High-Risk Endometrial Cancer Assessed by Immediate Intraoperative Frozen Sections of Sentinel Lymph Nodes - A Retrospective Study.

While sentinel lymph node (SLN) sampling has been established for low-risk endometrial cancer, few data exists on high-risk histologies. This study aims to measure the accuracy of immediate intraoperative SLN biopsy with frozen section in high-risk endometrial cancer. Patients diagnosed with endometrial cancer of high-grade histology (grade 3 endometrioid, clear cell, serous, carcinosarcoma, de- or undifferentiated histology) between 2014 and 2019 at a single institution who underwent SLN mapping, followed by pelvic lymphadenectomy with or without para-aortic lymphadenectomy were included. SLNs were assessed intraoperatively using multiple frozen sections and H&E staining. Lymph node metastases detected by SLN biopsy were compared with complete lymphadenectomy specimens. 35 patients with high-grade endometrial cancer histology underwent SLN mapping followed by lymphadenectomy. In 34 of 35 (97%) of these patients mapping with at least one SLN was successful. Positive SLNs were identified in 7/34 patients (20.6%). There were no patients who had positive lymph nodes on complete lymphadenectomy without a positive SLN, resulting in 100% sensitivity, and 0% false-negative rate. SLN mapping using intraoperative frozen sections in high-risk endometrial cancer demonstrated 100% sensitivity and 0% false-negative rate, provides immediate feedback on successful SLN mapping and valuable intraoperative information on the disease status guiding the intraoperative decision for completion lymphadenectomy.

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Diagnostic Accuracy and Clinical Impact of Sentinel Lymph Node Sampling in Endometrial Cancer at High Risk of Recurrence: A Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9123874 ◽

2020 ◽

Vol 9 (12) ◽

pp. 3874

Author(s):

Lise Lecointre ◽

Massimo Lodi ◽

Émilie Faller ◽

Thomas Boisramé ◽

Vincent Agnus ◽

...

Keyword(s):

Clinical Trials ◽

Endometrial Cancer ◽

Lymph Node ◽

High Risk ◽

Sentinel Lymph Node ◽

Meta Analysis ◽

False Negative ◽

False Negative Rate ◽

Number Of Patients ◽

The Impact

Purpose. To assess the value of sentinel lymph node (SLN) sampling in high risk endometrial cancer according to the ESMO-ESGO-ESTRO classification. Methods. We performed a comprehensive search on PubMed for clinical trials evaluating SLN sampling in patients with high risk endometrial cancer: stage I endometrioid, grade 3, with at least 50% myometrial invasion, regardless of lymphovascular space invasion status; or stage II; or node-negative stage III endometrioid, no residual disease; or non-endometrioid (serous or clear cell or undifferentiated carcinoma, or carcinosarcoma). All patients underwent SLN sampling followed by pelvic with or without para-aortic lymphadenectomy. Results. We included 17 original studies concerning 1322 women. Mean detection rates were 89% for unilateral and 68% for bilateral. Pooled sensitivity was 88.5% (95%CI: 81.2–93.2%), negative predictive value was 96.0% (95%CI: 93.1–97.7%), and false negative rate was 11.5% (95%CI: 6.8; 18.8%). We noted heterogeneity in SLN techniques between studies, concerning the tracer and its detection, the injection site, the number of injections, and the surgical approach. Finally, we found a correlation between the number of patients included and the SLN sampling performances. Discussion. This meta-analysis estimated the SLN sampling performances in high risk endometrial cancer patients. Data from the literature show the feasibility, the safety, the limits, and the impact on surgical de-escalation of this technique. In conclusion, our study supports the hypothesis that SLN sampling could be a valuable technique to diagnose lymph node involvement for patients with high risk endometrial cancer in replacement of conventional lymphadenectomy. Consequently, randomized clinical trials are necessary to confirm this hypothesis.

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Preoperative Identification of a Low-Risk Group for Lymph Node Metastasis in Endometrial Cancer: A Korean Gynecologic Oncology Group Study

Journal of Clinical Oncology ◽

10.1200/jco.2011.38.2416 ◽

2012 ◽

Vol 30 (12) ◽

pp. 1329-1334 ◽

Cited By ~ 76

Author(s):

