Value of additional level sections in the evaluation of lymph nodes for endometrial carcinoma staging

Objectives: To evaluate the value of deeper sections for conventional (non-sentinel) lymph node dissections in high-risk endometrial carcinoma (EC).

Methods: We conducted a retrospective review of all ECs with high-grade or serous histology, more than 50% myometrial invasion or International Federation of Gynecology and Obstetrics (FIGO) pathologic stage greater than 2, and conventional complete pelvic lymph node dissections. No sentinel lymph node (SLN) biopsies were performed. Nodes were originally processed entirely in 3-mm slices, with residual fatty tissue submitted separately. When lymph nodes were negative on original H&E sections, paraffin blocks were sectioned to produce 1 additional H&E slide at approximately 0.8 mm deep. With positive nodes, we examined the relationship between micrometastases, staging parameters, and recurrence.

Results: Fifty-one high-risk cases were identified, with a median of 15 pelvic lymph nodes per case. Fifteen (29%) cases contained positive nodes. Review of the original slides and additional sections of all blocks from the remaining 36 cases failed to reveal metastases. Statistically significant associations were found between node status and depth of myometrial invasion, lymphovascular invasion, and FIGO stage. We found no significant relationship between lymph node status and serous histology.

Conclusions: Our results suggest that enhanced detection of metastasis by SLN biopsies may be related to targeted lymph node selection rather than additional histologic sectioning.