Utilization and Outcomes of Sentinel Lymph Node Biopsy for Early Endometrial Cancer

Matsuo, Koji; Klar, Maximilian; Nusbaum, David J.; Hasanov, MF; Vallejo, Andrew; Ciesielski, Katharine M.; Muderspach, Laila I.; Roman, Lynda D.; Wright, Jason D.

doi:10.1097/aog.0000000000004733

Cited by 18 publications

(10 citation statements)

References 44 publications

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“…We hypothesize that this trend mainly reflects the concurrent increase in use of sentinel lymph node biopsy with robotic-assisted surgery for patients at potential risk of early endometrial cancer. 4,5 Although this is partly supported by the observation that the strongest association for nodal evaluation was performance of robotic-assisted surgery, the dataset does not provide information on whether sentinel node biopsy was performed. Our finding of increased use of nodal evaluation for patients with endometrial hyperplasia without atypia raises the potential risk of overtreatment in this population at low risk of cancer.…”

Section: Discussionmentioning

confidence: 99%

Increasing Utilization of Surgical Nodal Evaluation at Hysterectomy for Endometrial Hyperplasia

Matsuo

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Tavakoli

et al. 2022

Obstetrics &Amp; Gynecology

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Section: Discussionmentioning

confidence: 99%

Increasing Utilization of Surgical Nodal Evaluation at Hysterectomy for Endometrial Hyperplasia

Matsuo

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Tavakoli

et al. 2022

Obstetrics &Amp; Gynecology

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“…During the study period, the rate of identification of ITCs increased. This finding likely reflects the increased use of SLN biopsy for endometrial cancer in the United States . Specimens from patients who receive SLN biopsy typically undergo ultrastaging, which is more likely to identify ITCs .…”

Section: Discussionmentioning

confidence: 97%

“…Based on these trends, we anticipate that detection of ITCs will be increasingly frequent in the future. Decreased rates of ITCs in Black compared with White individuals may possibly be due to the decreased utilization of SLN biopsy …”

Section: Discussionmentioning

confidence: 99%

Lymph Node Isolated Tumor Cells in Patients With Endometrial Cancer

Matsuo,

Chen,

Neuman

et al. 2024

JAMA Netw Open

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ImportanceIsolated tumor cells (ITCs) are the histopathological finding of small clusters of cancer cells no greater than 0.2 mm in diameter in the regional lymph nodes. For endometrial cancer, the prognostic significance of ITCs is uncertain.ObjectiveTo assess clinico-pathological characteristics and oncologic outcomes associated with ITCs in endometrial cancer.Design, Setting, and ParticipantsThis retrospective cohort study using the National Cancer Database included patients with endometrial cancer who had primary hysterectomy and nodal evaluation from 2018 to 2020. Patients with microscopic and macroscopic nodal metastases and distant metastases were excluded. Data were analyzed from June to September 2023.ExposureRegional nodal status with ITCs (N0[i+] classification) or no nodal metastasis (N0 classification).Main Outcomes and Measures(1) Clinical and tumor characteristics associated with ITCs, assessed with multivariable binary logistic regression model, and (2) overall survival (OS) associated with ITCs, evaluated by nonproportional hazard analysis with restricted mean survival time at 36 months.ResultsA total of 56 527 patients were included, with a median (IQR) age of 64 (57-70) years. The majority had T1a lesion (37 836 [66.9%]) and grade 1 or 2 endometrioid tumors (40 589 [71.8%]). ITCs were seen in 1462 cases (2.6%). In a multivariable analysis, ITCs were associated with higher T classification, larger tumor size, lymphovascular space invasion (LVSI), and malignant peritoneal cytology. Of those tumor factors, LVSI had the largest association with ITCs (7.9% vs 1.4%; adjusted odds ratio [aOR], 4.37; 95% CI, 3.87-4.93), followed by T1b classification (5.3% vs 1.3%; aOR, 2.62; 95% CI, 2.30-2.99). At the cohort level, 24-month OS rates were 94.3% (95% CI, 92.4%-95.7%) for the ITC group and 96.1% (95% CI, 95.9%-96.3%) for the node-negative group, and the between-group difference in expected mean OS time at 36 months was 0.35 (SE, 0.19) months, but it was not statistically significant (P = .06). There was a statistically significant difference in OS when the low-risk group (stage IA, grade 1-2 endometrioid tumors with no LVSI) was assessed per nodal status and adjuvant therapy use (P &lt; .001): (1) among the cases treated with surgical therapy alone, 24-month OS rates were 95.9% (95% CI, 89.5%-98.5%) for the ITC group and 98.8% (95% CI, 98.6%-99.0%) for the node-negative group, and the between-group mean OS time difference at 36 months was 0.61 (SE, 0.43) months (P = .16); and (2) among the cases with ITCs, adjuvant therapy (radiotherapy alone, systemic chemotherapy alone, or both) was associated with improved survival compared with no adjuvant therapy (24-month OS rates, 100% vs 95.9%; between-group mean OS time difference at 36 months, 0.95 [SE, 0.43] months; P = .03).Conclusions and RelevanceIn this cohort study of patients with surgically staged endometrial cancer, the results of exploratory analysis suggested that presence of ITCs in the regional lymph node may be associated with OS in the low-risk group. While adjuvant therapy was associated with improved OS in the low-risk group with ITCs, careful interpretation is necessary given the favorable outcomes regardless of adjuvant therapy use. This hypothesis-generating observation in patients with low-risk endometrial cancer warrants further investigation, especially with prospective setting.

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“…The results of this study should prompt new research. In modern Gynecologic Oncology, sentinel lymph node biopsy (SLNB) in endometrial cancer has become a standard of care in many institutions 9–11 . It would be interesting to assess whether TVS and MRI could be techniques that accurately correlated with SLNB status.…”

mentioning

confidence: 99%

“…In modern Gynecologic Oncology, sentinel lymph node biopsy (SLNB) in endometrial cancer has become a standard of care in many institutions. 9 , 10 , 11 It would be interesting to assess whether TVS and MRI could be techniques that accurately correlated with SLNB status. If so, these imaging techniques would be a good alternative for those institutions where SNB is not available.…”

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confidence: 99%

Transvaginal ultrasound versus magnetic resonance imaging in local staging of endometrial cancer

Alcázar

2022

J of Clinical Ultrasound

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Utilization and Outcomes of Sentinel Lymph Node Biopsy for Early Endometrial Cancer

Abstract: The landscape of surgical nodal evaluation in the United States is shifting from lymphadenectomy to sentinel lymph node biopsy for early endometrial cancer.

Cited by 18 publications

References 44 publications

Increasing Utilization of Surgical Nodal Evaluation at Hysterectomy for Endometrial Hyperplasia

Increasing Utilization of Surgical Nodal Evaluation at Hysterectomy for Endometrial Hyperplasia

Lymph Node Isolated Tumor Cells in Patients With Endometrial Cancer

Transvaginal ultrasound versus magnetic resonance imaging in local staging of endometrial cancer

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