Lymph node targets
LND in EC patients can include different LN targets. Mariani et al.
reported the potential therapeutic role of pelvic and paraaortic LND in
node positive low risk patients with
EC(47). Of the node positive patients, 84% had pelvic
LN metastases and 67% had para-aortic node metastases.
They concluded that there is a need for systematic pelvic
and para-aortic LND. This finding is supported by a study which
investigated the anatomical pattern of LN metastases in patients with
high-risk early or advanced EC(48). Patients underwent
systematic pelvic and para-aortic LND and LNs were histologically
assessed. It was found that 18% of patients had positive pelvic nodes,
14.8% had positive para-aortic nodes, and 3.1% had isolated positive
para-aortic nodes. Despite the low prevalence, special attention is
warranted for the latter group to avoid possible misdiagnosis in stage
I-II EC(24). This distribution of
positive nodes indicates that LND, if performed, should contain both
pelvic and para-aortic nodes up to the renal vessels for an accurate
assessment of all
potentially positive nodes(5,48). Previous studies
assessing the efficacy of LND as a treatment did not include para-aortic
nodes(20).