Cervical versus endometrial injection for sentinel lymph node detection in endometrial cancer: a randomized clinical trial

Abstract

ObjectiveTo evaluate the relationship between pelvic/para-aortic sentinel lymph node status and two different injection sites of 99m-technetium (99mTc)-labeled phytate in patients with endometrial cancer.MethodsThis was a randomized controlled trial involving 81 patients with endometrial cancer. In the cervical group (n=40), injections of 99mTc were performed at the 3 and 9 o’clock positions of the uterine cervix. In the endometrial group (n=41), 99mTc was injected into the fundal endometrium using a transcervical catheter. Sentinel lymph nodes were detected through pre-operative lymphoscintigraphy and intra-operatively using a handheld gamma probe. All patients underwent complete pelvic and para-aortic lymphadenectomy procedures. Pathologic ultra-staging was performed with immunostaining for cytokeratin in sentinel lymph nodes after routine hematoxylin and eosin histological examinations. The primary endpoint was the estimation of detection rates, sensitivity, false-negative rates, negative predictive value, and analysis of the distribution of pelvic and para-aortic sentinel lymph nodes.ResultsThe rate of detection of at least one sentinel lymph node, sensitivity, and the negative predictive value was 80%, 66.6%, 96.6% for the cervical group and 85%, 66.6%, 96.9% for the endometrial group, respectively. False-negative sentinel lymph nodes were detected in one patient from each group . There was no significant difference between the groups in terms of total sentinel lymph node count, sentinel pelvic lymph node count, and pelvic bilaterality, but the para-aortic sentinel lymph node count was significantly higher in the endometrial group (p<0.001). Ultra-staging examination of the pelvic sentinel lymph nodes revealed isolated tumor cells in one patient from each group.ConclusionTranscervical endometrial tracer injection in endometrial cancer revealed similar pelvic but significantly higher para-aortic sentinel lymph node detection.

Implications of Isolated Para-Aortic Lymph Node Metastasis in Endometrial Cancer: A Large-Scale, Multicenter, and Retrospective Study

“…However, the potential risk of missing PLN-PAN+ remains one of the main concerns and criticisms ( 30 , 34 ), because SLN labeling on cervical tracer injection may not adequately map the PAN area ( 35 ). Then, additional fundal site injections of SLN labeling are needed to improve the assessment of PANs ( 36 , 37 ). Multinu et al found that ultrastaging and pathologic review can identify occult pelvic lymph node metastases and reduce the prevalence of true PLN-PAN+ ( 38 ).…”

The efficiency of a combined injection technique for sentinel lymph node mapping in intermediate‐high‐risk endometrial cancer

“…Several investigations have attempted to develop new methods to improve the detection rate of para‐aortic SLNs such like subserosal myometrial injection of the uterine fundus and hysteroscopy‐guided subendometrial tumor injections 12,13 . The data showcase that comparing with pelvic SLNs, fundus injection could better perceive para‐aortic SLNs 4,14 . Based upon the data, we suggest that fundal injection combined with cervical injection might be more efficient than cervical or fundal injection alone for intermediate‐high‐risk EC patients to detect pelvic and para‐aortic SLNs.…”

“…12,13 The data showcase that comparing with pelvic SLNs, fundus injection could better perceive paraaortic SLNs. 4,14 Based upon the data, we suggest that fundal injection combined with cervical injection might be more efficient than cervical or fundal injection alone for intermediate-high-risk EC patients to detect pelvic and para-aortic SLNs.…”

“…Prospective and retrospective research have illustrated that sentinel lymph node (SLN) mapping is a helpful approach with high sensitivity and low false-negative rate (FNR) when it was employed to elucidate lymph node status in patients with apparent uterine-confined endometrial cancer (EC). [1][2][3][4] The SENTI-ENDO study conducted in multicenters advised that the sensitivity and negative predictive value of SLN biopsy in patients with low-and intermediate-risk EC were 84% (95% confidence interval 62-95) and 97% (91-99), respectively. 5 The latest investigation demonstrates that SLN biopsy might be applicable in high-risk histologies (i.e., serous carcinoma, clear cell carcinoma, and carcinosarcoma).…”

The Birth of Legal Radiological Sciences in Brazil

“…The principles of operation detect the presence of gamma radiation, distinguish differences in the amount of gamma radiation emitted from different areas of the body or an organ, and translate the gamma energy pulses received by the detection probe into audible and numerical signals. Administration is performed by the nuclear physician in the sentinel lymph node (Pin, 2017;Gezer et al, 2020).…”