scholarly journals Sentinel Lymph Node Mapping in Endometrial Cancer after Supracervical Hysterectomy

2021 ◽  
Author(s):  
Nicolò Bizzarri ◽  
Andrea Rosati ◽  
Giovanni Scambia ◽  
Francesco Fanfani
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Endometrial Adenocarcinoma ◽  
Surgical Margin ◽  
Lymph Node Biopsy ◽  
Pelvic Lymphadenectomy ◽  
Supracervical Hysterectomy ◽  
Lymph Node Mapping ◽  
Cervical Stump

Abstract Background Occult endometrial cancer after supracervical hysterectomy is uncommon. Even if optimal management of those rare cases is still unproven, to guide the need for adjuvant treatment, restaging should be recommended in this situation. Methods The study was approved by institutional review board (DIPUSVSP-27-07-20107). We report the case of a 52-year-old woman with occult grade 2 endometrioid endometrial adenocarcinoma (pT1a) with negative surgical margin and smooth uterine muscle of uncertain malignant potential after supracervical hysterectomy and bilateral salpingo-oophorectomy performed for pelvic pain and uterine fibroids in a local hospital. Preoperative CT scan of chest-abdomen-pelvis did not show any lymphadenopathy or distant metastasis. Pelvic US scan revealed a normal cervical stump and a hypoechoic 18-mm right parametrial nodule. We describe the feasibility of laparoscopic sentinel lymph node identification with cervical stump injection of indocyanine green. Results The patient underwent laparoscopic radical trachelectomy, left pelvic sentinel lymph node biopsy, right pelvic lymphadenectomy, peritoneal washing. Patient did not report any intraoperative or postoperative complication. At final histology cervix, SLN (ultrastaging) and pelvic lymph nodes were negative, while parametrial nodule was reported as metastasis from endometrial adenocarcinoma. Surgical margins were clear. Patient was staged as FIGO IIIB and underwent adjuvant chemo-radiation. She is now alive and disease-free, 12 months after the surgery. Conclusions This video (Video 1) underlines the fact that SLN mapping with cervical injection is a feasible and safe technique also without the uterine corpus after supracervical hysterectomy. The unilateral mapping could be due to the presence of metastatic parametrium on the right side.

Use of a novel sentinel lymph node mapping algorithm reduces the need for pelvic lymphadenectomy in low-grade endometrial cancer

2017 ◽  
Vol 147 (3) ◽  
pp. 535-540 ◽  
Author(s):  
Edward Tanner ◽  
Allison Puechl ◽  
Kimberly Levinson ◽  
Laura J. Havrilesky ◽  
Abdulrahman Sinno ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Mapping ◽  
Pelvic Lymphadenectomy ◽  
Low Grade ◽  
Lymph Node Mapping ◽  
Mapping Algorithm

Sentinel lymph node mapping in endometrial cancer: performance of hysteroscopic injection of tracers

2020 ◽  
Vol 30 (3) ◽  
pp. 332-338 ◽  
Author(s):  
Fabio Martinelli ◽  
Antonino Ditto ◽  
Giorgio Bogani ◽  
Umberto Leone Roberti Maggiore ◽  
Mauro Signorelli ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Detection Rate ◽  
False Negative ◽  
Sentinel Lymph Node Mapping ◽  
Pelvic Lymphadenectomy ◽  
Oncologic Outcomes ◽  
Lymph Node Mapping ◽  
Aortic Area

ObjectiveTo report on the performance of hysteroscopic injection of tracers (indocyanine green (ICG) and technetium-99m (Tc-99m)) for sentinel lymph node (SLN) mapping in endometrial cancer.MethodsSingle-center retrospective evaluation of consecutive patients who underwent SLN mapping following hysteroscopic peritumoral injection of tracer. Detection rate (overall/bilateral/aortic) diagnostic accuracy, and oncologic outcomes were evaluated.ResultsA total of 221 procedures met the inclusion criteria. Mean patient age was 60 (range 28–84) years and mean body mass index was 26.9 (range 15–47) kg/m2 . In 164 cases (70.9%) mapping was performed laparoscopically. The overall detection rate of the technique was 94.1% (208/221 patients). Bilateral pelvic mapping was found in 62.5% of cases with at least one SLN detected and was more frequent using ICG than with Tc-99m (73.8% vs 53.3%; p<0.001). In 47.6% of cases SLNs mapped in both pelvic and aortic nodes, and in five cases (2.4%) only in the aortic area. In eight patients (3.8%) SLNs were found in aberrant (parametrial/presacral) areas. Mean number of detected SLNs was 3.7 (range 1–8). In 51.9% of cases at least one node other than SLNs was removed. Twenty-six patients (12.5%) had nodal involvement: 12 (46.2%) macrometastases, six (23.1%) micrometastases, and eight (30.7%) isolated tumor cells. In 12 cases (46.8%) the aortic area was involved. Overall, 6/221 (2.7%) patients had isolated para-aortic nodes. Three false-negative results were found, all in the Tc-99m group. All had isolated aortic metastases. Overall sensitivity was 88.5% (95% CI 71.7 to 100.0) and overall negative predictive value was 96.5% (95% CI 86.8 to 100.0). There were 10 (4.8%) recurrences: five abdominal/distant, four vaginal, and one nodal (in the aortic area following a unilateral mapping plus side-specific pelvic lymphadenectomy). Most recurrences (9/10 cases) were patients in whom a completion lymphadenectomy was performed. No deaths were reported after a mean follow-up of 47.7 months.ConclusionsHysteroscopic injection of tracers for SLN mapping in endometrial cancer is as accurate as cervical injection with a higher detection rate in the aortic area. ICG improves the bilateral detection rate. Adding lymphadenectomy to SLN mapping does not reduce the risk of relapse.

