Comparison of a sentinel lymph node and a selective lymphadenectomy algorithm in patients with endometrioid endometrial carcinoma and limited myometrial invasion

Abstract

Objectives To assess clinicopathologic outcomes between two nodal assessment approaches in patients with endometrioid endometrial carcinoma and limited myoinvasion. Methods Patients with endometrial cancer at two institutions were reviewed. At one institution, a complete pelvic and para-aortic lymphadenectomy to the renal veins was performed in select cases deemed at risk for nodal metastasis due to grade 3 cancer and/or primary tumor diameter >2 cm (LND cohort). This is a historic approach at this institution. At the other institution, a sentinel lymph node mapping algorithm was used per institutional protocol (SLN cohort). Low risk was defined as endometrioid adenocarcinoma with myometrial invasion <50%. Macrometastasis, micrometastasis, and isolated tumor cells were all considered node-positive. Results Of 1135 cases identified, 642 (57%) were managed with an SLN approach and 493 (43%) with an LND approach. Pelvic nodes (PLNs) were removed in 93% and 58% of patients, respectively (P<0.001); para-aortic nodes (PANs) were removed in 14.5% and 50% of patients, respectively (P<0.001). Median number of PLNs removed was 6 and 34, respectively; median number of PANs removed was 5 and 16, respectively (both P<0.001). Metastasis to PLNs was detected in 5.1% and 2.6% of patients, respectively (P=0.03), and to PANs in 0.8% and 1.0%, respectively (P=0.75). The 3-year disease-free survival rates were 94.9% (95%CI, 92.4–97.5) and 96.8% (95%CI, 95.2–98.5), respectively. Conclusions Our findings support the use of either strategy for endometrial cancer staging, with no apparent detriment to the SLN algorithm. The clinical significance of disease detected on ultrastaging and the role of adjuvant therapy is yet to be determined.

Sentinel lymph node mapping and staging in endometrial cancer: A Society of Gynecologic Oncology literature review with consensus recommendations

“…Despite some differences in patient characteristics and adjuvant therapy, the 3-year disease-free survival rates were not different (96.8% [(95% CI, 95.2–98.5] and 94.9% [95% CI, 92.4–97.5], respectively]. These data support the use of the SLN algorithm for staging patients with endometrioid adenocarcinoma with less than 50% myometrial invasion [78]. The oncologic outcomes of patients with deeply invasive high-grade lesions from the same institutions are currently being analyzed.…”

Current state of sentinel lymph nodes for women with endometrial cancer

“…A collaborative retrospective evaluation was conducted between two institutions: the Mayo Clinic whose practice was to perform selective comprehensive pelvic and aortic node dissections only for patients with 'high-risk' uterine features, and Memorial Sloan Kettering Cancer Center who performed SLN biopsy on all patients 44. In their pooled results of 1135 cases, no difference in 3-year disease-free survival rates (94.9% and 96.8%, respectively) was observed.…”

Lymph Node Metastasis in Patients With Endometrioid Endometrial Cancer: Overtreatment Is the Main Issue

“…Most recently, researchers have reported successful adaptation of sentinel lymph node (SLN) mapping to surgically treat EC. 24,25 In this study, we evaluated the efficacy of major uterine factors, including tumor size, depth of myometrial invasion, and FIGO grade to determine LNM and describe a model for predicting LNM in patients with EC.…”