Endometrial cancer-how many patients could benefit from sentinel lymph node dissection?

BACKGROUND: Sentinel lymph node dissection (SLND) may reduce morbidity in patients with endometrial cancer. The objective of this study is to estimate how many systematic lymph node dissections (LND) can be spared with an implementation of a SLN-procedure. METHODS: Retrospective, single-center study, SLND according to NCCN-Guidelines. RESULTS: In 109 patients of 154 consecutive patients, SLND was performed. The detection rate was 61% on both sides and 86% on at least one side. Classification of uterine risk factors is as follows: low risk 53, intermediate risk 25, high-intermediate risk 13, and high-risk 18. Stage IIIC: 0, 3, 7, 11, respectively. Under the assumption that 56 patients with "higher than low risk" factors would be treated by systematic LND, we spared 26 pelvic and paraaortic LND. After failures of SLN detection, unilateral pelvic LND was performed in 15 patients. Patients with "higher than low risk" factors and node-negative SLN are candidates for a randomized study to prove safety and efficacy. Only every third patient in our study met these criteria. CONCLUSIONS: In a cohort of patients with "higher than low risk" endometrial cancer, the implementation of SLND nearly divided the number of radical lymph node dissections in half. Further studies are required to define the best modalities for SLND.

Dynamic breast MRI in the course of neoadjuvant chemotherapy: standardized evaluation of tumor size and enhancement parameters in correlation to different histopathologic characteristics.

RATIONALE AND OBJECTIVES: Basic exploratory data analysis to evaluate enhancement and tumor size (SIZE) in contrast-enhanced breast magnetic resonance imaging (CE-MRI) during chemotherapy. Correlation with histopathology (human epidermal growth factor receptor (HER2/neu) status and estrogen receptor (ER) score). MATERIALS AND METHODS: Sixty-five women (mean age 47 +/- 10 years) with locally advanced breast cancer (mean SIZE 25 mL) had CE-MRI (three-dimensional fast low angle shot (FLASH); repetition time = 9.1 ms, echo time = 4.8 ms, flip angle (FA) 25 degrees, matrix size 256 x 256 pixels, field of view 350 mm, slice thickness 2 mm, number of slices = 32, one precontrast and five postcontrast series) before and after chemotherapy. Lesion segmentation and subsequent SIZE and enhancement analysis including maximum enhancement (MAX), area under the curve (AUC), time-to-peak (TTP), and maximum upslope (MUS) were performed. Correlation with histopathology (ER score and HER2/neu status). RESULTS: SIZE reduced significantly during therapy (25 mL vs. 5 mL, P < .0001). AUC, MAX, MUS decreased (P < .0001), TTP increased (P < .0001). SIZE and MAX were independent parameters (r(2) = .22). No correlation (P > .01) in any of the parameters with either ER score or HER2/neu status was found. HER2/neu score equal 2+pos. or 3+ showed significantly stronger changes in SIZE (P < .01), MAX (P < .01) and AUC (P < .05) compared to lower HER2/neu score (0 to 2+neg.). CONCLUSIONS: From routine MRI protocol and semiquantitative analysis of signal enhancement curves, information about size, and hemodynamic status of tumors under treatment may be extracted. Reduction in size and maximum enhancement were complementary parameters. In the course of therapy, size and enhancement may develop differently in clinically relevant histopathological subgroups.