Pelvic Lymph Node Metastases
- Nll. iliaci interni, externi & communes, obturatorii: ~10–20%
- According to the ASTEC study, pelvic lymph node metastases occur in about 10% of patients with clinical stage I.
- In patients with poorly differentiated tumors and deep myometrial invasion, the likelihood increases to ~20%.
- The SENTI-ENDO study confirms that pelvic lymph nodes are the primary sentinel lymph nodes in endometrial carcinoma.
Paraaortic Lymph Node Metastases
- Nll. lumbales (paraaortic lymph nodes): ~8–12%
- The SEPAL study shows that 8–12% of patients with endometrial carcinoma have paraaortic lymph node metastases.
- Interestingly, only 1–3% of patients had isolated paraaortic metastases without involvement of the pelvic lymph nodes.
Isolated Paraaortic Metastases (without Pelvic Involvement)
- 1–3% of patients with negative pelvic lymph nodes have isolated paraaortic metastases
- This low rate confirms that a complete paraaortic lymphadenectomy may not be necessary if the pelvic lymph nodes are negative.
Sacral and Subaortic Lymph Node Metastases
- Nll. sacrales & subaortici: 3–5%
- These lymph nodes are less frequently affected but are a relevant pathway for metastasis in advanced tumors.
Inguinal Lymph Node Metastases
- Nll. inguinales superficiales: 2–3%
- This route is rare in endometrial carcinoma and is usually associated with spread via the round ligament of the uterus.
Summary of Updated Metastasis Distribution (%)
| Lymph Node Region | Frequency of Metastases (%) |
|---|---|
| Pelvic (iliac, obturator) | 10–20% |
| Paraaortic (lumbar) | 8–12% |
| Isolated Paraaortic Metastases (with negative pelvic nodes) | 1–3% |
| Sacral & Subaortic | 3–5% |
| Inguinal | 2–3% |
Reference:
- ASTEC study group; Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomized study. Lancet. 2009 Jan 10;373(9658):125-36. doi: 10.1016/S0140-6736(08)61766-3. Epub 2008 Dec 16. Erratum in: Lancet. 2009 May 23;373(9677):1764. PMID: 19070889; PMCID: PMC2646126.
- Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet. 2010 Apr 3;375(9721):1165-72. doi: 10.1016/S0140-6736(09)62002-X. Epub 2010 Feb 24. Erratum in: Lancet. 2010 Aug 21;376(9741):594. PMID: 20188410.
- Ballester M, Dubernard G, Lécuru F, Heitz D, Mathevet P, Marret H, Querleu D, Golfier F, Leblanc E, Rouzier R, Daraï E. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicenter study (SENTI-ENDO). Lancet Oncol. 2011 May;12(5):469-76. doi: 10.1016/S1470-2045(11)70070-5. Epub 2011 Apr 12. PMID: 21489874.