Role of lymphadenectomy in endometrial cancer with nonbulky lymph node metastasis: Comparison of comprehensive surgical staging and sentinel lymph node algorithm

Abstract Objective The present study aimed to clarify the occurrence rate of lymphedema and prognosis in patients with endometrial cancer according to sentinel lymph node biopsy alone with intraoperative histopathological examination. Methods The study included 45 consecutive patients with endometrial cancer treated at Tohoku University Hospital between October 2014 and August 2017. All patients had endometrial carcinoma with endometrioid histology Grade 1 or Grade 2 confirmed by biopsy and stage I on magnetic resonance imaging and/or computed tomography at their preoperative evaluation. Sentinel lymph node detection was performed by radioisotope and dye. Patients who were diagnosed intraoperatively as negative for sentinel lymph node metastasis did not undergo further systematic pelvic lymphadenectomy. The occurrence rate of lymphedema and prognosis was evaluated. Results Bilateral sentinel lymph nodes were detected in 44 of 45 patients (97%). Forty-three patients underwent sentinel lymph node biopsy alone, and only two patients underwent systematic lymphadenectomy. Sentinel lymph node metastases were detected in one patient intraoperatively and two patients postoperatively as ITCs. No patients experienced recurrence. New symptomatic lower-extremity lymphedema was identified in one of 43 patients (2.3%) who underwent sentinel lymph node biopsy alone. Conclusion Sentinel lymph node biopsy alone with intraoperative histopathological diagnosis appears to be a safe and effective strategy to detect lymph node metastasis and to reduce the number of patients with lower-extremity lymphedema among patients with endometrial cancer.

Download Full-text

One-step nucleic acid amplification vs ultrastaging in the detection of sentinel lymph node metastasis in endometrial cancer patients

Journal of Surgical Oncology ◽

10.1002/jso.25322 ◽

2018 ◽

Vol 119 (3) ◽

pp. 361-369 ◽

Cited By ~ 10

Author(s):

Jan Kosťun ◽

Martin Pešta ◽

Jiří Sláma ◽

Robert Slunéčko ◽

Pavel Vlasák ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Nucleic Acid ◽

Sentinel Lymph Node ◽

Lymph Node Metastasis ◽

Cancer Patients ◽

Nucleic Acid Amplification ◽

Sentinel Lymph Node Metastasis ◽

Node Metastasis ◽

One Step

Download Full-text

ASO Author Reflections: Minimally Invasive Surgical Staging in Endometrial Cancer Diagnosed After Supracervical Hysterectomy - The Role of Cervical Injection to Detect Sentinel Lymph Node with Indocyanine Green

Annals of Surgical Oncology ◽

10.1245/s10434-021-10694-8 ◽

2021 ◽

Author(s):

Nicolò Bizzarri ◽

Andrea Rosati ◽

Giovanni Scambia ◽

Francesco Fanfani

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Minimally Invasive ◽

Indocyanine Green ◽

Surgical Staging ◽

Supracervical Hysterectomy ◽

Minimally Invasive Surgical

Download Full-text

Comparison of lymphoscintigraphy and single photon emission computed tomography with computed tomography (SPECT/CT) for sentinel lymph node detection in endometrial cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-001154 ◽

2020 ◽

Vol 30 (5) ◽

pp. 626-630

Author(s):

Shinichi Togami ◽

Toshihiko Kawamura ◽

Shintaro Yanazume ◽

Masaki Kamio ◽

Hiroaki Kobayashi

Keyword(s):

Computed Tomography ◽

Endometrial Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Node Metastasis ◽

