Does sentinel node biopsy improve the management of endometrial cancer? Data from 43 patients

Bats, Anne-Sophie; Clément, D.; Larousserie, F.; Frère‐Belda, Marie‐Aude Le; Pierquet-Ghazzar, Nadia; Hignette, C.; Lécuru, Fabrice

doi:10.1002/jso.20857

Cited by 61 publications

(22 citation statements)

References 33 publications

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“…While the prognosis of early stage EC is good, the prognosis of patients with unfavorable pathological characteristics and advanced disease is poor [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . Metastasis to lymph nodes is among the proven prognostic factors in EC which occurs in around 10% of patients with stage I disease and around 20% of patients with stages II and IIIA-B 5,22 .…”

Section: Discussionmentioning

confidence: 99%

“…Because of the poor prognosis associated with para-aortic lymph node metastases from EC, the FIGO modified its staging of EC and classified stage IIIC into 2 subgroups according to the paraaortic lymph nodes status [10][11][12] . European guidelines restricted the removal of lymph nodes to the pelvic group in most stage I EC patients, whereas the FIGO guidelines recommend routine sampling of pelvic as well as para-aortic nodes 13 . The majority (90%) of stage I EC patients will not have lymph node metastases and when subjected to lymphadenectomy may have side effects like surgical complications, lymphedema and post-operative lymphocyst formation 14 .…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Algorithm as a Novel Method for Lymph Node Assessment in Stage I Endometrial Cancer

Atta

Hegab

El-Ashkar

et al. 2018

Kasr-Al-Aini J.of Clin. Onc. and Nuc. Med.

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Background:The uterus has a complex lymphatic drainage consisting of many groups that are in danger of endometrial cancer (EC) spread. Lymph node metastasis is a genuine pointer of poor prognosis requiring adjuvant therapy. Lymphatic mapping surgically can be done by blue dye labeling and perioperative algorithm. Aim: To assess the role of perioperative sentinel lymph nodes (SLN) mapping algorithm in reducing the necessity of pelvic lymphadenectomy. Methods: Fifty patients with early stage I EC underwent surgical staging. Transcervical injection of methylene blue was used, laparotomy was done and retroperitoneal spaces were opened. All lymph nodes were histopathologically examined and the negative SLN were ultrastaged. Results: Methylene blue dye injection resulted in blue lymph nodes in 20 (40%) cases, suspicious in 2 (4%) and negative in 28 (56%). Histopathological examination of sampled lymph node showed metastases in 18/20 (90%) of blue nodes, 1/2 (50%) of suspicious nodes and 0/28 (0%) of negative nodes. There were no false negative cases in this study and the detection rate was 89%. Conclusion: Perioperative algorithm accuracy and simplicity make it a reliable approach for lymph node assessment in early stage EC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perioperative Algorithm as a Novel Method for Lymph Node Assessment in Stage I Endometrial Cancer

Atta

Hegab

El-Ashkar

et al. 2018

Kasr-Al-Aini J.of Clin. Onc. and Nuc. Med.

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“…In 2008, Bats et al [31] performed a prospective analysis utilizing cervical injection of RI and ISB with no FNs reported. Perrone et al [11] prospectively analyzed patients utilizing two techniques, injection of RI into the cervix or hysteroscopic injection, and found an overall detection rate of 68% (70% for cervical injection vs. 65% for hysteroscopic injection).…”

Section: Resultsmentioning

confidence: 99%

Is Sentinel Lymph Node Dissection an Appropriate Standard of Care for Low-Stage Endometrial Cancers? A Review of the Literature

Levinson

Escobar

2013

Gynecol Obstet Invest

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Background/Aims: To review the literature and compare detection rates, false negative (FN) rates, and negative predictive values (NPVs) of sentinel lymph node (SLN) biopsy in endometrial cancer to those in breast and vulvar cancer. Secondary objectives were to evaluate techniques of SLN biopsy in endometrial cancer. Methods: The PubMed database was searched for applicable scientific articles. Detection rates, FN rates, and NPVs were calculated for all studies. Studies were stratified by techniques and compared. Results: Nineteen articles met criteria for this review. The overall detection rates ranged from 62 to 100%, the FN rate ranged from 0 to 50%, and the NPVs ranged from 95 to 100%. There is no technique that is definitively superior to any other with regard to surgical modality, injectant used, injection site, or pathologic techniques. Conclusions: Studies on SLN biopsy in endometrial cancer have a large range of detection rates and FN rates, and larger studies including more patients with metastatic disease are needed for comparison with breast and vulvar cancers. While no techniques are definitively superior to others, minimally invasive surgery, cervical injection, and pathologic analysis utilizing HE staining, immunohistochemistry, and ultrastaging may be clinically advantageous.

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“…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].…”

Section: Cervical Injectionmentioning

confidence: 99%

“…SENTI-ENDO identified 5 in 111 with an associated SLN in the PA region. Detection of isolated PA node involvement would improve outcome prediction and may decrease the complications of postoperative whole pelvis radiotherapy by limiting the use of extended surgical staging [33].…”

Section: Surgical Routementioning

confidence: 99%

Sentinel lymph node in endometrial cancer: an overview

2013

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The role of complete pelvic and para-aortic lymphadenectomy in early endometrial cancer remains controversial in gynecologic oncology. Sentinel lymph node detection is an alternative to assess lymphatic spread in several solid tumors. The authors review the literature related to the detection of sentinel lymph node in endometrial cancer, the techniques employed, and its results and feasibility. The authors review reported case series of endometrial cancer in which the sentinel lymph node biopsy was performed. A systematic literature review was conducted using the PubMed database. Different techniques were used considering lymphatic imaging mapping (colorimetric, isotopic, and fluorescence procedures) and injection site (subserous, hysteroscopic, and cervical). Detection rates of sentinel lymph node were heterogeneous, varying between 44 and 100 % with false-negative rates between 0 and 33 %. Although technically demanding, hysteroscopy approach was associated with the highest detection rate. The largest trials showed a good detection rate with cervical injection, a more reproducible procedure. The laparoscopic route improved the results. Immunohistochemistry staining improved the micrometastasis detection in sentinel lymph node. Cost-effectiveness of systematic lymphadenectomy compared with sentinel lymph node procedure and its value on adjuvant therapies as well as a standardized reproducible and reliable technique must be assessed.

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Does sentinel node biopsy improve the management of endometrial cancer? Data from 43 patients

Abstract: Intracervical injection of radionuclide and blue dye chiefly revealed pelvic SLNs. The prevalence of micrometastases was within the expected range. Comparisons with peritumoral injection are needed.

Cited by 61 publications

References 33 publications

Perioperative Algorithm as a Novel Method for Lymph Node Assessment in Stage I Endometrial Cancer

Perioperative Algorithm as a Novel Method for Lymph Node Assessment in Stage I Endometrial Cancer

Is Sentinel Lymph Node Dissection an Appropriate Standard of Care for Low-Stage Endometrial Cancers? A Review of the Literature

Sentinel lymph node in endometrial cancer: an overview

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