Detection of sentinel lymph nodes in patients with endometrial cancer undergoing robotic-assisted staging: A comparison of colorimetric and fluorescence imaging

Sentinel lymph node in endometrial cancer: an overview

“…The detection of SLN is performed using colorimetric imaging of blue dyes (isosulfan blue, patent blue, and methylene blue), isotopic mapping with Technetium-99 (Tc-99), or both, through injection in a defined location [3,8,9]. Half-life is relatively long to allow a deferred identification of SLN, and both have a safety profile [9].…”

“…In 2008, a consensus panel stated that SLN in EC was worthy of further investigation [8]. Prospective investigation is reviving SLN in EC.…”

“…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.…”

“…Identification of microscopic disease outside the uterus can help to determine the need of adjuvant therapy. SLN application in EC is more accurate than MRI and intra-operative frozen section analysis in assessing lymph node status [1,8] and SLNs are three times more likely to harbor disease than non-SLNs [34]. SLN in EC, incorporating ultrastaging, may improve selection of women at high risk and could potentially avoid 80 % full unnecessary lymphadenectomy [6].…”