Open Access Review Article

Determining Predictive Factors of Para-aortic Lymph Node Involvement in Low-grade Endometrial Cancer

Devon Smith1*, Isabella Silvestre2, Elena Safronova1, Julieta Barroeta3, David Warshal4, Meredith Duffy4, Lauren Krill4, Robin Wilson-Smith5 and James Aikins4

1Department of Obstetrics and Gynecology, Cooper University Hospital, USA

2Cooper Medical School, Rowan University, USA

3Department of Pathology, Cooper University Hospital, USA

4Department of Gynecology Oncology, Cooper University Hospital, USA

5Department of Gynecology Oncology, Jefferson Health New Jersey, USA

Corresponding Author

Received Date: September 07, 2020;  Published Date: September 22, 2020


Objectives: The purpose of this study was to determine predictive factors of para-aortic lymph node (PALN) involvement in low-grade endometrial cancer of endometrioid type. These factors may influence treatment algorithms and determine the extent of lymph node dissection in patients with low grade endometrial cancer. Our hypothesis was that tumor size, location, and depth of myometrium invasion may be independent predictors of PALN involvement in low grade endometrial cancer.

Methods: A retrospective chart review was performed on patients with grades 1 or 2 endometrial cancer of endometroid type who underwent hysterectomy with lymph node removal from January 1, 2004 to August 1, 2014. Data was evaluated using independent t-tests, Mann Whitney U test, and chi square tests. Sensitivity, specificity, positive and negative predictive values were calculated for tumor size, location, and myometrium invasion in association with PALN and pelvic lymph node (PLN) involvement.

Results: A total of 259 patients met the inclusion criteria. Tumor size was not significantly different between positive and negative PALN samples (4.5cm vs 3.5cm, respectively; p=0.29). Location was not significantly different among positive and negative PALN groups, as the majority of patients in both groups had tumors in the fundal region (75% vs 70.5%, respectively; p=1.00). Myometrial invasion was not significantly different between positive and negative PALN groups (48% vs 28%, respectively; p=0.14). Myometrial invasion was significantly different among positive and negative PLN groups (71% vs 26%, respectively. p<0.001). Lymphovascular space invasion (LVSI) demonstrated a significant association with both positive PALN and PLN groups (100% vs 22.31%, and 81.25% vs 19.67%, respectively; p=0.003, <0.001).

Conclusions: LVSI may be an independent predictor of both PALN and PLN involvement in low grade endometrial tumors. It remains unclear whether tumor size, location, and myometrial invasion can be used to predict para-aortic nodal involvement in these cases.

Keywords: Low grade endometrial cancer; Endometrioid adenocarcinoma; Para-aortic lymph nodes; Nodal metastasis; Tumor size; Tumor location; Myometrial invasion; Lymphovascular space invasion

Signup for Newsletter
Scroll to Top