Furthermore, in the rare cases with para-aortic lymph node metastases and negative pelvic nodes, cancer dissemination is most commonly confined to the high para-aortic area (67%).[16] Also, patients with pelvic node metastases Selleckchem Pirfenidone may have occult aortic node involvement, with a rate of para-aortic dissemination higher than commonly reported. Todo et al.[32]

investigated the occurrence of occult metastases (i.e. micrometastases and isolated tumor cells) in the para-aortic area in patients with stage IIIC1 EC who underwent pelvic and para-aortic lymphadenectomy. Ultra-staging was performed by multiple slicing, staining and microscopic inspection of the specimens. The authors SCH772984 supplier found that 73% of these patients had occult aortic node involvement. Although the role of micrometastases is not fully understood, the presence of microscopic occult disease in the para-aortic area should be considered even in stage IIIC1 EC or in those patients with documented pelvic lymph node invasion and no known information regarding the para-aortic area. These findings

indicate that para-aortic lymph node invasion is very common when pelvic lymph node metastases are demonstrated. Also, in the majority of patients with para-aortic lymph node invasion, the area above the IMA is involved. Table 2 shows the overall risk of para-aortic and high para-aortic Quisqualic acid lymph node metastasis in EC. Sentinel lymph node mapping is

an accepted way to assess lymphatic spread in several solid tumors (i.e. breast cancer, vulval cancer and melanoma) and is gaining ground in cervical cancer and EC.[33-35] SLN biopsy can be considered a compromise between comprehensive surgical staging and the complete omission of lymphadenectomy. In an ideal world, SLN mapping should be as good as a systematic lymphadenectomy in the identification of patients with lymph node dissemination, while reducing the morbidity associated with an extensive surgical procedure. Although the complexity of uterine lymphatic drainage may discourage use of this procedure, the estimated accuracy rate is, in general, reasonably good.[36-39] The prospective multi-institutional SENTI-ENDO study suggested that in stage I and II EC patients, SLN biopsy has a sensitivity of 84%.[40] Moreover, ultra-staging of the SLN may be even more sensitive than a full lymphadenectomy, with lymph nodes evaluated by conventional pathology.[35, 41] However, we still do not know the clinical importance of isolated tumor cells discovered in a lymph node that is negative by traditional histological analysis. Recently, a paper from the Memorial Sloan-Kettering Cancer Center, describing one of the largest prospective single-institution cohorts, showed that applying an SLN mapping algorithm may be a safe and effective alternative to systematic lymphadenectomy.