Lymphatic spread of endometriosis to pelvic sentinel lymph nodes: a prospective clinical study.

Abstract:

OBJECTIVE:To establish the prevalence of endometriosis metastatic to pelvic sentinel lymph nodes (PSLN) in women with ovarian and/or peritoneal endometriosis. DESIGN:Prospective clinical study. SETTING:Academic research institution. PATIENT(S):Women with a laparoscopic diagnosis of ovarian and/or peritoneal endometriosis verified by intraoperative frozen section analysis. INTERVENTION(S):Resection of endometriotic lesions and PSLN after cervical blue dye injection. MAIN OUTCOME MEASURE(S):Histologic analysis of PSLN for the presence of endometriosis and immunohistochemical analysis of estrogen receptor (ER), progesterone receptor (PR), cytokeratin (CK), and CD-10 expression. RESULT(S):The study enrolled 26 women with suspected endometriosis; endometriosis was confirmed in 23 women, and a PSLN was identified in 19 women. A total of 37 (right side: 20; left side: 17) lymph nodes were removed. The prevalence of endometriotic lesions in PSLN was 11% (2 of 19). Both lesions were positive for ER, PR, CK, and CD-10. Isolated endometriotic-like cells (IELCs) staining positive for ER and PR were identified in the peripheral sinus of 16 (80%) of 20 and 14 (70%) of 20 PSLN, respectively. All IELCs lacked CK staining, whereas CD-10 staining was present in 16 (80%) of 20 cases, indicating a stromal origin of IELCs. Intraoperative and/or postoperative complications were observed in 1 (5%) of 19 women. CONCLUSION(S):Spread of IELCs to PSLN is common in ovarian and/or peritoneal endometriosis. Metastatic lesions in PSLN are present in 11% of women. Further studies to evaluate the prognostic and predictive value of endometriotic spread to PSLN are warranted.

journal_name

Fertil Steril

journal_title

Fertility and sterility

authors

Tempfer CB,Wenzl R,Horvat R,Grimm C,Polterauer S,Buerkle B,Reinthaller A,Huber JC

doi

10.1016/j.fertnstert.2011.06.070

subject

Has Abstract

pub_date

2011-09-01 00:00:00

pages

692-6

issue

3

eissn

0015-0282

issn

1556-5653

pii

S0015-0282(11)01087-9

journal_volume

96

pub_type

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