Sokbom Kang ◽

Woo Dae Kang ◽

Hyun Hoon Chung ◽

Dae Hoon Jeong ◽

Sang-Soo Seo ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Risk Group ◽

False Negative ◽

False Negative Rate ◽

Low Risk ◽

Ca 125 ◽

Node Metastasis ◽

Negative Rate

Purpose The aim of this study was to develop a preoperative risk prediction model for lymph node metastasis in patients with endometrial cancer and to identify a low-risk group before surgery. Patients and Methods The medical records of 360 patients with endometrial cancer who underwent surgical staging were collected from four institutions and were retrospectively reviewed. By using serum CA-125 levels, preoperative biopsy data, and magnetic resonance imaging (MRI) data, a multivariate logistic model was created. Patients whose predicted probability was less than 4% were defined as low risk. The developed model was externally validated in 180 patients from two independent institutions. Results Serum CA-125 levels and three MRI parameters (deep myometrial invasion, lymph node enlargement, and extension beyond uterine corpus) were found to be independent risk factors for nodal metastasis. The model classified 53% of patients as part of a low-risk group, and the false negative rate was 1.7%. In the validation cohort, the model classified 43% of patients as low-risk, and the false negative rate was 1.4%. The model showed good discrimination (area under the receiver operator characteristic curve = 0.85) and was calibrated well. The negative likelihood ratio of our low-risk criteria was 0.11 (95% CI, 0.04 to 0.29), which was equivalent to the false-negative rate of 1.3% (95% CI, 0.5% to 3.3%) at the assumed prevalence of nodal metastasis of 10%. Conclusion Using serum CA-125 and MRI as criteria resulted in the accurate identification of a low-risk group for lymph node metastasis among patients with endometrial cancer.

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The Number of Removed Lymph Nodes for an Acceptable False Negative Rate in Sentinel Lymph Node Biopsy for Breast Cancer

Journal of Breast Cancer ◽

10.4048/jbc.2009.12.2.100 ◽

2009 ◽

Vol 12 (2) ◽

pp. 100 ◽

Cited By ~ 4

Author(s):

Bon Young Koo ◽

Seong Gu Jeong ◽

Tae Ik Eom ◽

Hee Joon Kang ◽

Lee Su Kim

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Lymph Nodes ◽

False Negative ◽

False Negative Rate ◽

Lymph Node Biopsy ◽

Node Biopsy ◽

Negative Rate

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Evaluation of the Sentinel Lymph Node Algorithm With Blue Dye Labeling for Early-Stage Endometrial Cancer in a Multicentric Setting

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31829b1b98 ◽

2013 ◽

Vol 23 (7) ◽

pp. 1237-1243 ◽

Cited By ~ 22

Author(s):

Fabien Vidal ◽

Pierre Leguevaque ◽

Stephanie Motton ◽

Jerome Delotte ◽

Gwenael Ferron ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Early Stage ◽

Clinical Stage ◽

False Negative ◽

False Negative Rate ◽

Blue Dye ◽

Negative Rate ◽

Early Stage Endometrial Cancer

ObjectivesSentinel lymph node (SLN) removal may be a midterm between no and full pelvic dissection in early endometrial cancer. Whereas the use of blue dye alone in SLN detection has a poor accuracy, its integration in an SLN algorithm may yield better results and overcome hurdles such as the requirement of nuclear medicine facility.MethodsSixty-six patients with clinical stage I endometrial cancer were prospectively enrolled in a multicentre study between May 2003 and June 2009. Patent blue was injected intraoperatively into the cervix. We retrospectively assessed the accuracy of a previously described SLN algorithm consisting of the following sequence: (1) pelvic node area is inspected for removal of all mapped SLN and (2) excision of every suspicious non-SLN, (3) in the absence of mapping in a hemipelvis, a standard ipsilateral lymphadenectomy is then performed.ResultsSentinel nodes were identified in 41 patients (62.1%), mostly in interiliac and obturator areas. None was detected in the para-aortic area. Detection was bilateral in 23 cases (56.1%). Seven patients (10.6%) had positive nodes. The false-negative rate was 40% using SLN detection alone. When the algorithm was applied, the false-negative rate was 14.3%. The use of a SLN algorithm would have avoided 53% of lymphadenectomiesConclusionOur multicentric evaluation validates the use of a SLN algorithm based on blue-only sentinel node mapping in early-stage endometrial cancer. The application of such SLN algorithm should be evaluated in a prospective context and might lead to decrease unnecessary lymphadenectomies.

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489 The Role of Sentinel Lymph Node Biopsy in Cutaneous Head and Neck Melanoma: A Systematic Review and Meta-Analysis

British Journal of Surgery ◽

10.1093/bjs/znab134.289 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

E Johnston ◽

S Taylor ◽

F Bannon ◽

S McAllister

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Head And Neck ◽

False Negative ◽

False Negative Rate ◽

Lymph Node Biopsy ◽

Node Biopsy ◽

Negative Rate ◽

Sentinel Node Identification

Abstract Introduction and Aims The aim of this systematic review is to provide an up-to-date evaluation of the role and test performance of sentinel lymph node biopsy (SLNB) in the head and neck. Method This review follows the PRISMA guidelines. Database searches for MEDLINE and EMBASE were constructed to retrieve human studies published between 1st January 2010 and 1st July 2020 assessing the role and accuracy of sentinel lymph node biopsy in cutaneous malignant melanoma of the head and neck. Articles were independently screened by two reviewers and critically appraised using the MINORS criteria. The primary outcomes consisted of the sentinel node identification rate and test-performance measures, including the false-negative rate and the posttest probability negative. Results A total of 27 studies, including 4688 patients, met the eligibility criteria. Statistical analysis produced weighted summary estimates for the sentinel node identification rate of 97.3% (95% CI, 95.9% to 98.6%), the false-negative rate of 21.3% (95% CI, 17.0% to 25.4%) and the posttest probability negative of 4.8% (95% CI, 3.9% to 5.8%). Discussion Sentinel lymph node biopsy is accurate and feasible in the head and neck. Despite technical improvements in localisation techniques, the false negative rate remains disproportionately higher than for melanoma in other anatomical sites.

