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

Abstract

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.

Utility of indocyanine green (ICG) intra-operative angiography to determine uterine vascular perfusion at the time of radical trachelectomy

“…Real-time observation of blood flow during surgery is possible using ICG fluorescence imaging. This technology has quickly gained popularity, and its use has expanded to an evaluation of graft vessels [6] in coronary bypass surgery and blood flow evaluation in reconstructed organs such as free flaps [7–9]. The aim of our study was to measure and analyze uterine perfusion utilizing laser angiography with ICG during uterine artery sparing and non-sparing radical trachelectomy.…”

Should Omentectomy Be a Part of Surgical Staging in Patients with Endometrioid Adenocarcinoma of the Uterine Corpus?

“…Endometrial carcinoma is frequently confined to the uterus at the time of diagnosis, and as such, it usually carries a good prognosis with high curability [8]. However, patients with high-risk factors, including higher tumor grade, aggressive histology, and advanced stage, represent actual challenges [9].…”