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Benjamin E. Greer, Wui-Jin Koh, Nadeem Abu-Rustum, Michael A. Bookman, Robert E. Bristow, Susana M. Campos, Kathleen R. Cho, Larry Copeland, Marta Ann Crispens, Patricia J. Eifel, Warner K. Huh, Wainwright Jaggernauth, Daniel S. Kapp, John J. Kavanagh, John R. Lurain III, Mark Morgan, Robert J. Morgan Jr, C. Bethan Powell, Steven W. Remmenga, R. Kevin Reynolds, Angeles Alvarez Secord, William Small Jr and Nelson Teng

Uterine Neoplasms Clinical Practice Guidelines in Oncology NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation is based on lowerlevel evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lowerlevel evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Overview Adenocarcinoma of the endometrium is the most common malignancy in the female genital tract in the United States. An estimated 40,100 new diagnoses of uterine cancer and 7470 deaths from this disease will occur in 2008.1 Uterine sarcomas are uncommon and account for approximately 1 in 12 of all uterine cancers.2 These guidelines describe epithelial carcinomas and uterine sarcomas; each of these major categories contains specific histologic groups that require different management (see page 500). By definition, these guidelines cannot incorporate all possible clinical variations and are not intended to replace good clinical judgment or individualization of treatments. Exceptions to the rule were discussed among panel members during the process of developing these guidelines. For patients with suspected uterine neoplasms, initial preoperative evaluation includes a history and physical examination, endometrial biopsy, chest radiograph, a CBC,...
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Nadeem R. Abu-Rustum

cancer Compare and contrast the surgical strategies of SLN mapping, complete or selective lymphadenectomy, or no nodal evaluation in patients with endometrial cancer Define the key factors for successful SLN mapping including adherence to an SLN

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Ata S. Moshiri and Paul Nghiem

. Lemos BD Storer BE Iyer JG . Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: analysis of 5823 cases as the basis of the first consensus staging system . J Am Acad Dermatol 2010 ; 63 : 751 – 761 . 2. Lemos

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Jennifer L. Schwartz, Sandra L. Wong, Scott A. McLean, James A. Hayman, Christopher D. Lao, Jeffrey H. Kozlow, Kelly M. Malloy, Carol R. Bradford, Marcus L. Frohm, Douglas R. Fullen, Lori Lowe and Christopher K. Bichakjian

. Subcategories associated with survival of stages I and II are defined by the method of nodal evaluation (SLN/microscopically negative vs clinically negative); stage III is subcategorized by the extent of nodal metastasis. Other factors that may have prognostic

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Sarah T. Le, Pritesh S. Karia, Beverley J. Vollenhoven, Robert J. Besaw, Colleen M. Feltmate and Chrysalyne D. Schmults

% had a positive or close margin, 76% had clear margins, and 2% were unspecified. Patients with positive or close margins were treated with further resection (70%) or salvage radiation therapy (30%). Nodal evaluation had been performed in all patients

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Vishwajith Sridharan, Vinayak Muralidhar, Danielle N. Margalit, Roy B. Tishler, James A. DeCaprio, Manisha Thakuria, Guilherme Rabinowits and Jonathan D. Schoenfeld

clinical and socioeconomic factors. 26 Although older patients were less likely to undergo nodal evaluation overall, they still had a higher incidence of pathologic Table 2. Univariate and Multivariate Analysis of Factors Affecting Merkel Cell

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Christopher K. Bichakjian, Thomas Olencki, Murad Alam, James S. Andersen, Daniel Berg, Glen M. Bowen, Richard T. Cheney, Gregory A. Daniels, L. Frank Glass, Roy C. Grekin, Kenneth Grossman, Alan L. Ho, Karl D. Lewis, Daniel D. Lydiatt, William H. Morrison, Kishwer S. Nehal, Kelly C. Nelson, Paul Nghiem, Clifford S. Perlis, Ashok R. Shaha, Wade L. Thorstad, Malika Tuli, Marshall M. Urist, Timothy S. Wang, Andrew E. Werchniak, Sandra L. Wong, John A. Zic, Karin G. Hoffmann, Nicole R. McMillian and Maria Ho

multidisciplinary management . Cancer 2007 ; 110 : 1 – 12 . 7. Lemos BD Storer BE Iyer JG . Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: analysis of 5823 cases as the basis of the first consensus staging system

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Jonathan S. Zager, Jane L. Messina, L. Frank Glass and Vernon K. Sondak

. 30. Lemos BD Storer BE Iyer JG . Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: analysis of 5823 cases as the basis of the first consensus staging system . J Am Acad Dermatol 2010 ; 63 : 751 – 761

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Thanh H. Dellinger, Amy A. Hakim, Stephen J. Lee, Mark T. Wakabayashi, Robert J. Morgan and Ernest S. Han

nodal evaluation suffices. Following surgical treatment, adjuvant treatment relies on margin status and additional risk factors. For tumors with positive margins, reexcision is recommended if feasible versus adjuvant external-beam RT (EBRT) to the

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Christopher K. Bichakjian, Thomas Olencki, Sumaira Z. Aasi, Murad Alam, James S. Andersen, Rachel Blitzblau, Glen M. Bowen, Carlo M. Contreras, Gregory A. Daniels, Roy Decker, Jeffrey M. Farma, Kris Fisher, Brian Gastman, Karthik Ghosh, Roy C. Grekin, Kenneth Grossman, Alan L. Ho, Karl D. Lewis, Manisha Loss, Daniel D. Lydiatt, Jane Messina, Kishwer S. Nehal, Paul Nghiem, Igor Puzanov, Chrysalyne D. Schmults, Ashok R. Shaha, Valencia Thomas, Yaohui G. Xu, John A. Zic, Karin G. Hoffmann and Anita M. Engh

in which FDG-PET/CT was compared with subsequent pathologic nodal evaluation (SLNB or LND), the calculated sensitivity of FDG-PET/CT was markedly different across studies. 121 , 129 , 135 Colgan et al 121 retrospectively analyzed 33 patients who