Pre-operative lymphatic mapping and intra-operative sentinel lymph node detection in early stage endometrial cancer

Abstract

Lymphatic mapping and sentinel lymph node (SLN) biopsy are becoming increasingly useful for the identification of tumour lymphatic spread in a wide variety of neoplasms, such as breast cancer and melanoma, reducing unnecessary radical lymph node resection. The aim of our study was to determine the feasibility of lymphatic mapping with both labelled colloid and patent blue violet in patients with early stage endometrial cancer. Sixteen consecutive patients with endometrial cancer, stage International Federation of Gynecology and Obstetrics (FIGO Ib), were included in the study. Lymphoscintigraphy and laparoscopically assisted intra-operative SLN detection were performed in all patients. In addition, to verify the prognostic role of this method, 12 of 16 patients were followed up for a period of at least 1 year. In 15 of 16 patients, 24 SLNs (all internal iliac lymph nodes) were detected at lymphoscintigraphy (six monolateral and nine bilateral). At histological analysis, three of the 24 were positive for micrometastases, whereas the remaining 21 were negative. No other surgically dissected lymph nodes presented metastases. At 1 year of follow-up, none of the 12 patients presented relapse of their disease. In conclusion, in endometrial cancer, both pre-operative lymphoscintigraphy and intra-operative gamma-probe detection of SLNs represent promising tools for the visualization of SLNs. The status of the latter may yield a correct representation of pelvic lymph node involvement, providing important information for further treatment.

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

“…Two more papers have been published concerning the feasibility of SLN detection in the same kind of patients by injecting 99m-Technetium-labeled colloidal particles [16,18]. Other authors reported on SLN detection with a dual labeling method by injecting both vital dye and 99m-Technetium labeled colloidal particles [15,17,19,20,32,33]. Among the seven papers focusing on the feasibility of intraoperative SLN detection by using vital dye as labeling tracer, only Holub et al [14] investigated SLN detection rate obtainable through laparoscopy and reported a higher detection rate after injecting blue dye both pericervically and into the subserosal myometrium than after injecting blue dye into the subserosal myometrium only.…”

“…As suggested by other authors, 4 ml of Patent Blue Violet (PBV; Bleu Patente' V 2.5% sodique, Guerbet, Roissy, France) were injected directly into the substance of the cervix at 3, 6, 9, and 12 O'clock (depth of injection 0.5-1 cm) by using a 22-gauge spinal needle after the induction of general anesthesia [14,15,17,19].…”

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

“…SLN detection rates in our study were lower than in previous reports: 53.5% by blue dye, 64.3% by radionuclide injection, and 69.0% by both methods combined. In earlier studies, SLN detection rates using combined detection and intracervical injection were 100% [17] and 94.1% [18] (Table IV) [3,[19][20][21][22][23][24][25].…”

“…SLN detection by radionuclide and blue dye injection into the cervix is easy to perform and yields acceptable detection rates in Journal of Surgical Oncology DOI 10.1002/jso [17] 11 Tc 99m þ blue dye (cervix) 100 0% Pelosi et al [21] 16 Tc 99m (cervix) 93.7 0% Barranger et al [18] 17 Tc 99m þ blue dye (cervix) 94.1 0% Lelievre et al [22] 15 Tc 99m þ blue dye (cervix) 93.3 0% Niikura et al [23] 28 Tc 99m (ssm) 82 0% Holub et al [24] 25 Blue dye (ssm þ cervix) 84 0% Frumovitz et al [25] 18 Tc 99m þ blue dye (ssm) 45 0% ssm, subserosal myometrium.…”

Application of Sentinel Lymph Node Dissection in Gynecologic Cancers: Review

“…Pelosi ve ark., 10 olgunun evre IB ve birinin Evre IIA olduğu toplam 11 olguluk bir laparoskopik SLN çalışma-sında, olgulara pre-operatif radioaktif izotop ve intra-operatif mavi boya enjekte etmişler ve altı-sında bilateral ve beşinde unilateral tutulum olduğunu, 17 LN'den üçünde metastaz olduğunu bulmuşlardır. 46 Yine Pelosi ve ark.nın yaptıkları bir çalışmada FIGO IB endometriyal kanser olan 16 hastanın 15'inde kommon iliak lenf nodlarında tutulum bulunmuştur (%93,7). Yirmi dört LN'den üçünde mikrometastaz bulunmuş ve takip edilen 12 hastada rekürrens olmadığı rapor edilmiştir.…”