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 Apoptosis 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 HER2 inhibitor 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

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