Sentinel node biopsy for diagnosis of lymph node involvement in endometrial cancer

Nagar, Hans; Goodall, Richard; Lyons, Thomas J; Schmidt‐Hansen, Mia; Morrison, Jo

doi:10.1002/14651858.cd013021

Cited by 22 publications

(21 citation statements)

References 28 publications

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“…These and other studies demonstrated that SLN injection and biopsy improved the detection rates of positive lymph nodes principally through the detection of low-volume metastatic disease with ultrastaging [12]. It appears that SLN detection rates do not differ significantly between the different tracers and sites of injection with most authors favoring ICG and cervical injections [13]. However, the prognostic significance and therapeutic implications of micrometastases, and more importantly ITC, remains unclear [14].…”

Section: Endometrial Cancermentioning

confidence: 87%

Role of sentinel lymph node biopsy for gynecologic cancers

Chow

Karam

2021

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewTo provide an overview of the current knowledge and recent advances of sentinel lymph node (SLN) assessment in uterine, cervical, vulvar, and ovarian cancers. Recent findingsIn endometrial cancer, SLN evaluation has become increasingly utilized as part of the treatment of earlystage disease, with data showing improved detection of pelvic lymph node metastasis. In cervical cancer, SLN biopsy has also gained increasing traction with studies demonstrating the feasibility and accuracy of SLN detection. Evaluation with frozen section, however, remains limited in the detection of metastases. The prognostic significance of positive SLN in vulvar cancer is currently being investigated, with preliminary data showing lower recurrence rates in patients receiving adjuvant radiation. SummarySLN evaluation remains standard of care to detect lymph node metastasis in early-staged endometrial cancer. In cervical cancer, SLN biopsy has been shown to be reliable, while decreasing morbidity without impacting disease-free survival in select patients. The technique and high sensitivity of SLN biopsy in vulvar cancer has been demonstrated in large prospective trials. There are no randomized controlled trials in ovarian cancer that evaluate the role of SLN biopsy on treatment and outcome; current SLN evaluation remains investigational.

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Section: Endometrial Cancermentioning

confidence: 87%

Role of sentinel lymph node biopsy for gynecologic cancers

Chow

Karam

2021

Current Opinion in Obstetrics &Amp; Gynecology

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“…Even though ICG SLN mapping showed no false negative, full lymphadenectomy should be performed to assess the diagnostic accuracy of the sentinel lymph node biopsy. The risk of recurrence or residual disease following surgery would be increased if full lymphadenectomy was not performed after the sentinel lymph node biopsy (10). Because ultrastaging of the sentinel lymph node is a limitation of micrometastasis in the pathological report, diagnostic accuracy remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Sentinel Node Mapping with Surgical Staging following Hysteroscopic Endometrial Resection in Endometrial Stromal Sarcoma

Wasinghon

Lee

2020

Gynecol Obstet Reprod Med

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A 50-year-old woman presented with symptoms of abnormal uterine bleeding. Ultrasonography showed an intrauterine cavity nodule sized approximately 2 cm. A hysteroscopic resection was diagnosed. The histopathology revealed high-grade endometrial stromal sarcoma. The surgery was laparoscopic surgical staging with indocyanine green sentinel lymph node mapping. Two positive indocyanine green sentinel lymph node of the right and left pelvic nodes showed no nodal metastasis. Also, the five positive indocyanine green sentinel lymph node showed no nodal metastasis. The occult lymph nodes were dissected at the right and left pelvic nodes for nodes 4 and 9, respectively. Conclusively, hysteroscopic resection is beneficial for the diagnosis of uterine sarcoma. Notwithstanding, laparoscopy can be used for uterine cancer and the indocyanine green sentinel lymph node showed no false negative. The patient was stage IA.

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“…Multiple tracers have been used for SLN mapping in EC, including blue dye, technetium-99 (Tc-99), and indocyanine green (ICG). The combination of Tc-99 and blue dye has an average detection rate of 86.3% (80.7–91.9%) [ 41 ]. However, this tracer requires collaboration with a nuclear medicine unit and preoperative imaging, which increases the cost and requires a painful preoperative injection for patients [ 42 ].…”

Section: Sentinel Lymph Node Mapping In Endometrial Cancermentioning

confidence: 99%

Sentinel Lymph Node Mapping in High-Grade Endometrial Cancer

et al. 2022

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Sentinel lymph node (SLN) mapping is becoming an acceptable alternative to full lymphadenectomy for evaluating lymphatic spread in clinical stage I endometrial cancer (EC). While the assessment of pelvic and para-aortic lymph nodes is part of the surgical staging of EC, there is a long-standing debate over the therapeutic value of full lymphadenectomy in this setting. Although lymphadenectomy offers critical information on lymphatic spread and prognosis, most patients will not derive oncologic benefit from this procedure as the majority of patients do not have lymph node involvement. SLN mapping offers prognostic information while simultaneously avoiding the morbidity associated with an extensive and often unnecessary lymphadenectomy. A key factor in the decision making when planning for EC surgery is the histologic subtype. Since the risk of lymphatic spread is less than 5% in low-grade EC, these patients might not benefit from lymph node assessment. Nonetheless, in high-grade EC, the risk for lymph node metastases is much higher (20–30%); therefore, it is crucial to determine the spread of disease both for determining prognosis and for tailoring the appropriate adjuvant treatment. Studies on the accuracy of SLN mapping in high-grade EC have shown a detection rate of over 90%. The available evidence supports adopting the SLN approach as an accurate method for surgical staging. However, there is a paucity of prospective data on the long-term oncologic outcome for patients undergoing SLN mapping in high-grade EC, and more trials are warranted to answer this question.

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Sentinel node biopsy for diagnosis of lymph node involvement in endometrial cancer

Cited by 22 publications

References 28 publications

Role of sentinel lymph node biopsy for gynecologic cancers

Role of sentinel lymph node biopsy for gynecologic cancers

Laparoscopic Sentinel Node Mapping with Surgical Staging following Hysteroscopic Endometrial Resection in Endometrial Stromal Sarcoma

Sentinel Lymph Node Mapping in High-Grade Endometrial Cancer

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