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Assessment of Lymph Node Involvement with PET-CT in Advanced Epithelial Ovarian Cancer. A FRANCOGYN Group Study

Journal of Clinical Medicine ◽

10.3390/jcm10040602 ◽

2021 ◽

Vol 10 (4) ◽

pp. 602

Author(s):

Antoine Tardieu ◽

Lobna Ouldamer ◽

François Margueritte ◽

Lauranne Rossard ◽

Aymeline Lacorre ◽

...

Keyword(s):

Lymph Node ◽

False Negative ◽

False Negative Rate ◽

Lymph Node Involvement ◽

Accuracy Rate ◽

Peritoneal Cancer ◽

Negative Rate ◽

Number Of Patients ◽

Pet Ct ◽

Node Involvement

The objective of our study is to evaluate the diagnostic performance of positron emission tomography/computed tomography (PET-CT) for the assessment of lymph node involvement in advanced epithelial ovarian, fallopian tubal or peritoneal cancer (EOC). This was a retrospective, bicentric study. We included all patients over 18 years of age with a histological diagnosis of advanced EOC who had undergone PET-CT at the time of diagnosis or prior to cytoreduction surgery with pelvic or para-aortic lymphadenectomy. We included 145 patients with primary advanced EOC. The performance of PET-CT was calculated from the data of 63 patients. The sensitivity of PET-CT for preoperative lymph node evaluation was 26.7%, specificity was 90.9%, PPV was 72.7%, and NPV was 57.7%. The accuracy rate was 60.3%, and the false-negative rate was 34.9%. In the case of primary cytoreduction (n = 16), the sensitivity of PET-CT was 50%, specificity was 87.5%, PPV was 80%, and NPV was 63.6%. The accuracy rate was 68.8%, and the false negative rate was 25%. After neoadjuvant chemotherapy (n = 47), the sensitivity of PET-CT was 18.2%, specificity was 92%, PPV was 66.7%, and NPV was 56.1%. The accuracy rate was 57.5%, and the false negative rate was 38.3%. Due to its high specificity, the performance of a preoperative PET-CT scan could contribute to the de-escalation and reduction of lymphadenectomy in the surgical management of advanced EOC in a significant number of patients free of lymph node metastases.

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Bilateral ultrastaging of sentinel lymph node in cervical cancer: Lowering the false-negative rate and improving the detection of micrometastasis

Gynecologic Oncology ◽

10.1016/j.ygyno.2012.08.035 ◽

2012 ◽

Vol 127 (3) ◽

pp. 462-466 ◽

Cited By ~ 68

Author(s):

David Cibula ◽

Nadeem R. Abu-Rustum ◽

Ladislav Dusek ◽

Jiri Slama ◽

Michal Zikán ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

False Negative ◽

False Negative Rate ◽

Negative Rate

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Preoperative Tumor Biopsy Results In More Detected Sentinel Node Than Intraoperative Biopsy In Breast Cancer Patients

10.21203/rs.3.rs-23291/v1 ◽

2020 ◽

Author(s):

chenxi yuan ◽

xinzhao wang ◽

zhaoyun liu ◽

chao li ◽

mengxue bian ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

False Negative ◽

False Negative Rate ◽

Excisional Biopsy ◽

Breast Cancer Surgery ◽

Tumor Biopsy ◽

Tracer Injection ◽

Negative Rate

Abstract Background Sentinel lymph node biopsy (SLNB) acts as a vital role in the breast cancer surgery, and the identified number of sentinel nodes determines its accuracy to represent the status of axillae. There remain two tumor biopsy modes in breast cancer, preoperative and intraoperative biopsy. We compared the effect of the two different biopsies on the result of SLNB. Methods Patients with clinical stage T1-3, N0 tumor were enrolled in this study. 53% received preoperative tumor biopsy and 47% received intraoperative excisional biopsy. For search of the sentinel lymph node, patients received dual tracer injection. The number of SLNs detected and false negative rate were compared between groups. Results 204 patients were enrolled, 108 received preoperative tumor biopsy and 96 received intraoperative excisional biopsy. Among all the patients, 160 received ALND following SLNB. Preoperative tumor biopsy detected more SLNs than intraoperative biopsy (mean rank 113.87 vs. 90.9, p= 0.004). False negative rate in preoperative and intraoperative tumor biopsy was 3% and 18%, respectively. Conclusions Patients in preoperative tumor biopsy group could find more SLNs than intraoperative biopsy patients. False negative rate was also lower in preoperative biopsy group.

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