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

Abstract

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.

Robotic blue-dye sentinel lymph node detection for endometrial cancer – Factors predicting successful mapping

“…14 We identified clinical factors, specifically lower BMI and the absence of LVSI; and surgical factors, specifically, surgeon experience in performing lymph node mapping and the use of patent blue dye, to be associated with successful mapping. Factors related to uterine pathology itself, including tumor histology, grade, method of diagnosis, the presence of an endometrial polyp, and LUSI were not found to be associated with successful mapping.…”

Metabolic Tumor Volume on 18F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

“…Our ability to compare staging using 18 F-FDG PET/CT with that using sentinel lymph node procedures is currently limited, as the true performance in endometrial carcinomas is not well established because the studies have been small and the techniques applied have often varied (26). A recent update from the Memorial Sloan Kettering Cancer Center after 10 y of experience with sentinel lymph node mapping in uterine cancer concluded that prospective studies are needed to validate the use of sentinel lymph node mapping in early-stage endometrial cancer (27). Interestingly, the negative predictive value in the present study was very high (97%-98%), confirming the 95% reported by Criverallo et al (13) and the 96% reported by Antonsen et al (22).…”

Lower Limb Lymphedema and Neurological Complications After Lymphadenectomy for Gynecological Cancer

“…23 The analysis of histotype, miometrial invasion, and grading remains the only way to predict the risk of lymph nodal metastasis.…”