Issues surrounding lymphadenectomy in the management of endometrial cancer

Abstract

The development of surgical staging in the management of endometrial cancer has arisen over the last several decades with anticipated benefits including prognostic information, tailoring of adjuvant treatment, and a possible therapeutic effect. This review addresses the important issues surrounding lymphadenectomy in endometrial cancer. Other issues including the use of sentinel lymph node techniques, advanced imaging modalities and the consideration of a binary grading system to simplify triaging of patients will also be discussed.

Detection of Sentinel Nodes for Endometrial Cancer With Robotic Assisted Fluorescence Imaging: Cervical Versus Hysteroscopic Injection

“…However, the role of systematic lymphadenectomy in endometrial cancer remains controversial. 9 Lymph node mapping, or SLN biopsy, for endometrial cancer may provide benefits over traditional lymphadenectomy. There is increased detection of metastatic disease in SLNs compared with randomly collected lymphadenectomy specimens, 10 which may be secondary to the more rigorous pathologic assessment techniques used to evaluate SLNs for metastatic disease.…”

A Prospective Evaluation of Lymphatic Dissemination in Endometrial Cancer

“…to an incomplete lymphadenectomy limited to the area below the IMA. 10 The frequency of PALN metastasis was reported to be 3.4% to 11.5%. 3,11Y14 We detected PALN metastasis in 12 patients, with 11 of them above the IMA.…”

Management of lymph nodes in endometrioid uterine cancer

“…Similarly, the value of preoperative or intra-operative assessment of the depth of myometrial invasion remains controversial. MRI gives a false positive rate of 10% and a false negative rate of 35% [18,19]. Furthermore, 33% of diagnoses made from frozen sections did not correlate with the final pathology and 28% were upstaged [20].…”