Which of the following direct lymph node dissections in endometrial carcinoma:a) Penetration into half of myometriumb) Clear cell Carcinomac) Fundal involvement d) Peritoneal metastasise) Papillary serous carcinoma
Indications for lymph node (pelvic and Para-aortic) dissection in endometrial cancer
Tumor histology:

Clear cell carcinoma
Papillary serous carcinoma
Squamous carcinoma

Adenocarcinoma (endometriod) grade II and Ill.
More than half of myometrial invasion
Isthmus- cervix extension
Extrauterine disease

Note: In absence of this factor only bilateral pelvic lymphadenectomy is performed if the tumor size is greater than 2 cms. Para-aortic lymphadenectomy would be performed if pelvic lymph nodes are positive.
Lymphadenectomy is altogether omitted for a patient with above risk factors absent, the absence of cervical involvement and tumor size less than 2 cms.

As far as Peritoneal metastasis is concerned:

"Positive peritoneal cytology in itself is not a marker of poor prognosis, i.e. is not an indication for lymph node dissection unless and until associated with other poor prognostic markers as above."   ... Novak 14th /ed p 1358
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