 37, No. 11, 01.11.2013, p. 1728-1736.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The pattern of Myometrial invasion as a predictor of lymph node metastasis or Extrauterine disease in low-grade endometrial carcinoma

AU - Euscher, Elizabeth

AU - Fox, Patricia

AU - Bassett, Roland

AU - Al-Ghawi, Hayma

AU - Ali-Fehmi, Rouba

AU - Barbuto, Denise

AU - Djordjevic, Bojana

AU - Frauenhoffer, Elizabeth

AU - Kim, Insun

AU - Hong, Sun Rang

AU - Montiel, Delia

AU - Moschiano, Elizabeth

AU - Roma, Andres

AU - Silva, Elvio

AU - Malpica, Anais

PY - 2013/11/1

Y1 - 2013/11/1

N2 - The purpose of this study was to examine predictors of lymph node (LN) metastases or extrauterine disease (ED) in low-grade (FIGO grade 1 or 2) endometrioid carcinoma (LGEC) in a multi-institutional setting. For LGEC with and without LN metastasis or ED, each of the 9 participating institutions evaluated patients' age, tumor size, myometrial invasion (MI), FIGO grade, % solid component, the presence or absence of papillary architecture, microcystic, elongated, and fragmented glands (MELF), single-cell/cell-cluster invasion (SCI), lymphovascular invasion (LVI), lower uterine segment (LUS) and cervical stromal (CX) involvement, and numbers of pelvic and para-Aortic LNs sampled. A total of 304 cases were reviewed: LN or ED, 96; LN/ED, 208. Patients' ages ranged from 23 to 91 years (median 61 y). Table 1 summarizes the histopathologic variables that were noted for the LN or ED group: tumor size ≥2 cm, 93/96 (97%); MI>50%, 54/96 (56%); MELF, 67/96 (70%); SCI, 33/96 (34%); LVI, 79/96 (82%); >20% solid, 65/96 (68%); papillary architecture present, 68/96 (72%); LUS involved, 64/96 (67%); and CX involved, 41/96 (43%). For the LN/ED group, the results were as follows: tumor size ≥2 cm, 152/208 (73%); MI>50%, 56/208 (27%); MELF, 79/208 (38%); SCI, 19/208 (9%); LVI, 56/208 (27%); >20% solid, 160/208 (77%); papillary architecture present, 122/208 (59%); LUS involved, 77/208 (37%); CX involved, 24/208 (12%). There was no evidence of a difference in the number of pelvic or para-Aortic LNs sampled between groups (P=0.9 and 0.1, respectively). After multivariate analysis, the depth of MI, CX involvement, LVI, and SCI emerged as significant predictors of advanced-stage disease. Although univariate analysis pointed to LUS involvement, MELF pattern of invasion, and papillary architecture as possible predictors of advanced-stage disease, these were not shown to be significant by multivariate analysis. This study validates MI, CX involvement, and LVI as significant predictors of LN or ED. The association of SCI pattern with advanced-stage LGEC is a novel finding.

AB - The purpose of this study was to examine predictors of lymph node (LN) metastases or extrauterine disease (ED) in low-grade (FIGO grade 1 or 2) endometrioid carcinoma (LGEC) in a multi-institutional setting. For LGEC with and without LN metastasis or ED, each of the 9 participating institutions evaluated patients' age, tumor size, myometrial invasion (MI), FIGO grade, % solid component, the presence or absence of papillary architecture, microcystic, elongated, and fragmented glands (MELF), single-cell/cell-cluster invasion (SCI), lymphovascular invasion (LVI), lower uterine segment (LUS) and cervical stromal (CX) involvement, and numbers of pelvic and para-Aortic LNs sampled. A total of 304 cases were reviewed: LN or ED, 96; LN/ED, 208. Patients' ages ranged from 23 to 91 years (median 61 y). Table 1 summarizes the histopathologic variables that were noted for the LN or ED group: tumor size ≥2 cm, 93/96 (97%); MI>50%, 54/96 (56%); MELF, 67/96 (70%); SCI, 33/96 (34%); LVI, 79/96 (82%); >20% solid, 65/96 (68%); papillary architecture present, 68/96 (72%); LUS involved, 64/96 (67%); and CX involved, 41/96 (43%). For the LN/ED group, the results were as follows: tumor size ≥2 cm, 152/208 (73%); MI>50%, 56/208 (27%); MELF, 79/208 (38%); SCI, 19/208 (9%); LVI, 56/208 (27%); >20% solid, 160/208 (77%); papillary architecture present, 122/208 (59%); LUS involved, 77/208 (37%); CX involved, 24/208 (12%). There was no evidence of a difference in the number of pelvic or para-Aortic LNs sampled between groups (P=0.9 and 0.1, respectively). After multivariate analysis, the depth of MI, CX involvement, LVI, and SCI emerged as significant predictors of advanced-stage disease. Although univariate analysis pointed to LUS involvement, MELF pattern of invasion, and papillary architecture as possible predictors of advanced-stage disease, these were not shown to be significant by multivariate analysis. This study validates MI, CX involvement, and LVI as significant predictors of LN or ED. The association of SCI pattern with advanced-stage LGEC is a novel finding.

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