Using FIGO histologic grade to determine when to perform lymphadenectomies in endometrioid adenocarcinoma of the...

Controversy remains as to whether selective pelvic and periaortic lymphadenectomies should be performed in low grade (grade 1 or 2) endometrioid endometrial cancer. The authors reviewed their experience over the last three years in their population of endometrioid adenocarcinomas of the endometrium to see if lymphadenectomies were necessary in low grade malignancies.

The records of all patients with endometrioid adenocarcinoma of the endometrium undergoing primary surgery by the gynecologic oncology service between November 1, 1991, and August 31, 1994, were analyzed for age, FIGO stage, grade, histologic type, lymphovascular space invasion, peritoneal cytology, and time to recurrence.

Sixty-five patients with endometrioid adenocarcinoma of the endometrium were found. Twenty-five had grade I disease, 31, grade 2 disease, and 9, grade 3. Forty-seven patients had stage I disease, 5 stage II disease, 12 stage III disease and 1, stage IV disease. No patient with grade 1 disease had positive lymph nodes on examination. Six with grade 2 (19.4%) and two (22.2%) with grade 3 disease had positive lymph nodes. The percentage of patients with positive lymph nodes was not significantly different between those with grade 2 and 3 disease (p = 0.86) but was significantly different between grade 2 or 3 and grade 1 (p = 0.021) (p = 0.017).

Pelvic and periaortic lymphadenectomies should be performed as part of standard surgical therapy in patients with FIGO grade 2 endometrioid adenocarcinomas of the endometrium. The decision as to whether to perform lymphadenectomies in grade 1 tumors must be left to the discretion of the surgeon since a chance exists that a higher grade or more deeply invasive tumor may be found on final pathological diagnosis.