Uptake and Outcomes of Sentinel Lymph Node Mapping in Women With Atypical Endometrial Hyperplasia

Abstract

OBJECTIVE: To examine the utilization, morbidity, and cost of sentinel lymph node mapping in women undergoing hysterectomy for complex atypical endometrial hyperplasia. METHODS: Women with complex atypical endometrial hyperplasia who underwent hysterectomy from 2012 to 2018 in the Perspective database were examined. Perioperative morbidity, mortality, and cost were examined based on performance of sentinel lymph node mapping, lymph node dissection or no nodal evaluation. RESULTS: Among 10,266 women, sentinel lymph node mapping was performed in 620 (6.0%), lymph node dissection in 538 (5.2%), and no lymphatic evaluation in 9,108 (88.7%). Use of sentinel lymph node mapping increased from 0.8% in 2012 to 14.0% in 2018, and the rate of lymph node dissection rose from 5.7% to 6.4% (P<.001). In an adjusted model, residence in the western United States, treatment by high-volume hospitals and use of robotic-assisted hysterectomy were associated with sentinel lymph node mapping (P<.05 for all). The complication rates were similar between the three groups. The median cost for sentinel lymph node mapping ($9,673) and lymph node dissection ($9,754) were higher than in those who did not undergo nodal assessment ($8,435) (P<.001). CONCLUSION: Performance of sentinel lymph node mapping is increasing rapidly for women with complex atypical endometrial hyperplasia but is not associated with increased perioperative morbidity or mortality.

Uptake and outcomes of sentinel lymph node mapping in women undergoing minimally invasive surgery for endometrial cancer

“…13 Using a previously defined methodology, perioperative complications were classified as intraoperative (ureteral, bladder, intestinal, vascular or other injuries), surgical site (abscess, gastrointestinal complications, haemorrhage or other wound complications) and medical (urinary complications, deep vein thrombosis, pulmonary embolism, pulmonary complications, cardiovascular complications, neurological complications, shock and infection). 13,15 A merged measure of any complication (intraoperative, surgical site or medical complication) was also analysed. Blood transfusions were defined as the receipt of red blood cells during the index hospitalisation.…”

Increasing Utilization of Surgical Nodal Evaluation at Hysterectomy for Endometrial Hyperplasia

“…A 2021 retrospective study found that performance of lymph node evaluation in patients who underwent hysterectomy for complex endometrial hyperplasia with atypia increased from 0.8% to 14.0% between 2012 and 2018 in the United States (a 17.5-fold increase). 2 The objective of the study was to examine the national-level trends and characteristics of surgical nodal evaluation at hysterectomy for endometrial hyperplasia with or without atypia.…”

Utilization of lymph node evaluation at hysterectomy for cervical carcinoma in situ

“…For some preinvasive gynecological conditions, such as atypical endometrial hyperplasia, there has been a trend towards increasing utilization of surgical nodal evaluation with sentinel lymph node biopsy at the time of hysterectomy. 24 Collectively, these recent trends are likely driven by the increased availability of sentinel lymph node mapping which decreases the morbidity of nodal evaluation.…”