In a 1997 study of 595 patients with melanoma, Joseph et al evaluated the contribution of serial sectioning, immunohistochemistry (IHC) and a molecular technique with reverse transcriptase polymerase chain reaction (RT-PCR) to routine SB525334 mouse hematoxylin and eosin (H&E) histology to detect lymph node metastases. The study showed that routine H&E histology identified 73.8% of all metastases [3]. The remainder was detected by serial sectioning (7.8%) and IHC staining (18.4%) [3]. Moreover, RT-PCR upstaged 47% of the negative sentinel lymph nodes (SLN) [3]. In breast cancer, Selleck NVP-HSP990 Cote et al reported that serial sectioning and IHC were

able to detect respectively 7% and 20% of metastases in negative lymph nodes on H&E histology

[1]. In 2001, a multicenter study of stage I-III colorectal cancer by Saha et al. reported Thiazovivin in vitro that serial sectioning and IHC detected lymph node micrometastases in 14% of patients [4]. The concept of ultrastaging implies that lymph nodes be systematically analysed using serial sectioning and IHC. However, histological and/or molecular techniques used to assess ultrastaging on all nodes are time consuming and expensive thus limiting its routine use. Hence, the concept of ultrastaging is inseparable from that of SLN biopsy [5]. In melanoma, breast cancer, vulvar and colon cancers, the relevance of SLN biopsy has been validated and is considered an alternative to comprehensive lymphadenectomy to assess lymph node status. Although accumulating data on SLN in uterine cancers

are available, its validation remains a matter of debate especially for endometrial cancers due to the absence of consensus on the SLN technique. Moreover, few data are available on ultrastaging in uterine cancers. Therefore, the objective of the present review is to evaluate the contribution of ultrastaging in uterine cancers and its potential therapeutic implications. Concept of ultrastaging in uterine cancers Despite favourable prognostic features, pelvic recurrence occurs in up to 15% of patients with early stage cervical cancer and histologically negative pelvic lymph nodes by routine examination using H&E staining 6-phosphogluconolactonase [6, 7]. Holmgren et al. suggested that some of these recurrences could be due to metastases not detected by routine H&E histology of lymph nodes, so-called “”dormant”" or “”occult”" metastases [8]. Hafner et al. reported that using routine H&E histology, the chances of identifying a tumour cell cluster of less than 3 cell diameters was only 1% [9]. In 2003, Dargent and Enria evoked the concept of micrometastases without clear histological definition in cervical cancer. They reported that the use of serial sectioning and IHC gave a possible tenfold increase in detecting micrometastases [10].