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Pathologisch-anatomische Aufarbeitung und Befundung von Lymphknoten bei gynäkologischen Malignomen

Recommendations for the handling and oncologic pathology report of lymph node specimens submitted for evaluation of metastatic disease in gynecologic malignancies

  • Schwerpunkt: Zervixpathologie
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Zusammenfassung

Der Lymphknotenstatus ist einer der wichtigsten Prognosefaktoren bei gynäkologischen Malignomen und oft Grundlage für das Management von Patientinnen in der adjuvanten Situation. Die Zahl der entfernten Lymphknoten ist ein wesentlicher Parameter der operativen Radikalität und der Qualitätssicherung. In dieser Übersicht wird zur histopathologischen Aufarbeitung und Befundung von Lymphadenektomiepräparaten bei Karzinomen des weiblichen Genitaltrakts (ausgenommen Mammakarzinom) Stellung genommen. Im Besonderen wird eingegangen auf die Bearbeitung von Lymphknoten im Schnellschnitt sowie von Sentinel-Lymphknoten.

Der Befundbericht sollte die Zahl der metastatisch befallenen, im Verhältnis zur Zahl der entfernten Lymphknoten, die Metastasengröße sowie eine eventuelle paranodale Infiltration beinhalten. Beim Nachweis von isolierten Tumorzellen und Mikrometastasen, insbesondere in Sentinel-Lymphknoten, sollte die Detektionsmethode genannt werden. Bei unbekannten Primärtumoren (sogenanntes CUP-Syndrom) sollte — ggf. nach immunhistochemischer Analyse — zum möglichen Primärtumor Stellung genommen werden.

Abstract

The nodal status is one of the strongest prognostic factors in gynecologic malignancies. Metastatic involvement of regional and distant lymph nodes represents the selection basis for adjuvant therapy in a large number of solid neoplasms. The number of resected lymph nodes is one of the most important parameters in the quality control of the surgical procedure, in particular with respect to radicality. The present paper provides recommendations for gross dissection, laboratory procedures and reporting for lymph node biopsies, lymph node dissections and sentinel lymph node biopsies (SLN) for cancers of the vulva, vagina, uterine cervix, endometrium, Fallopian tubes and the ovaries, submitted for the evaluation of metastatic disease.

The pathologic oncology report should include information about the number and size of resected lymph nodes, the number of involved lymph nodes with the maximum size of metastases and the presence of paranodal infiltration. In addition, the detection of isolated tumor cells should be reported, particularly with respect to the detection method (immunostains or molecular methods). In cases of metastatic disease and carcinoma of unknown primary (CUP-syndrome), information should be given regarding the primary tumor.

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Literatur

  1. Abrahamsen HN, Hamilton-Dutoit SJ, Larsen J, Steiniche T (2004) Sentinel lymph nodes in malignant melanoma. Extended histopathologic evaluation improves diagnostic precision. Cancer 100:1683–1691

    Article  PubMed  Google Scholar 

  2. Altgassen C, Gottschild D, Dürst M, Schneider A, Studiengruppe der AGO-Studie Uterus III (2002) Detektion des Sentinellymphknotens bei Patientinnen mit Zervixkarzinom. Prospektive klinische Multizenterstudie zur Detektion des Sentinellymphknotens bei Patientinnen zur Operation eines Zervixkarzinoms – AGO-Studie Uterus III. Geburtshilfe Frauenheilk 62:358–362

    Article  Google Scholar 

  3. Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) (2001) Kurzgefaßte interdsiziplinäre AGO-Leitlinien für die Diagnostik und Therapie des Endometriumkarzinoms. Zentralbl Gynakol 124:58–62

    Google Scholar 

  4. Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) (2001) Kurzgefaßte interdsiziplinäre AGO-Leitlinien für die Diagnostik und Therapie des Zervixkarzinoms. Zentralbl Gynakol 123:292–298