scholarly journals Sentinel lymph nodes biopsy in the surgical treatment of endometrial cancer: history and present

2019 ◽  
Vol 14 (4) ◽  
pp. 65-71
Author(s):  
M. O. Ochirov ◽  
A. Yu. Kishkina ◽  
L. A. Kolomiets ◽  
V. I. Chernov
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Surgical Treatment ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Mapping ◽  
Lymph Node Biopsy ◽  
Cancer History ◽  
Lymph Node Mapping ◽  
Node Biopsy ◽  
Immunohistochemical Testing

This article reviews the concept of sentinel lymph node biopsy in patients with endometrial cancer. This technique is becoming increasingly appreciated and was included into the latest standards of surgical treatment for gynecological cancers. Sentinel lymph node mapping is a reliable and highly specific (100 %) method, which can be used for determining the indications for adjuvant therapy in addition to a detailed pathomorphological examination that should include immunohistochemical testing and ultrastaging.

Sentinel lymph node biopsy for robotic-assisted endometrial cancer staging: further improvement of perioperative outcomes

2019 ◽  
Vol 30 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Jvan Casarin ◽  
Francesco Multinu ◽  
Lucia Tortorella ◽  
Serena Cappuccio ◽  
Amy L Weaver ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Surgical Outcomes ◽  
Early Stage ◽  
Lymph Node Biopsy ◽  
Pelvic Lymphadenectomy ◽  
Robotic Assisted ◽  
Node Biopsy

ObjectivesIt is unclear if sentinel lymph node biopsy is associated with improved surgical outcomes compared with lymphadenectomy in patients with endometrial cancer. In this study we aimed to compare peri-operative surgical outcomes and treatment-related morbidity in patients who underwent robotic-assisted sentinel lymph node biopsy versus systematic pelvic lymphadenectomy or hysterectomy alone for apparent early-stage endometrial cancer.MethodsRecords were reviewed of consecutive patients with International Federation of Gynecology and Obstetrics stages I–III endometrial cancer undergoing robotic-assisted staging from January 1, 2009, through June 30, 2016. For the purpose of this analysis we focused on the actual patients who had sentinel node biopsy only (ie, excluding those who had an associated lymphadenectomy either for failed mapping or during the learning curve). We also excluded patients who had para-aortic lymph node dissection from the lymphadenectomy group. Perioperative and 30-day surgical outcomes were compared between patients who underwent sentinel lymph node assessment and those who had pelvic lymphadenectomy or hysterectomy alone, respectively. Inverse probability of treatment weighting derived from propensity scores was used to minimize allocation bias in the comparison of outcomes between groups.ResultsA total of 621 patients were analyzed: 188 (30.3%) with sentinel lymph node biopsy, 198 (31.9%) with pelvic lymphadenectomy, and 235 (37.8%) with hysterectomy alone. Inverse probability of treatment weights analysis balanced for baseline characteristics (age, body mass index, American Society of Anesthesiologists score, Charlson co-morbidity index, parity, prior cesarean section, and previous abdominal operation) showed no significant differences in intra-operative and post-operative complications, re-admissions, and re-operations between the groups. Compared with pelvic lymphadenectomy, the sentinel lymph node biopsy group had a shorter mean operative time (138.0 vs 222.8 min, p<0.001) and less median blood loss (50 vs 100 mL, p<0.001). Sentinel lymph node biopsy also was not associated with worse morbidity compared with hysterectomy alone.ConclusionsIntroduction of sentinel lymph node biopsy reduces operative times and improves peri-operative surgical outcomes of robotic-assisted staging for apparent early-stage endometrial cancer without worsening the morbidity of hysterectomy alone.

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