Sentinel Lymph Node Biopsy in the Treatment of Endometrial Cancer: Why We Fail? Results of a Prospective Multicenter Study on the Factors Associated with Failure of Node Mapping with Indocyanine Green

Abstract

Background: The sentinel lymph node (SLN) mapping for endometrial cancer staging is gaining wide diffusion, but there is no definitive evidence on the factors associated with the failure of mapping. Objectives: To analyze the factors associated with the possible failure of bilateral SLN mapping with indocyanine green (ICG). Methods: A prospective observational study without control on 110 patients with endometrial cancer apparently confined to the uterus, underwent laparoscopic surgical staging with SLN mapping with ICG. Results: Possible risk factors associated with bilateral mapping failure were analyzed, and a multivariate analysis was performed. The bilateral detection rate for SLNs mapping was 72.7%, whereas at least one SLN was detected in 79.1% of patients. No SLNs were identified in 6.3%. None of the patients or features related to tumor were associated with a risk of failure of the method. The only factor analyzed that was significantly associated with the success of bilateral mapping was the surgeon (p = 0.003). Conclusions: Neither obesity nor the presence of lymph node metastases was associated with mapping failure. However, there remains a need for further studies to understand all the mechanisms linked to the unsuccessful method results and to reduce the use of systematic lymphadenectomy in the case of mapping failure.

The Feasibility of Sentinel Lymph-Node, Mapped with Indocyanine Green, Biopsy in Endometrial Cancer Patients: A Prospective Study

“…The latter factor has been associated with successful bilateral mapping by some authors. The results of the study performed by Ianieri M. et al, showed that the surgeon was the only independent factor associated with the success of SLB [20]. As mentioned previously, the overall and bilateral detection rate in our study tended to increase with the experience as well and could be considered in agreement with this statement.…”

Failure of sentinel lymph node mapping in a patient with endometrial cancer with chronic lymphocytic leukemia: A case report

“…Ianieri et al . demonstrated that the only risk factor associated with the failure of SLN mapping was the human factor, that is, the surgeon . In the current case report, failure of SLN mapping in a patient with endometrial cancer with a 12‐year history of CLL may be related with obstruction of lymphatic flow.…”

Sentinel lymph node mapping in endometrial cancer after 2020 ESGO-ESTRO-ESP consensus update: what will happen in the next few years?

“…Much effort still must be made to minimize the false negative detection rate. The objective of the study of Ianieri et al, was to analyse factors associated with possible failure of bilateral SLN mapping with the use of ICG [24]. The authors evaluated different clinical (age, body mass index, menopausal status, previous history of pelvic surgery), pathological (tumor histology, diameter, clinical stage, lymphovascular space invasion status), and institutional (surgeon's experience and technical ability) factors that could be associated with unsuccessful SLN mapping procedure.…”

“…The authors evaluated different clinical (age, body mass index, menopausal status, previous history of pelvic surgery), pathological (tumor histology, diameter, clinical stage, lymphovascular space invasion status), and institutional (surgeon's experience and technical ability) factors that could be associated with unsuccessful SLN mapping procedure. Based on the multivariate analysis, the only significant factor associated with the success of bilateral SLN mapping was the surgeon's technical ability and experience [24]. SLN detection rates increase with number of procedures performed.…”