Impact of Sentinel Node Mapping in Decreasing the Risk of Lymphocele in Endometrial Cancer

Diniz, Thiago Pereira; Drizlionoks, Eric; Faloppa, Carlos Chaves; Menezes, J.; Mantoan, Henrique; Gonçalves, Bruna Tirapelli; Brandão, Paulo Henrique Domingues Miranda; Kumagai, Lillian Yuri; Badiglian-Filho, Levon; Costa, Alexandre André Balieiro Anastácio da; Baiocchi, Glauco

doi:10.1245/s10434-020-09282-z

Cited by 14 publications

(6 citation statements)

References 16 publications

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“…Eventually, fourteen peer-reviewed and published studies were selected that met all the eligibility criteria, and of which data were available ( Fig. 1 ) [ 14 15 28 29 30 31 32 33 34 35 36 37 38 39 ]. The risk of bias, using the QUADAS-2 tool, is depicted in Figs.…”

Section: Resultsmentioning

confidence: 99%

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The added value of SLN mapping with indocyanine green in low- and intermediate-risk endometrial cancer management: a systematic review and meta-analysis

et al. 2022

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Objective The aim of this study was to assess the SLN detection rate in presumed early stage, low- and intermediate-risk endometrial cancers, the incidence of SLN metastases, and the negative predictive value of SLN mapping performed with indocyanine green (ICG). Methods A systematic review with meta-analyses was conducted. Study inclusion criteria were A) low- and intermediate-risk endometrial cancer, B) the use of ICG per cervical injection; C) a minimum of twenty included patients per study. To assess the negative predictive value of SLN mapping, D) a subsequent lymphadenectomy was an additional inclusion criterion. Results Fourteen studies were selected, involving 2,117 patients. The overall and bilateral SLN detection rates were 95.6% (95% confidence interval [CI]=92.4%–97.9%) and 76.5% (95% CI=68.1%–84.0%), respectively. The incidence of SLN metastases was 9.6% (95% CI=5.1%–15.2%) in patients with grade 1–2 endometrial cancer and 11.8% (95% CI=8.1%–16.1%) in patients with grade 1–3 endometrial cancer. The negative predictive value of SLN mapping was 100% (95% CI=98.8%–100%) in studies that included grade 1–2 endometrial cancer and 99.2% (95% CI=97.9%–99.9%) in studies that also included grade 3. Conclusion SLN mapping with ICG is feasible with a high detection rate and negative predictive value in low- and intermediate-risk endometrial cancers. Given the incidence of SLN metastases is approximately 10% in those patients, SLN mapping may lead to stage shifting with potential therapeutic consequences. Given the high negative predictive value with SLN mapping, routine lymphadenectomy should be omitted in low- and intermediate-risk endometrial cancer.

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Section: Resultsmentioning

confidence: 99%

“…There are several reasons for this discrepancy. In some studies, not all patients had ICG as tracer for SLN mapping, thus only a selection of the study population could be included in our study [ 30 33 37 ]. In another included study, the decision regarding lymph node dissection was at the discretion of the individual surgeon [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

The added value of SLN mapping with indocyanine green in low- and intermediate-risk endometrial cancer management: a systematic review and meta-analysis

et al. 2022

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“…While another research stated that systemic LAD was the only factor that associated with the presence of lymphocele, the number of dissected nodes showed no impact. Compared with SLN+LAD group, SLN only group significantly decreased lymphocele rate from 14.1% to 3.4% (p=0.009) ( 95 ). Mayo Clinic analyzed 378 patients and found that SLN may significantly decrease the risk of lymphedema compared with LAD (26.0% vs. 49.4%, p<0.001) ( 96 ).…”

Section: The Therapeutic Safety Of Slnmmentioning

confidence: 97%

Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review

et al. 2021

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Endometrial cancer (EC) is known as a common gynecological malignancy. The incidence rate is on the increase annually. Lymph node status plays a crucial role in evaluating the prognosis and selecting adjuvant therapy. Currently, the patients with high-risk (not comply with any of the following: (1) well-differentiated or moderately differentiated, pathological grade G1 or G2; (2) myometrial invasion< 1/2; (3) tumor diameter < 2 cm are commonly recommended for a systematic lymphadenectomy (LAD). However, conventional LAD shows high complication incidence and uncertain survival benefits. Sentinel lymph node (SLN) refers to the first lymph node that is passed by the lymphatic metastasis of the primary malignant tumor through the regional lymphatic drainage pathway and can indicate the involvement of lymph nodes across the drainage area. Mounting evidence has demonstrated a high detection rate (DR), sensitivity, and negative predictive value (NPV) in patients with early-stage lower risk EC using sentinel lymph node mapping (SLNM) with pathologic ultra-staging. Meanwhile, SLNM did not compromise the patient’s progression-free survival (PFS) and overall survival (OS) with low operative complications. However, the application of SLNM in early-stage high-risk EC patients remains controversial. As revealed by the recent studies, SLNM may also be feasible, effective, and safe in high-risk patients. This review aims at making a systematic description of the progress made in the application of SLNM in the treatment of EC and the relevant controversies, including the application of SLNM in high-risk patients.

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“…SLN removal alone resulted in a lower incidence of leg lymphedema than complete pelvic and paraaortic lymphadenectomy (1.3% vs 18.1%, p=0.0003) 60 . In a retrospective review of 348 patients, lymphocele was found in 3.4% (n=6/178) of SLNM-only patients, compared with 14.1% (n=24/170) in the SLNM with complete lymphadenectomy group (p=0.009) 61 . Complete lymphadenectomy was the only risk factor for lymphocele in a multivariate analysis (odds ratio=3.68, p=0.009) 61 .…”

Section: Benefit Of Slnmmentioning

confidence: 98%

“…In a retrospective review of 348 patients, lymphocele was found in 3.4% (n=6/178) of SLNM-only patients, compared with 14.1% (n=24/170) in the SLNM with complete lymphadenectomy group (p=0.009) 61 . Complete lymphadenectomy was the only risk factor for lymphocele in a multivariate analysis (odds ratio=3.68, p=0.009) 61 . The operative time (244 min vs 140 min), blood loss (240 mL vs 94 mL), length of hospital stay, and postoperative complication were lower in the SLN removal group than in the complete lymphadenectomy group 16,62 .…”

Section: Benefit Of Slnmmentioning

confidence: 98%

Sentinel lymph node mapping in endometrial cancer: an updated review

Lee

2022

Hong Kong Journal of Gynaecology, Obstetrics and Midwifery

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lymph node mapping (SLNM) is widely used in staging of both low-and high-risk early-stage endometrial cancer. It has a high detection rate, high sensitivity, high negative predictive value, and low false negative rate in detection of lymph node metastasis. Cervical injection of indocyanine green for SLNM is the preferred method. SLNM reduces the number of lymph node removal and reduces complications from lymphadenectomy without compromising oncological safety. This review discusses the latest evidence of SLNM in endometrial cancer staging in terms of technique, accuracy, limitations, impact on lymphadenectomy complications, and cancer survival.

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Impact of Sentinel Node Mapping in Decreasing the Risk of Lymphocele in Endometrial Cancer

Cited by 14 publications

References 16 publications

The added value of SLN mapping with indocyanine green in low- and intermediate-risk endometrial cancer management: a systematic review and meta-analysis

The added value of SLN mapping with indocyanine green in low- and intermediate-risk endometrial cancer management: a systematic review and meta-analysis

Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review

Sentinel lymph node mapping in endometrial cancer: an updated review

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