Sentinel lymph node mapping for endometrial cancer improves the detection of metastatic disease to regional lymph nodes

Collado, F. Khoury; Murray, M.; Sonoda, Y.; Levine, D.; Leitao, M.; Chi, D.; Barakat, R.; Abu-Rustum, N.

doi:10.1016/j.ygyno.2010.12.045

Cited by 17 publications

(22 citation statements)

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“…28 With immunohistochemistry ultrastaging, an additional 3% to 4% of micrometastases to SLNs, which may have been otherwise missed by routine H&E staining, can be detected. 3,[29][30][31] Tables 1 and 2 show the results of enhanced pathology and the added value of low-volume metastasis detection.…”

Section: Pathologymentioning

confidence: 99%

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Sentinel Lymph Node Mapping for Endometrial Cancer: A Modern Approach to Surgical Staging

Abu‐Rustum¹

2014

J Natl Compr Canc Netw

182

145

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Most patients with endometrial cancer will present with early-stage disease. Although the rate of metastasis in these patients is low, proffering excellent prognoses, the standard of treatment in many practices still includes a complete or selective pelvic and para-aortic lymphadenectomy for staging; and accurate surgical staging is the most important prognostic factor. Many patients will undergo a comprehensive lymphadenectomy despite having disease confined to the uterus, resulting in prolonged operating time, additional cost, and potential side effects, such as lower extremity lymphedema. However, recent studies show that a complete lymphadenectomy may have no therapeutic benefit in patients with early-stage endometrial cancer. Sentinel lymph node (SLN) mapping, which has been used in other cancer types, may be an acceptable surgical strategy between a complete lymphadenectomy and no nodal evaluation in patients with endometrial cancer. SLN mapping is based on the concept that lymph node metastasis is the result of an orderly process; that is, lymph drains in a specific pattern away from the tumor, and therefore, if the SLN, or first node, is negative for metastasis, then the nodes after the SLN should also be negative. This approach can help patients avoid the side effects associated with a complete lymphadenectomy, although disease must be thoroughly staged for accurate prognosis and determination of appropriate treatment approach. Surgeon experience, adherence to an SLN algorithm, and the use of pathologic "ultrastaging" are key factors for successful SLN mapping.

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Section: Pathologymentioning

confidence: 99%

“…A recent study showed that SLNs are 3 times more likely than non-SLNs to harbor metastatic disease. 3 Gould et al 4 coined the term sentinel node in 1960 with his observations of carcinoma of the parotid gland. He suggested that examining the SLN for metastatic disease could help determine whether a patient needed a radical neck dissection.…”

mentioning

confidence: 99%

Sentinel Lymph Node Mapping for Endometrial Cancer: A Modern Approach to Surgical Staging

Abu‐Rustum¹

2014

J Natl Compr Canc Netw

182

145

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“…Occasionally, the only evidence of extrauterine disease is the presence of metastases in the SLN. Considering the poorer prognosis associated with the detection of lymphatic metastases, a much more exhaustive analysis is justified [74,79]. Therefore, pathological assessment by the ultrastaging of the SLN is the most important advance in the SLNB technique [80].…”

