Cervical and hysteroscopic injection for identification of sentinel lymph node in endometrial cancer

Sentinel lymph node in endometrial cancer: an overview

“…Considering the surgical risk of EC patients, the lower risk of metastasis in early stages and the controversial role of therapeutic lymphadenectomy in unselected patients, SLN biopsy, incorporating ultrastaging, could find its indication in low-and intermediate-risk women with EC: it brings the advantages of a conservative and more sensitive procedure and might select patients for adjuvant therapy. Moreover, SLN biopsy lends itself to laparoscopic surgery, which is an attractive alternative [10,19].…”

“…According to Maccauro et al and Niikura et al, the PA basin is frequently involved in drainage from the uterus corpus, and therefore, peri-tumoural injection allows a more complete detection of the corpus drainage [10] and becomes mandatory for assessing the PA area [28]. Also, subserosal injection could improve PA lymph node detection, considering its fundal drainage [33].…”

“…Only 16 % of EC cancer is located in the lower part of the uterus [25], and cervical injection may miss higher pelvic or PA sentinel node identification [10]. That is why Holloway et al recommended that should SLN not be identified with cervical injection, para-rectal and the pre-sacral space should be inspected, which may lead to identification of the common iliac or PA SLN [8].…”

“…The primary goal of SLN in EC consists in reducing the morbidity of a full lymphadenectomy (by decreasing surgical time), as well as early (need of blood transfusion, fever, wound infection, thromboembolism [10]) and late complications (lymphocysts formation, leg lymphedema, transient neuralgias [3,6,[8][9][10][11][12][13][14]). Besides, SLN allows an accurate exploration of all drainage routes as well as those considered aberrant or not routinely examined [12].…”

“…Moreover, the use of more sensitive techniques for SLN detection could better identify pelvic nodes and probably reduce the reported incidence of isolated infra-renal metastasis [8]. The secondary goal is to improve detection of micrometastasis, which is associated with a recurrence risk [13], with resource to ultra-sectioning and immunohistochemestry (IHC) protocols [3,6,[8][9][10][11][12][13]. Therefore, the risk of recurrence related to positive lymph nodes missing despite a full lymphadenectomy could be reduced [12], and SLN could improve selection of patients for adjuvant therapy.…”