    Article  PubMed  Google Scholar 

  5. Baltzer J (1991) Management des Zervixkarzinoms — postoperative Strahlenbehandlung nach Wertheim-Operation. Ja oder nein? Zentralbl Gynakol 113:661–665

    CAS  PubMed  Google Scholar 

  6. Barranger E, Cortez A, Marpeau O et al. (2004) Histopathologic validation of the sentinel node concept in cervical cancer. Ann Oncol 15:870–874

    Article  CAS  PubMed  Google Scholar 

  7. Beckmann MW und Informastionszentrum für Standards in der Onkologie (ISTO) in der Deutschen Krebsgesellschaft (2004) Interdisziplinäre S2-Leitlinie für die Diagnostik und Therapie des Zervixkarzinoms. Zuckschwerdt, München Wien New York

  8. Burchill SA, Selby PJ (2000) Molecular detection of low level disease in patients wtih cancer. J Pathol 190:6–14

    Article  CAS  PubMed  Google Scholar 

  9. Cady B (2000) Sentinel lymph node procedure in squamous cell carcinoma of the vulva. J Clin Oncol 18:2795–2797

    Google Scholar 

  10. Cote RJ, Peterson HF, Chaiwun B (1999) Role of immunohistochemical detection of lymph-node metastases in the management of breast cancer. Lancet 354:896–900

    Article  CAS  PubMed  Google Scholar 

  11. Dam PA van, Hauspy J, Vanderheyden T et al. (2003) Intraoperative sentinel node identification with Technetium-99m-labeled nanocolloid in patients with cancer of the uterine cervix: a feasibility study. Int J Gynecol Cancer 13:182–186

    Article  PubMed  Google Scholar 

  12. Dam PA van, Sonnemans H, van Dam PJ et al. (2004) Sentinel node detection in patients with vaginal carcinoma. Gynecol Oncol 92:89–92

    Article  PubMed  Google Scholar 

  13. Di Re E, Grosso G, Raspagliesi F, Baiocchi G (1996) Fallopian tube cancer: incidence and role of lymphatic spread. Gynecol Oncol 62:199–202

    Article  PubMed  Google Scholar 

  14. Fanfani F, Ludovisi M, Zannoni GF et al. (2004) Frozen section examination of pelvic lymph nodes in endometrial and cervical cancer: accuracy in patients submitted to neoadjuvant treatments. Gynecol Oncol 94:779–784

    Article  PubMed  Google Scholar 

  15. Fisher ER, Palekar A, Rockette H et al. (1978) Pathologic findings from the National Surgical Adjuvant Breast Cancer Project (protocol no. 4). Cancer 42:2032–2038

    CAS  PubMed  Google Scholar 

  16. Fishman A, Klein A, Zemer R et al. (2000) Detection of mircometastases by cytokeratin 20 (reverse transcription polymerase chain reaction) in lymph nodes of patients with endometrial cancer. Gyneol Oncol 77:399–404

    Article  CAS  Google Scholar 

  17. Fitzgibbons PL, LiVolsi VA (2000) Recommendations for handling radioactive specimens obtained by sentinel lymphadenectomy. Surgical Pathology Committee of the College of American Pathologists, and the Association of Directors of Anatomic and Surgical Pathology. Am J Surg Pathol 24:1549–1551

    CAS  PubMed  Google Scholar 

  18. Fitzgibbons PL, Page DL, Weaver D (2000) Prognostic factors in breast cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 124:966–978

    CAS  PubMed  Google Scholar 

  19. Girardi F, Pickel H, Winter R (1993) Pelvic and parametrial lymph nodes in the quality control of the surgical treatment of cervical cancer. Gynecol Oncol 50:330–333

    Article  CAS  PubMed  Google Scholar 

  20. Goldhirsch A, Wood WC, Gelber RD et al. (2003) Meeting highlights: updated international expert consensus on the primary therapy of early breast cancer. J Clin Oncol 21:1–9

