Feasibility of Sentinel Lymph Node Sampling in Early-Stage Carcinoma Endometrium: Single-Institution Experience

Overview

Journal J Obstet Gynaecol India

Specialty Gynecology & Obstetrics

Date 2022 Aug 4

PMID 35923512

Authors

Aswathy G Nath

S Suchetha

V M Pradeep

P Rema

J Sivaranjith

Jagathnath Krishna

Rari P Mony

Affiliations

Soon will be listed here.

Abstract

Introduction: Accurate surgical staging is an essential component in the management of carcinoma endometrium to assess the stage of disease and to tailor adjuvant treatment. Sentinel node technique was introduced as an alternative for extensive lymphadenectomy in early stages to avoid complications associated with lymphadenectomy.

Aims And Objectives: To assess the detection rate and diagnostic accuracy of SLN mapping in patients with early-stage carcinoma endometrium.

Materials And Methods: Prospective validation study involving 30 patients diagnosed to have early-stage carcinoma endometrium. Sentinel nodes were detected by combined methods of radio colloid dye and isosulphan blue dye injection.

Results: Sentinel lymph node was detected in 19 patients (63.4%). 11 patients had no sentinel nodes. Total number of sentinel nodes isolated was 68 with a mean of 2.26 per patient (range 0-4). Ten (33.33%) patients had single sentinel node location, while 9 (30%) had more than 1 sentinel lymph nodes. Twelve patients had bilateral sentinel nodes, and the most frequent location of sentinel node was obturator, 19 (63.3%) especially on right hemi-pelvis. One patient had a hot para-aortic node, while none had blue para-aortic sentinel node. Average number of lymph nodes obtained by lymphadenectomy was 13 per patient (range 7-22). All patients with sentinel node had negative frozen report as well as in histopathology. Two patients in whom no sentinel nodes were detected by either techniques had metastatic nodes in histopathology report.

Conclusion: Detection rate was maximum with radiocolloid dye, and it is better to utilize the technique for less graded tumours and endometrioid variants.

References

Gien L, Kwon J, Carey M . Sentinel node mapping with isosulfan blue dye in endometrial cancer. J Obstet Gynaecol Can. 2006; 27(12):1107-12. DOI: 10.1016/s1701-2163(16)30393-0. View

Crosbie E, Roberts C, Qian W, Swart A, Kitchener H, Renehan A . Body mass index does not influence post-treatment survival in early stage endometrial cancer: results from the MRC ASTEC trial. Eur J Cancer. 2011; 48(6):853-64. DOI: 10.1016/j.ejca.2011.10.003. View

Hoogendam J, Veldhuis W, Hobbelink M, Verheijen R, van den Bosch M, Zweemer R . 99mTc SPECT/CT Versus Planar Lymphoscintigraphy for Preoperative Sentinel Lymph Node Detection in Cervical Cancer: A Systematic Review and Metaanalysis. J Nucl Med. 2015; 56(5):675-80. DOI: 10.2967/jnumed.114.152439. View

Maccauro M, Lucignani G, Aliberti G, Villano C, Castellani M, Solima E . Sentinel lymph node detection following the hysteroscopic peritumoural injection of 99mTc-labelled albumin nanocolloid in endometrial cancer. Eur J Nucl Med Mol Imaging. 2004; 32(5):569-74. DOI: 10.1007/s00259-004-1709-4. View

Chan J, Wu H, Cheung M, Shin J, Osann K, Kapp D . The outcomes of 27,063 women with unstaged endometrioid uterine cancer. Gynecol Oncol. 2007; 106(2):282-8. DOI: 10.1016/j.ygyno.2007.05.033. View

Rossi E, Kowalski L, Scalici J, Cantrell L, Schuler K, Hanna R . A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol. 2017; 18(3):384-392. DOI: 10.1016/S1470-2045(17)30068-2. View

Cody 3rd H, Hill A, Tran K, Brennan M, Borgen P . Credentialing for breast lymphatic mapping: how many cases are enough?. Ann Surg. 1999; 229(5):723-6; discussion 726-8. PMC: 1420817. DOI: 10.1097/00000658-199905000-00015. View

Khoury-Collado F, Glaser G, Zivanovic O, Sonoda Y, Levine D, Chi D . Improving sentinel lymph node detection rates in endometrial cancer: how many cases are needed?. Gynecol Oncol. 2009; 115(3):453-5. DOI: 10.1016/j.ygyno.2009.08.026. View

Abu-Rustum N, Khoury-Collado F, Pandit-Taskar N, Soslow R, Dao F, Sonoda Y . Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma?. Gynecol Oncol. 2009; 113(2):163-9. PMC: 3959736. DOI: 10.1016/j.ygyno.2009.01.003. View

10.

Creasman W, Mutch D, Herzog T . ASTEC lymphadenectomy and radiation therapy studies: are conclusions valid?. Gynecol Oncol. 2009; 116(3):293-4. DOI: 10.1016/j.ygyno.2009.10.065. View

11.

Raspagliesi F, Ditto A, Kusamura S, Fontanelli R, Vecchione F, Maccauro M . Hysteroscopic injection of tracers in sentinel node detection of endometrial cancer: a feasibility study. Am J Obstet Gynecol. 2004; 191(2):435-9. DOI: 10.1016/j.ajog.2004.03.008. View

12.

Morton D, Wen D, Wong J, Economou J, Cagle L, Storm F . Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992; 127(4):392-9. DOI: 10.1001/archsurg.1992.01420040034005. View

13.

Benedetti Panici P, Basile S, Maneschi F, Lissoni A, Signorelli M, Scambia G . Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008; 100(23):1707-16. DOI: 10.1093/jnci/djn397. View

14.

Echt M, Finan M, Hoffman M, Kline R, ROBERTS W, Fiorica J . Detection of sentinel lymph nodes with lymphazurin in cervical, uterine, and vulvar malignancies. South Med J. 1999; 92(2):204-8. DOI: 10.1097/00007611-199902000-00008. View

15.

Altgassen C, Pagenstecher J, Hornung D, Diedrich K, Hornemann A . A new approach to label sentinel nodes in endometrial cancer. Gynecol Oncol. 2007; 105(2):457-61. DOI: 10.1016/j.ygyno.2007.01.021. View