Accuracy of Sentinel Node in Detecting Lymph Node Metastasis in Primary Endometrial Carcinoma

Abstract

Background: Endometrial carcinoma is the most common gynecological cancer and its treatment is still controversial, especially in its early stages. There are conflicting data about the efficacy of retroperitoneal lymphadenectomy during abdominal hysterectomy and bilateral salpingoophrectomy treatment. Lymphadenectomy carries a risk of severe complications, especially in women with co-morbidities. Selective lymphadenectomy has been widely employed for staging evaluation of endometrial carcinoma because it is simple and seems to provide reliable data regarding nodal metastasis. This study was designed to evaluate accuracy of sentinel node sampling in detecting lymph node metastasis in primary endometrial carcinoma during staging laparotomy. Materials and Methods: Ninety-three women with endometrial carcinoma at high-risk for nodal metastasis were studied. During laparotomy, methylene blue dye was injected into sub-serosal myometrium, then retroperitoneal spaces were opened and blue lymph nodes within pelvic and para-aortic regions were removed as separate specimens for histopathological examination (sentinel lymph nodes = SLNs). Hysterectomy and selective lymphadenectomy then performed for all women included in this study. Results: Deposition of methylene dye into at least one lymph node was observed in 73.1% (68/93) of studied cases. 18.3% (17/93) of studied women had positive lymph node metastasis and 94.1% (16/17) of them had positive metastasis in SLNs. In this study, SNLs had 94.4% sensitivity and 100% specificity in prediction of lymph node metastasis. Mean number of lymph nodes removed from each case decreased when SLNs biopsy were taken. Conclusions: SLNs are the key lymph nodes in endometrial tumor metastasis and their involvement could be an indicator for whether or not complete systematic lymphadenectomy is needed during staging laparotomy.

Paraaortic sentinel lymph node detection in intermediate and high-risk endometrial cancer by transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR)

“…The intraoperative SLN detection rate in the present series was almost 80%, being slightly lower than the rate observed in previous studies performed with cervical tracer injection in intermediate or high-risk EC, in which the SLN detection rate ranged from 83% to 100% [ 3 4 6 8 18 19 20 21 22 23 24 25 ]. Two studies evaluating the SLN procedure with subserosal injection of blue dye in intermediate and/or high-risk EC patients showed detection rates of 73% and 89% [ 26 27 ]. The decreased overall SLN detection in our series could be explained not only by the site of tracer injection but also by the type of tracer, as indocyanine green (ICG) has shown to provide higher SLN detection rates [ 11 ].…”

Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis

“…a Includes 3 studies comparing ICG and blue dye, 12,22,28 2 comparing radiotracer with/without dye, 57,67 3 comparing cervical vs uterine injection, 41,49,76 5 comparing grade 1 vs grades 2e3, 22,27,29,37,64 and 5 comparing endometrioid and non-endometrioid histology. 22,27,29,37,64 Operating time and adverse events The additional operating time for SLN mapping compared with LND ranged from 3 to 40 minutes (6 studies). 23,28,35,43,44,55 One study reported lower blood loss with SLN mapping compared with LND.…”

“…In the studies reporting on adverse events (n ¼ 1390 women), 1 patient had an anaphylactic reaction to the blue dye 34 ; no other serious adverse events related to SLN mapping were reported. 11,21,24,26,29,30,33,34,[36][37][38]41,44,46,48,50,52,54,55,59,64,[66][67][68] Seven patients experienced serious complications related to completion LND after SLN mapping (5 lymphoceles, 2 vascular injuries). 30,36,50,[55][56][57][58][59] None of the studies reporting adverse events reported longterm outcomes comparing the risk of lymphedema in patients undergoing either SLN mapping alone or in comparison with complete lymphadenectomy.…”

Sentinel lymph nodes in endometrial cancer update 2018

“…Sentinel lymph node (SLN) is the first node receiving lymphatic drainage from the primary tumor, and the pathological status of SLN reflects the overall status of entire lymphatic basin. [10]…”

“…Women with negative SLN for metastasis may be managed by SLN biopsy instead of systemic lymphadenectomy. [10]…”