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Objective: To evaluate the relation between mismatch repair (MMR) status and the risk of lymph node metastasis in endometrial cancer, and whether this additional data can be incorporated to current SLN (sentinel lymph node) algorithm., Methods: We included a series of 332 women that underwent SLN mapping ± systematic lymphadenectomy from January 2013 to December 2021. Protein expressions of MLH1, MSH2, MSH6, PMS2 were examined by immuno-histochemistry and considered MMRd (deficient) when at least one protein was not expressed., Results: MMRd was noted in 20.8% of cases and correlated to grade 3 (p = 0.018) and presence of lymphovascular space invasion (p = 0.032). Moreover, MMRd was an independent risk factor for lymph node metastasis (OR 2.76, 95% CI 1.36-5.62). Notably, 21.7% (15/69) cases with MMRd had lymph node metastasis compared to 9.5% (25/263) of cases with MMRp (proficient) (p = 0.005). The overall and bilateral SLN detection rates were 91.9% and 75.9%, respectively. Of the 80 (24%) cases of non-bilateral SLN detection, 66.2% had low-grade tumors (G1/G2) and myometrial invasion <50%. Considering MMR status an independent prognostic factor for lymph node metastasis, a systematic lymphadenectomy (side specific or bilateral) would forgo in 53.7% (43/80) of cases with non-bilateral detection, representing 13% (43/332) of all endometroid tumors., Conclusion: MMR status was independently related to lymph node metastasis in endometrioid EC. Moreover, MMR status may help to select patients that can forgo systematic lymphadenectomy in case of undetected SLN., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: Increasing data suggest that patients with early-stage cervical cancer and favorable pathological characteristics have a low risk of parametrial invasion (PI) and benefit from less radical surgery. Our aim was to evaluate the clinical-pathological factors that are related to PI and identify a group of patients who are at low risk for PI., Methods: We analyzed a series of 345 patients with stage Ia2 to Ib2 cervical cancer, for which they underwent radical surgery from January 1990 to October 2016 at AC Camargo Cancer Center. Chi-square and Fisher's exact tests were used to analyze the correlations between PI and clinicopathological variables., Results: A total of 217 (62.9%) patients were classified as having squamous cell carcinoma, and 128(37.1%) had adenocarcinoma or adenosquamous carcinoma. Sixteen (4.6%) patients had PI. The presence of perineural invasion (p=0.003), tumor size >2cm (p=0.044), depth of invasion >10mm (p=0.004), the presence of lymphovascular space invasion(LVSI) (p<0.001), and lymph node metastasis (p<0.001) were related to PI. However, only LVSI (p=0.043) and lymph node metastasis (p<0.001) remained risk factors for PI in the multivariate analysis. Of the patients with tumors ≤2cm and no LVSI, only 1(1.2%) had PI; however, this patient had lymph node metastasis and deep stromal invasion (>10mm). No patient with tumor size ≤2cm and negative lymph nodes had PI., Conclusions: Patients with tumors ≤2cm and those who lack LVSI are unlikely to have PI, unless lymph node metastasis or deep stromal invasion is present. Our data can help select patients in whom a more conservative approach is warranted, such as simple hysterectomy and simple trachelectomy that is associated with pelvic lymphadenectomy., (Copyright © 2017 Elsevier Inc. All rights reserved.)