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A Quality Process Study of Lymph Node Evaluation in Endometrial Cancer

Forde, Gareth K. M.D., Ph.D.; Carlson, Jay W. D.O.; Downey, Gordon O. M.D.; Doss, Barbara J. M.D.; Shoemaker, Allen Ph.D.; Harrison, Charles R. M.D.

International Journal of Gynecological Pathology: July 2011 - Volume 30 - Issue 4 - p 335–339
doi: 10.1097/PGP.0b013e31820dc39d

Our objective was to analyze the reported lymph node counts between surgeons, histology prosectors, and pathologists using a cohort of patients enrolled on a national protocol that standardized surgical intent.

This is a retrospective review of patients with uterine cancer who underwent a standardized formal staging procedure as dictated by a National Cancer Institute sponsored protocol. Patients were staged using the International Federation of Gynecology and Obstetrics 1988 guidelines. All patients required a hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic and para-aortic lymphadenectomy. Lymphadenectomy specimens were separated by the following regions: external iliac, obturator, common iliac, and periaortic. Lymph node counts were analyzed by region, surgeon, histology prosector, and pathologist.

There were 78 patients enrolled in the protocol during the study period. Of them, 72 (92%) patients met the inclusion criteria. A total of 2397 lymph nodes were counted, with an average total number of 33 (SD=9) lymph nodes dissected per patient. Surgeons A, B, and C had an average lymph node count of 32, 33, and 35, respectively, with no significant difference in mean node count (P=0.66). Prosectors 1 to 4 dissected an average of 34, 33, 28, and 35 lymph nodes, respectively (P=0.091). There were 2 pathologists with ≥10 cases. Their mean lymph node counts were 35 and 30, respectively, with no significant difference in mean node count (P=0.079).

This systematic review did not identify a discrepancy in nodal count among surgeons, prosectors, or pathologists at our institution. The methods used may be helpful in structuring interdepartmental reviews for completeness of nodal dissections in cases where surgical intent has been standardized.

Grand Rapids Medical Education Partners (G.K.F., A.S.)

Gynecologic Oncology of West Michigan (G.O.D., C.R.H.)

Department of Pathology, Spectrum Health (B.J.D.), Grand Rapids, MI

Mercy Medical Center (J.W.C.), Des Moines, IA

Article Précis: Standardization of multidisciplinary lymph node counting in endometrial cancer.

Address correspondence and reprint requests to Gareth K. Forde, MD, PhD, 330 Barclay NE Suite 102, Grand Rapids, MI 49503. e-mail:

©2011International Society of Gynecological Pathologists