Intraoperative sentinel lymph node detection by vital dye through laparoscopy or laparotomy in early endometrial cancer

Abstract

SLNs detection rate is significantly higher through laparoscopy than through laparotomy after vital dye pericervical injection but intraoperative vital dye pericervical injection is not reliable as part of standard care for predicting lymphatic spread in women with early stage endometrial cancer.

Sentinel lymph node in endometrial cancer: an overview

“…The laparoscopic route seems to allow a higher SLN identification than laparotomy [6]. Mais et al evaluated 34 patients in a prospective cohort with the purpose of comparing SLN detection in laparoscopy vs laparotomy.…”

“…The sentinel lymph node (SLN), by definition, is the first node to receive metastasizing cancer cells, as first described in 1960 by Gold et al for parotid cancer [6]. In 1996, Burke et al reported the SLN first application in EC [7].…”

“…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.…”

“…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]. The authors review the concerning techniques employed and their results and feasibilities to detect SLN node in EC.…”