In cervical cancer, although the prognostic relevance of micrometastases has not yet been established, Juretzka et al recommend adjuvant radiotherapy in the event of detection VEGFR inhibitor of micrometastases [69]. Marchiolè et al found that the relative risk of recurrence in presence of true micrometastases (focus of metastatic disease ranging from 0.2 mm to no more

than 2 mm) was 2.30 (CI: 1.65-3.20, p < 0.01) and 2.22 (CI: 1.30-3.80, p = 0.09) in the presence of submicrometastases (focus of metastatic disease no more than 0.2 mm including the presence of single non cohesive tumour cells) [13]. These authors addressed the issue of adjuvant therapy in patients with both lymphovascular space involvement and micrometastases [13]. However, despite a high incidence of micrometastases in cervical cancer, Coutant et al PR 171 failed to demonstrate a relation between the presence of micrometastases or submicrometastases and the recurrence rate, probably due to the small sample size and a relative short follow-up [29]. In early stage endometrial cancer, Yabushita et al. [22] analyzed the relation between disease recurrence and presence of micrometastases by IHC in pelvic lymph nodes. Although in their report, the term micrometastases is used to refer to metastases in which tumor cells were detected

only by the IHC method and the term occult metastasis refers to the presence of tumor cell fragments, the authors found that micrometastases in lymph node was associated with recurrence of disease in univariate (p < 0.0001) and multivariate analysis (p = 0.009). However, as for cervical cancer, the debate on whether the detection of micrometastases could be an indicator of adjuvant therapy continues. Conclusion Although accumulating data emphasize the contribution of serial sectioning and IHC to detect micrometastases, the clinical implications of ultrastaging on adjuvant therapy remains a matter of debate in uterine cancers. References

1. Cote RJ, Peterson HF, Chaiwun B, Gelber RD, Goldhirsch A, Castiglione-Gertsch M, Gusterson B, Neville AM: Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. International Breast SB431542 order cancer Study Group. Lancet 1999,354(9182):896–900.PubMedCrossRef 2. Reich Cediranib (AZD2171) O, Winter R, iegl B, Tamussino K, Hass J, Petru E: Does the size of pelvic lymph nodes predict metastatic involvment in patient with endometrial cancer? Int j Gynecol Cancer 1996, 6:4.CrossRef 3. Joseph E, Messina J, Glass FL, Cruse CW, Rapaport DP, Berman C, Reintgen DS: Cancer J Sci Am. 1997,3(6):341–345.PubMed 4. Saha S, Bilchik A, Wiese D, Espinosa M, Badin J, Ganatra BK, Desai D, Kaushal S, Singh T, Arora M: Ultrastaging of colorectal cancer by sentinel lymph node mapping technique–a multicenter trial. Ann Surg Oncol 2001, 8:94S-98S.PubMed 5. Cserni G: Axillary staging of breast cancer and the sentinel node.