    Google Scholar 

  21. Gospodarowicz MK, Miller D, Groome PA et al. for the UICC TNM Project (2004) The process for continous improvement of the TNM classification. Cancer 100:1–5

    Article  PubMed  Google Scholar 

  22. Hansen NM, Grube BJ, Te W (2001) Clinical significance of axillary micrometastases in breast cancer: how small is too small? American Society of Clinical Oncology, ASCO-Abstract Book, Abstract No. 91

    Google Scholar 

  23. Hermanek P, Hutter RVP, Sobin LH, Wittekind C (1999) Classification of isolated tumor cells and micrometastases. Cancer 86:2668–2673

    Article  CAS  PubMed  Google Scholar 

  24. Horn LC, Schmidt D (2002) Histopathologische Basisinformation und morphologische Prognosefaktoren beim Endometriumkarzinom. Zentralbl Gynakol 124:36–44

    CAS  PubMed  Google Scholar 

  25. Horn LC, Fischer U, Bilek K (2001) Pathologisch-anatomische Aufarbeitung und morphologische Basisinformation für das Management von Dysplasien und Karzinomen der Cervix uteri. Zentralbl Gynakol 123:255–265

    Article  CAS  PubMed  Google Scholar 

  26. Kjörstad KE, Kolbensvedt A, Stricker T (1984) Value of a complete lymphadenectomy in the radical treatment of cancer on the cervix. Cancer 54:2215–2219

    PubMed  Google Scholar 

  27. Kühn T, Kreienberg R (2004) Wächterlymphknoten-Biopsie beim Mammakarzinom. Deutsche Gesellschaft für Senologie definiert Qualitätsstandards. Dtsch Med Wochenschr 129:387–390

    Article  PubMed  Google Scholar 

  28. Kühnel G, Horn LC, Fischer U et al. (2001)18FDG-Positronen-Emissions-Tomographie beim Zervixkarzinom: Erste Ergebnisse. Zentralbl Gynakol 123:229–235

    Article  PubMed  Google Scholar 

  29. Kuhn W, DuBois A, Pfisterer J (2001) Operative Therapie des fortgeschrittenen Ovarialkarzinoms. Gynäkologe 43:1050–1057

    Google Scholar 

  30. Lawrence WD (2001) ADASP recommendations for processing and reporting of lymph node specimens submitted for evaluation of metastatic disease. Virch Arch 439:601–603

    CAS  Google Scholar 

  31. Lax SF (2002) Molekulare Pathogenese des Endometriumkarzinoms auf der Basis eines dualistischen Modells. Zentralbl Gynakol 124:10–16

    CAS  PubMed  Google Scholar 

  32. Lee E, Chae Y, Kim I et al. (2002) Prognostic relevance of immunohistochemically detected lymph node micrometastasis in patients with gastric carcinoma. Cancer 94:2867–2873

    Article  PubMed  Google Scholar 

  33. Lelievre L, Camatte S, Le Ferere-Belda MA et al. (2004) Sentinel lymph node biopsy in cervix and corpus uteri cancers. Int J Gynecol Cyncer 14:271–278

    Article  CAS  Google Scholar 

  34. Lentz SE, Muderspach LI, Felix JC et al. (2004) Identification of mircometastases in histologically negative nodes of early-stage cervical cancer patients. Obstet Gynecol 103:1204–1210

    PubMed  Google Scholar 

  35. Levavi H, Sabah G, Hardoff R et al. (2003) Failure of sentinel node identification following neo-adjuvant chemo-radiotherapy for locally advanced squamous cell carcinoma of the vulva. Eur J Gynaecol Oncol 24:433–434

    CAS  PubMed  Google Scholar 

  36. Marchiolè P, Buénerd A, Scoazec JY et al. (2004) Sentinel lymph node biopsy is not accurate in predicting lymph node status for patients with cervical carcinoma. Cancer 100:2154–2159