Section: Ultrastagingmentioning

confidence: 99%

Role of Sentinel Node Biopsy in Endometrial Cancer

Noval¹

2020

Current Cancer Treatment

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Lymphadenectomy, for early stages of endometrial cancer (EC), provides a low detection rate of lymphatic metastasis, without having demonstrated a therapeutic effect; so that the collection and histological analysis of the sentinel lymph node (SLN) might be an alternative to lymphadenectomy. The contribution of SLN to surgical staging represents a change in the paradigm of lymphadenectomy in EC, being an intermediate approach between not assessing the condition of the lymph nodes and complete pelvic and paraaortic dissection. Accurate identification of the main uterine drainage pathway increases the likelihood of detecting metastases during lymphatic mapping. In addition, pathological assessment by the ultrastaging of the SLN is the most important advance in the SLN biopsy (SLNB) technique. The application of the SLNB presumes a decrease in surgical and long-term morbidity, with an increase in the detection of lymphatic metastasis, mainly at the expense of detecting low tumour volume, selecting the group of patients that would benefit from a modification in adjuvant therapy. The SLNB can be established as an oncologically safe and effective method in the surgical staging of early-stage EC. Prospective studies are required to determine optimal behaviour and prognosis in the detection of low-volume metastases.Keywords: endometrial cancer, lymphatic mapping, predictive value of tests, sentinel lymph node biopsy, ultrastaging This information, provided by SLN, will change the therapeutic approach, with a potential benefit in the prognosis, both in survival and quality of life [6]. Detection methodTheoretically, the ideal method for studying SLN in EC should meet the following requirements:1. Cause the least amount of patient discomfort possible, be easy to perform and be reproducible.2. Be a preoperative procedure that enables planning of the surgical approach according to the anatomical location of the SLN.3. Enable a laparoscopic approach according to the concept of minimally invasive surgery.4. Enable the detection of SLN without complete dissection of the retroperitoneal space.5. Obtain a lymphatic map representative of the tumour drainage or, at least, of the uterine body drainage [7]. Lymphatic drainage of the uterusUnlike superficial tumours, such as melanoma, the physiology of lymphatic drainage in deeper/visceral tumours is not well established [8]. Uterine drainage, as well as being bilateral, is therefore complex [9]. Anatomically, three segments of uterine lymphatic drainage have been established:1. The lower uterine segment drains from the paracervix to the parametrium and to the broad ligament, passing by the obturator, internal iliac and interiliac lymph node chains.2. The middle third of the uterus drains the round ligament and the external iliac lymph node chain.3. The upper uterine segment drains through the infundibular pelvic ligament, uterine-ovarian plexus and gonadal vessels towards the common iliac lymph node chain, presacral lymph nodes and paraaortic lymph nodes [10].Physiologically, there a...

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“…At each level, one side is stained with HE and the other with immunohistochemistry (IHC) using the anti‐cytokeratin AE1:AE3 (Ventana Medical Systems) for a total of four slides per block . With this IHC ‘ultrastaging’, we are able to detect an additional 3–4% of micrometastases to SLN, which may have been otherwise missed by routine HE staining (Tables , ) …”

Section: Sln Mapping Techniquesmentioning

confidence: 99%

“…in 1996, but has only gained in popularity over the last 5 years. At Memorial Sloan–Kettering Cancer Center (MSKCC), we began using SLN mapping for uterine cervical cancer in 2003, and have found that when using a cervical injection in apparent early stage endometrial cancer cases, SLN are three times more likely to harbor disease than non‐SLN …”

Section: Introductionmentioning

confidence: 99%

Update on sentinel node mapping in uterine cancer: 10‐year experience at Memorial Sloan–Kettering Cancer Center

Abu‐Rustum

2013

J of Obstet and Gynaecol

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Endometrial cancer is the most common gynecologic malignancy. In the majority of patients, the disease will present at an early stage, without metastasis, and with an excellent prognosis. Although the rate of metastasis in patients with early stage endometrial cancer is low, the standard of treatment still includes a complete or selective pelvic and para-aortic lymphadenectomy for staging. Many patients will undergo a comprehensive lymphadenectomy despite having disease confined to the uterus, resulting in detrimental side-effects, including lower extremity lymphedema. Recent studies, such as 'A Study in the Treatment of Endometrial Cancer', have shown that there is no therapeutic benefit to a complete lymphadenectomy in early stage endometrial cancer, although further study is needed to confirm these findings. The use of sentinel lymph node (SLN) mapping in endometrial cancer may provide an appropriate middle ground between the two schools of thought of complete lymphadenectomy versus no nodal evaluation. SLN mapping, which is gaining everincreasing acceptance in many cancer types, is based on the concept that lymph node metastasis is the result of an orderly process, that is, the lymph drains in a specific pattern away from the tumor, and therefore if the SLN, or first node, is negative for metastasis, then the nodes after the SLN should also be negative. We present here the Memorial Sloan-Kettering Cancer Center experience with SLN mapping in uterine cancer, a technique we first began using in 2003 and have improved over the years.

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Sentinel lymph node mapping for endometrial cancer improves the detection of metastatic disease to regional lymph nodes

Cited by 17 publications

References 0 publications

Sentinel Lymph Node Mapping for Endometrial Cancer: A Modern Approach to Surgical Staging

Sentinel Lymph Node Mapping for Endometrial Cancer: A Modern Approach to Surgical Staging

Role of Sentinel Node Biopsy in Endometrial Cancer

Update on sentinel node mapping in uterine cancer: 10‐year experience at Memorial Sloan–Kettering Cancer Center

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