Detection Rate ◽

Single Photon ◽

Photon Emission ◽

Single Photon Emission ◽

Node Metastasis

BackgroundEndometrial cancer is the most common gynecologic cancer, and lymph node metastasis is one of the most important prognostic factors. Increasing evidence shows that sentinel lymph node (SLN) mapping is an effective alternative to comprehensive lymphadenectomy. Single photon emission CT with computed tomography (SPECT/CT) is associated with a high SLN detection rate.ObjectiveTo compare the clinical efficacy of SPECT/CT with that of lymphoscintigraphy in detecting SLNs in patients with endometrial cancer.MethodsBetween May 2014 and October 2018, 151 patients with endometrial cancer were enrolled in this study at the Department of Obstetrics and Gynecology of the Kagoshima University Hospital. Inclusion criteria were patients with endometrial cancer, older than 18 years, and with pre-operative International Federation of Gynecology and Obstetrics (FIGO) staging of I and II. All patients underwent pre-operative CT, and patients with suspected peritoneal dissemination and lymph node metastasis were excluded from this study. Pelvic SLNs were detected by injection of tecnetium-99m-labeled phytate into the uterine cervix. The number and locations of SLNs detected using lymphoscintigraphy and SPECT/CT were evaluated. JMP software (version 14, SAS Institute Inc., Cary, North Carolina, USA) was used for statistical analysis.ResultsA total of 151 patients who underwent pre-operative lymphoscintigraphy and SPECT/CT were included in the study. The median age was 57 years (range 24–79), and the median body mass index was 24.3 kg/m2 (range 16–40). The final pathology was as follows: 135 (89%) endometrioid carcinoma, 11 (7%) serous carcinoma, one (1%) clear cell carcinoma, and four (3%) other histotypes. Based on SPECT/CT, 204 pelvic SLNs were detected. The bilateral pelvic SLN detection rate was better for SPECT/CT (43% (65/151)) than for lymphoscintigraphy (32% (48/151)) (p<0.0001). The overall pelvic SLN detection rate (at least one pelvic SLN detected) was also better with SPECT/CT (77% (16/151)) vs lymphoscintigraphy (68% (102/151)) (p<0.0001). The distribution of SLN locations detected using SPECT/CT was as follows: external iliac, 91 (45%); obturator, 61 (30%); common iliac, 28 (14%); internal iliac, 19 (9%); para-aortic, 2 (1%); parametrium, 2 (1%), and presacral, 1 (1%). The SLN detection rate using SPECT/CT was significantly worse in patients of advanced age (p<0.0001).DiscussionOverall and bilateral SLN detection rate was better with SPECT/CT than with lymphoscintigraphy in patients with stage I/II endometrial cancer.

Download Full-text

Implications of Isolated Para-Aortic Lymph Node Metastasis in Endometrial Cancer: A Large-Scale, Multicenter, and Retrospective Study

Frontiers in Medicine ◽

10.3389/fmed.2021.754890 ◽

2021 ◽

Vol 8 ◽

Author(s):

Wenting Li ◽

Jie Jiang ◽

Yu Fu ◽

Yuanming Shen ◽

Chuyao Zhang ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Large Scale ◽

Low Risk ◽

Surgical Staging ◽

Node Metastasis ◽

Aortic Lymph Node ◽

Risk Patients ◽

Metastatic Sites

Objective: To systematically evaluate lymph node metastasis (LNM) patterns in patients with endometrial cancer (EC) who underwent complete surgical staging, which included systematic pelvic and para-aortic lymphadenectomy.Methods: Four thousand and one patients who underwent complete surgical staging including systematic pelvic and para-aortic lymphadenectomy for EC were enrolled from 30 centers in China from 2001 to 2019. We systematically displayed the clinical and prognostic characteristics of patients with various LNM patterns, especially the PLN-PAN+ [para-aortic lymph node (PAN) metastasis without pelvic lymph node (PLN) metastasis]. The efficacy of PAN+ (para-aortic lymph node metastasis) prediction with clinical and pathological features was evaluated.Results: Overall, 431 of the 4,001 patients (10.8%) showed definite LNM according to pathological diagnosis. The PAN+ showed the highest frequency (6.6%) among all metastatic sites. One hundred fourteen cases (26.5%) were PLN-PAN+ (PAN metastasis without PLN metastasis), 167 cases (38.7%) showed PLN+PAN-(PLN metastasis without PAN metastasis), and 150 cases (34.8%) showed metastasis to both regions (PLN+PAN+). There was also 1.9% (51/2,660) of low-risk patients who had PLN-PAN+. There are no statistical differences in relapse-free survival (RFS) and disease-specific survival (DSS) among PLN+PAN-, PLN-PAN+, and PLN+PAN+. The sensitivity of gross PLNs, gross PANs, and lymphovascular space involvement (LVSI) to predict PAN+ was 53.8 [95% confidence interval (CI): 47.6–59.9], 74.2 95% CI: 65.6–81.4), and 45.8% (95% CI: 38.7–53.2), respectively.Conclusion: Over one-fourth of EC patients with LMN metastases were PLN-PAN+. PLN-PAN+ shares approximate survival outcomes (RFS and DSS) with other LNM patterns. No effective clinical methods were achieved for predicting PAN+. Thus, PLN-PAN+ is a non-negligible LNM pattern that cannot be underestimated in EC, even in low-risk patients.

Download Full-text