    Article  PubMed  Google Scholar 

  37. Martínez-Palones JM, Gil-Moreno A, Pérez-Benavente MA et al. (2004) Interoperative sentinel node identification in early stage cervical cancer using a combination of radiolabeled albumin injection and isosulfane blue dye injection. Gynecol Oncol 92:845–850

    Article  PubMed  Google Scholar 

  38. Michel G, Morice P, Castaigne D et al. (1998) Lymphatic spread in stage IB an II cervical carcinoma: anatomy and surgical implications. Obstet Gynecol 91:360–363

    Article  CAS  PubMed  Google Scholar 

  39. Moore RG, Granai CO, Gajewski W et al. (2003) Pathologic evaluation of inguinal sentinel lymph nodes in vulvar cancer patients: a comparison of immunohistochemical staining versus ultrastaging with hematoxylin and eosin staining. Gynecol Oncol 91:378–382

    Article  PubMed  Google Scholar 

  40. Morice P, Castaigne D, Pautier P et al. (1999) Interest of para-aortic lymphadenectomy in patients with stage IB and II cervical carcinoma. Gynecol Oncol 73:106–110

    Article  CAS  PubMed  Google Scholar 

  41. Natsugoe S, Mueller J, Stein HJ et al. (1998) Micrometastasis and tumor cell microinvolvement of lymph nodes from esophageal squamous cell carcinoma 83:858–866

    CAS  Google Scholar 

  42. Niikura H, Okamura C, Utsonomiya H et al. (2004) Sentinel lymph node detection in patients with endometrial cancer. Gynecol Oncol 92:669–674

    Article  PubMed  Google Scholar 

  43. Nijman HW, Khalifa M, Covens A (2004) What is the number of lymph nodes required for an „adequate“ pelvic lymphadenectomy? Eur J Gynaecol Oncol 25:87–89

    CAS  PubMed  Google Scholar 

  44. Palamba HW, Rombouts MC, Ruers TLM et al. (2001) Extranodal extension of axillary metastases of invasive breast carcionomas as a possible predictor for the total number of positive nodes. Eur J Surg Oncol 27:719–722

    Article  CAS  PubMed  Google Scholar 

  45. Panici PB, Angioli R (2002) Role of lymphadenectomy in ovarian cancer. Best Pract Res Clin Obstet Gynaecol 16:529–551

    Article  PubMed  Google Scholar 

  46. Plante M, Renaud MC, Tetu B et al. (2003) Laparoscopic sentinel node mapping in early-stage cervical cancer. Gynecol Oncol 91:494–503

    Article  CAS  PubMed  Google Scholar 

  47. Ratanawichitrasin A, Biscotti CV, Levy L, Crowe JP (1999) Touch imprint cytologic analysis of sentinel lymph nodes for detecting axillary metastases in patients with breast cancer. Br J Surg 86:1346–1348

    Article  CAS  PubMed  Google Scholar 

  48. Rosen PP, Saigo PE, Braun DW et al. (1981) Axillary micro- and macrometastases in breast cancer. Ann Surg 194:585–591

    CAS  PubMed  Google Scholar 

  49. Sakuragi N, Satoh C, Takeda N et al. (1999) Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy. Cancer 85:1547–1554

    Article  CAS  PubMed  Google Scholar 

  50. Schnürch HG (2000) Therapie des Vulva- und Vaginakarzinoms. Onkologe 6:1046–1060

    Article  Google Scholar 

  51. Scholz HS, Lax SF, Benedicic C et al. (2003) Accuracy of frozen section examination of pelvic lymph nodes in patients with FIGO stage IB to IIB cervical cancer. Gynecol Oncol 90:605–609

    Article  PubMed  Google Scholar 

  52. Schwartz GF, Giuliano AE, Veronesi U, and the Consensus Conference Committee (2002) Proceedings of the Consensus Conference on the role of sentinel node biopsy in carcinoma of the breast. April 19–22, 2001, Philadelphia, Pennsylvenia. Cancer 94:2542–2551

