Ultrastaging of lymph node in uterine cancers

Review of the English literature on SN procedure in cervical and endometrial cancers and histological techniques including hematoxylin and eosin (H&E) staining, serial sectioning, immunohistochemistry (IHC) and molecular techniques to detect micrometastases.In both cervical and endometrial cancers, H&E and IHC appeared insufficient to detect micrometastases. In cervical cancer, using H&E, serial sectioning and IHC, the rate of macrometastases varied between 7.1% and 36.3% with a mean value of 25.8%. The percentage of women with micrometastases ranged from 0% and 47.4% with a mean value of 28.3%. In endometrial cancer, the rate of macrometastases varied from 0% to 22%. Using H&E, serial sectioning and IHC, the rate of micrometastases varied from 0% to 15% with a mean value of 5.8%. In both cervical and endometrial cancers, data on the contribution of molecular techniques to detect micrometastases are insufficient to clarify their role in SN ultrastaging.In uterine cancers, H&E, serial sectioning and IHC appears the best histological combined technique to detect micrometastases. Although accumulating data have proved the relation between the risk of recurrence and the presence of micrometastases, their clinical implications on indications for adjuvant therapy has to be clarified.Studies conducted in the 90's reported that sensitive immunochemical and/or molecular techniques used to analyze lymph nodes likely to contain metastases could assess the clinical stage to a previously unachievable degree of accuracy (ultrastaging) [1,2]. In a 1997 study of 595 patients with melanoma, Joseph et al evaluated the contribution of serial sectioning, immunohistochemistry (IHC) and a molecular technique with reverse transcriptase polymerase chain reaction (RT-PCR) to routine hematoxylin and eosin (H&E) histology to detect lymph node metastases. The study showed that routine H&E histology identified 73.8% of all metastases [3]. The remainder was detected by serial sectioning (7.8%) a