Sentinel lymph node biopsy in early stage endometrial cancer: a Turkish gynecologic oncology group study (TRSGO-SLN-001)

Abstract

ObjectiveThe aim of this multicenter study was to evaluate the feasibility of sentinel lymph node (SLN) mapping in clinically uterine confined endometrial cancer.MethodsPatients who underwent primary surgery for endometrial cancer with an SLN algorithm were reviewed. Indocyanine green or blue dye was used as a tracer. SLNs and/or suspicious lymph nodes were resected. Side specific lymphadenectomy was performed when mapping was unsuccessful. SLNs were ultrastaged on final pathology.Results357 eligible patients were analyzed. Median age was 59 years. Median number of resected SLNs was 2 (range 1–12) per patient. Minimal invasive and open surgeries were performed in 264 (73.9%) and 93 (26.1%) patients, respectively. Indocyanine green was used in 231 (64.7%) and blue dye in 126 (35.3%) patients. The dyes were injected into the cervix in 355 (99.4%) patients. The overall and bilateral SLN detection rates were 91.9% and 71.4%, respectively. The mapping rates using indocyanine green or blue dye were comparable (P=0.526). There were 43 (12%) patients with lymphatic metastasis. The SLN algorithm was not able to detect 3 of 43 patients who had isolated paraaortic metastasis. After SLN biopsy, complete pelvic lymphadenectomy was performed in 286 (80.1%) patients. Sensitivity and negative predictive value were both 100% for the detection of pelvic lymph node metastases. In addition, 117 (32.8%) patients underwent completion paraaortic lymphadenectomy after SLN biopsy. In these patients, sensitivity for detecting metastases to pelvic and/or paraaortic lymph nodes was 90.3% with a negative predictive value of 96.6%. The risk of non-SLN involvement in patients with macrometastatic SLNs, micrometastatic SLNs, and isolated tumor cells in SLNs were 61.2%, 14.3% and 0%, respectively.ConclusionsSLN biopsy had good accuracy in detecting lymphatic metastasis. However, one-third of cases with metastatic SLNs also had non-SLN involvement and this risk increased to two-thirds of cases with macrometastatic SLNs. The effect of leaving these nodes in situ on survival should be evaluated in further studies.

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

“…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.…”

“…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 ].…”

Avoiding Full Lymphadenectomies in Intermediate- and High-Risk Endometrial Cancer by Sentinel Lymph Node Biopsy Implementation

“…The recent study of Taskin et al ( 23) evaluated the feasibility of SLN mapping in uterine confined endometrial cancer, it reported 60% of patients with macrometastatic SLN who also presented non-SLN involvement. All of these patients received chemotherapy but there is not consistent evidence suggesting that leaving these nodes in situ has a detrimental effect on survival (23). Retrospective studies of Buda et al ( 24) evaluated the impact of SLN mapping compared to SLN plus complete lymphadenectomy on the prognosis in patients with intermediate and high-risk EC and concluded that the 5-year recurrence free survival was similar in both groups (79.2 vs 81.6 respectively, p = 0.831) (24,25).…”

Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review

“…Similar results were reached by Biocchi, 54.5% macrometastasis and 15.4% micrometastasis were found non-SLN involvement, whereas in patients with ITCs in SLN, no metastasis was found in non-SLN ( 161 ). Turkish Gynecologic Oncology Group showed that one third SLN positive had non-SLN metastases, and the ratio increases to two thirds when SLN involvement was macrometastasis ( 162 ). Although non-SLN metastases could be controlled by adjuvant therapy and the promising results of high-risk EC patients support the hypothesis, the appropriate management of non-SLN is still worthy of further studies.…”