    Article  PubMed  Google Scholar 

  53. Silverberg SG, Connolly JL, Dabbs D et al. (2001) Recommendations for processing and reporting of lymph node specimens submitted for evaluating of metastatic disease. Am J Clin Pathol 115:799–801

    Article  PubMed  Google Scholar 

  54. Silverberg SG (2002) Sentinel node processing. Recommendations for pathologists. Am J Surg Pathol 26:383–385

    Article  PubMed  Google Scholar 

  55. Singletary SE, Greene FL, Sobin LH (2003) Classification of isolated tumor cells. Clarification of the 6th edition of the American Joint Committee on Cancer Staging Manual. Cancer 99:2740–2741

    Article  Google Scholar 

  56. Terada KY, Shimizu DM, Wong JH (2000) Sentinel node dissection and ultrastaging in squamous cell cancer of the vulva. Gynecol Oncol 76:40–44

    Article  CAS  PubMed  Google Scholar 

  57. Verheijen RHM, Pijpers R, van Diest PJ et al. (2000) Sentinel node detection in cervical cancer. Obstet Gynecol 96:135–138

    Article  CAS  PubMed  Google Scholar 

  58. Veronesi U, Paganelli G, Viale G et al. (1999) Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst 91:368–373

    Article  CAS  PubMed  Google Scholar 

  59. Weitz J, Kienle P, Magener A et al. (1999) Detection of disseminated colorectal cancer cells in lymph nodes, blood and bone marrow. Clin Cancer Res 5:1830–1836

    CAS  PubMed  Google Scholar 

  60. Wittekind C, Meyer HJ, Bootz F (2002) TNM-Klassifikation maligner Tumoren. Springer, Berlin Heidelberg New York Tokyo

  61. Wittekind C, Greene FL, Henson DE et al. (2003) TNM-supplement. A commentary on uniform use. Wiley-Liss, New York

  62. Yared MA, Middleton LP, Smith TL et al. (2002) Recommendations for sentinel lymph node processing in breast cancer. Am J Surg Pathol 26:377–382

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Abteilung für Gynäko- & Perinatalpathologie, Institut für Pathologie der Universität Leipzig

    L.-C. Horn

  2. Universitäts-Frauenklinik Leipzig, Triersches Institut

    J. Einenkel & M. Höckel

  3. Klinik und Poliklinik für Geburtshilfe und Frauenheilkunde, Johannes-Gutenberg-Universität Mainz

    H. Kölbl

  4. Institut für Pathologie Mannheim, Referenzzentrum für Gynäkopathologie

    F. Kommoss & D. Schmidt

  5. Landeskrankenhaus Institute für Pathologie, Graz West und Medizinische Universität Graz

    S. F. Lax

  6. Institut für Pathologie, Hamburg

    L. Riethdorf

  7. Klinik für Gynäkologie und Geburtshilfe, Lukas-Krankenhaus Neuss

    H.-G. Schnürch

  8. Institut für Pathologie, Universität Leipzig, Liebigstraße 26, 04103, Leipzig

    L.-C. Horn

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  1. L.-C. Horn
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  3. M. Höckel
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  9. D. Schmidt
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Interdisziplinäre Ad-hoc-Kommission der Arbeitsgemeinschaft Gynäkopathologie in der Deutschen Gesellschaft für Pathologie und Mitgliedern der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), Organgruppe Uterus (L.-C. Horn, H. Kölbl, S.F. Lax, D. Schmidt), Organgruppe Vulva/Vagina (L.-C. Horn, H.-G. Schnürch) und Organgruppe Ovar (F. Kommoss)

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Horn, LC., Einenkel, J., Höckel, M. et al. Pathologisch-anatomische Aufarbeitung und Befundung von Lymphknoten bei gynäkologischen Malignomen. Pathologe 26, 266–272 (2005). https://doi.org/10.1007/s00292-005-0764-3

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