Fig 1.
This diagram depicts the processing of the resected sentinel lymph node. Each lymph node was cut in 2 mm thick slices and placed in a dedicated tissue cassette and labeled accordingly. Six serial microtome sections were made from each tissue block. Three of them were stained with hematoxylin & eosin (H&E). Serial sections #2 and #4 were stained by immunohistochemistry (IHC) for pancytokeratin (Pan-CK) and cytokeratin-7 (CK7) respectively. CK7 was used to ensure the cancer was not of gastrointestinal origin. Serial section #6 was used as a negative control for IHC.
Fig 2.
A negative sentinel lymph node with endosalpingiosis in a patient with complex atypical hyperplasia (case # 6, S1 Table). (A) The photomicrograph shows a cystic glandular structure in the lymph node that is lined with fallopian tube-type ciliated epithelium on hematoxylin and eosin (H&E) stain. (B) Immunohistochemical stain for cytokeratin highlights the glandular structure at the same location as on the H&E slide (10x objective).
Fig 3.
A sentinel lymph node with isolated tumor cells (case # 50, S1 and S5 Tables). (A) The photomicrograph shows a portion of a normal-appearing lymphoid structure with no obvious tumor cells by hematoxylin and eosin (H&E) stain. (B) Few isolated tumor cells were highlighted by cytokeratin immunohistochemical stain (arrows) within the same area of the lymph node as seen on the H&E slide (10x objective).
Fig 4.
A sentinel lymph node with micrometastatic carcinoma (case # 58, S1 and S5 Tables). (A) A cluster of tumor cells seen by hematoxylin and eosin (H&E) stain. (B) Cytokeratin immunohistochemical stain highlighted the same focus of the tumor seen on the H&E slide (10x objective).
Fig 5.
A sentinel lymph node with a metastatic carcinoma (case # 54, S1 and S5 Tables). Hematoxylin and eosin stain shows almost complete effacement of the lymph node by endometrioid adenocarcinoma. Small clusters of remnant lymphoid cells are present (2x objective).
Table 1.
Fisher’s Exact comparison of the SLN status versus the tumor features as individually stated in the sub-tables.
Table 2.
Wilcoxon Rank-Sum test, comparison of the T-size versus SLN status.
Table 3.
The pathological features associated with sentinel lymph node involvement in endometrial carcinomas, listed by the importance based on the p-values.
Table 4.
Test measures of the five pathologic features associated with the sentinel lymph node involvement in endometrial carcinomas.
Fig 6.
Pathological features associated with sentinel lymph node involvement.
There are five uterine pathological features which are associated with sentinel lymph node (SLN) involvement. The figures are arranged according to their importance as listed in Table 3. (A) Lower uterine segment (LUS) involvement was present in 100% of the cases with positive SLNs as opposed to <20% in those cases with negative lymph nodes. (B) In Group-II, cases with positive SLN had an average tumor size of 5 CM or greater. (C) Histological lymphovascular (LV) invasion was observed in 55% of the cases with positive SLNs but 6% in those with negative nodes. (D) Cervical stromal (CS) involvement had occurred in 36% of patients with positive SLNs while only in 4% of those who has no SLN metastasis. (E) A myometrial depth of invasion (DI) of ≥50% occurred in >50% of the patients with positive SLNs while it was seen in <20% of those with negative SLNs.