AIMS: Endometrial cancer (EC) is the most common gynecological cancer worldwide and its incidence is rising. The cornerstone of its management is surgical treatment with nodal staging. A monocentric study investigating the potential of the molecular biology method of one-step nucleic acid amplification (OSNA) in sentinel lymph node (SLN) analysis was conducted at our institution between April 2016 and January 2018. Histopathological ultrastaging was used as the reference standard for SLN examination and OSNA as the index test. The aim of this study was to assess the long-term outcome of patients with discordant SLN and OSNA results. To our knowledge, this is the first study exploring this issue. METHODS AND RESULTS: Patients were followed in line with the current ESMO/ESGO/ESTRO recommendations. The institutional electronic database was retrospectively searched for patients' follow-up data from April 2016 till March 2023. Only patients who provided a written valid consent and had a positive OSNA and negative ultrastaging of their SLN analysis were included in the study. The primary endpoint was the retrospective analysis of their clinical outcome. Data from 58 patients enrolled into our previous study were reviewed and 12 discordant patients who met the inclusion criteria for this study were identified. The median follow-up was 83 months. Disease recurrence was detected in 3 (25%) patients, two of these were nodal and both patients died. One patient had a solitary lung metastasis which was surgically treated, and the patient was disease-free during the whole study period. CONCLUSION: The recurrence rate of patients included in the study was in the intermediate-high and high-risk group range, and hence, higher than expected based on ultrastaging results. Furthermore, benign epithelial inclusions do not seem to adversely affect OSNA SLN analysis in EC patients.

Department of Gynaecology and Obstetrics and Biomedical Center University Hospital Pilsen and Faculty of Medicine in Pilsen Charles University Plzeň Lochotín Czech Republic

Department of Gynaecology and Obstetrics University Hospital Pilsen and Faculty of Medicine in Pilsen Charles University Plzeň Lochotín Czech Republic

Department of Immunochemistry University Hospital Pilsen and Faculty of Medicine in Pilsen Charles University Plzeň Bory Czech Republic

Šikl's Department of Pathology University Hospital Pilsen and Faculty of Medicine in Pilsen Charles University Plzeň Lochotín Czech Republic

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Berek J. S., Matias‐Guiu X., Creutzberg C., et al., “FIGO Staging of Endometrial Cancer: 2023,” International Journal of Gynaecology and Obstetrics 162, no. 2 (2023): 383–394. PubMed

Khoury‐Collado F., Murray M. P., Hensley M. L., et al., “Sentinel Lymph Node Mapping for Endometrial Cancer Improves the Detection of Metastatic Disease to Regional Lymph Nodes,” Gynecologic Oncology 122, no. 2 (2011): 251–254. PubMed

Abu‐Rustum N. R., Khoury‐Collado F., Pandit‐Taskar N., et al., “Sentinel Lymph Node Mapping for Grade 1 Endometrial Cancer: Is It the Answer to the Surgical Staging Dilemma?,” Gynecologic Oncology 113, no. 2 (2009): 163–169. PubMed PMC

Frumovitz M., Plante M., Lee P. S., et al., “The FILM Trial: A Randomized Phase III Multicenter Study Assessing Near Infrared Fluorescence in the Identification of Sentinel Lymph Nodes (SLN),” Gynecologic Oncology 149 (2018): 7.

Rossi E. C., Kowalski L. D., Scalici J., et al., “A Comparison of Sentinel Lymph Node Biopsy to Lymphadenectomy for Endometrial Cancer Staging (FIRES Trial): A Multicentre, Prospective, Cohort Study,” Lancet Oncology 18, no. 3 (2017): 384–392. PubMed

Taniyama K., Motoshita J., Sakane J., et al., “Combination Analysis of a Whole Lymph Node by One‐Step Nucleic Acid Amplification and Histology for Intraoperative Detection of Micrometastasis,” Pathobiology 73, no. 4 (2006): 183–191. PubMed

Shimazu K., Miyake T., Okuno J., et al., “One‐Step Nucleic Acid Amplification Can Identify Sentinel Node‐Negative Breast Cancer Patients With Excellent Prognosis,” Anticancer Research 39, no. 3 (2019): 1447–1454. PubMed

Crafa F., Vanella S., Catalano O. A., Pomykala K. L., and Baiamonte M., “Role of One‐Step Nucleic Acid Amplification in Colorectal Cancer Lymph Node Metastases Detection,” World Journal of Gastroenterology 28, no. 30 (2022): 4019–4043. PubMed PMC

van Haaren E. R. M., Poodt I. G. M., Spiekerman van Weezelenburg M. A., et al., “Impact of Analysis of the Sentinel Lymph Node by One‐Step Nucleic Acid Amplification (OSNA) Compared to Conventional Histopathology on Axillary and Systemic Treatment: Data From the Dutch Nationwide Cohort of Breast Cancer Patients,” Breast Cancer Research and Treatment 202, no. 2 (2023): 245–255. PubMed PMC

Colombo N., Creutzberg C., Amant F., et al., “ESMO‐ESGO‐ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow‐Updagger,” Annals of Oncology 27, no. 1 (2016): 16–41. PubMed

Aalders J. G., Abeler V., and Kolstad P., “Recurrent Adenocarcinoma of the Endometrium: A Clinical and Histopathological Study of 379 Patients,” Gynecologic Oncology 17, no. 1 (1984): 85–103. PubMed

Abu‐Rustum N. R., Chi D. S., Leitao M., et al., “What Is the Incidence of Isolated Paraaortic Nodal Recurrence in Grade 1 Endometrial Carcinoma?,” Gynecologic Oncology 111, no. 1 (2008): 46–48. PubMed

Creutzberg C. L., Nout R. A., Lybeert M. L., et al., “Fifteen‐Year Radiotherapy Outcomes of the Randomized PORTEC‐1 Trial for Endometrial Carcinoma,” International Journal of Radiation Oncology, Biology, Physics 81, no. 4 (2011): e631–e638. PubMed

Capasso I., Garzon S., Kumar S., et al., “Prognostic Factors in Patients With Endometrial Cancer With Isolated Lymphatic Recurrence,” International Journal of Gynecological Cancer 33, no. 8 (2023): 1169–1178. PubMed

DiSaia P. J., Creasman W. T., Boronow R. C., and Blessing J. A., “Risk Factors and Recurrent Patterns in Stage I Endometrial Cancer,” American Journal of Obstetrics and Gynecology 151, no. 8 (1985): 1009–1015. PubMed

Kost'un J., Pesta M., Slama J., et al., “One‐Step Nucleic Acid Amplification vs Ultrastaging in the Detection of Sentinel Lymph Node Metastasis in Endometrial Cancer Patients,” Journal of Surgical Oncology 119, no. 3 (2019): 361–369. PubMed

Creasman W., “Revised FIGO Staging for Carcinoma of the Endometrium,” International Journal of Gynaecology and Obstetrics 105, no. 2 (2009): 109. PubMed

Benedetti Panici P., Basile S., Maneschi F., et al., “Systematic Pelvic Lymphadenectomy vs. no Lymphadenectomy in Early‐Stage Endometrial Carcinoma: Randomized Clinical Trial,” Journal of the National Cancer Institute 100, no. 23 (2008): 1707–1716. PubMed

Raffone A., Travaglino A., Santoro A., et al., “Accuracy of One‐Step Nucleic Acid Amplification in Detecting Lymph Node Metastases in Endometrial Cancer,” Pathology Oncology Research 26, no. 4 (2020): 2049–2056. PubMed

Fera E. L., Bizzarri N., Petrecca A., et al., “Evaluation of the One‐Step Nucleic Acid Amplification Method for Rapid Detection of Lymph Node Metastases in Endometrial Cancer: Prospective, Multicenter, Comparative Study,” International Journal of Gynecological Cancer 33, no. 7 (2023): 1063–1069. PubMed

Fanfani F., Monterossi G., Di Meo M. L., et al., “Standard Ultra‐Staging Compared to One‐Step Nucleic Acid Amplification for the Detection of Sentinel Lymph Node Metastasis in Endometrial Cancer Patients: A Retrospective Cohort Comparison,” International Journal of Gynecological Cancer 30, no. 3 (2020): 372–377. PubMed

de Boer S. M., Powell M. E., Mileshkin L., et al., “Toxicity and Quality of Life After Adjuvant Chemoradiotherapy Versus Radiotherapy Alone for Women With High‐Risk Endometrial Cancer (PORTEC‐3): An Open‐Label, Multicentre, Randomised, Phase 3 Trial,” Lancet Oncology 17, no. 8 (2016): 1114–1126. PubMed

Ronsini C., Iavarone I., Reino A., et al., “Radiotherapy and Chemotherapy Features in the Treatment for Locoregional Recurrence of Endometrial Cancer: A Systematic Review,” Journal of Personalized Medicine 13, no. 6 (2023): 886. PubMed PMC

Vizza E., Cutillo G., Bruno V., et al., “Pattern of Recurrence in Patients With Endometrial Cancer: A Retrospective Study,” European Journal of Surgical Oncology 46, no. 9 (2020): 1697–1702. PubMed

Ronsini C., Napolitano S., Iavarone I., et al., “The Role of Adjuvant Therapy for the Treatment of Micrometastases in Endometrial Cancer: A Systematic Review and Meta‐Analysis,” Journal of Clinical Medicine 13, no. 5 (2024): 1496. PubMed PMC

Lopez‐Ruiz M. E., Diestro M. D., Yebenes L., et al., “One‐Step Nucleic Acid Amplification (OSNA) for the Detection of Sentinel Lymph Node Metastasis in Endometrial Cancer,” Gynecologic Oncology 143, no. 1 (2016): 54–59. PubMed

Togami S., Tanimoto A., Yanazume S., et al., “Evaluation of the One‐Step Nucleic Acid Amplification Assay for Detecting Lymph Node Metastasis in Patients With Cervical and Endometrial Cancer: A Multicenter Prospective Study,” Gynecologic Oncology 170 (2023): 70–76. PubMed