Abstract
ObjectivesTo determine the feasibility and performance of sentinel lymph-node (SLN) mapping among women with high-risk endometrial cancer (EC).Materials and methodsNinety-eight patients at high-risk EC were enrolled in this retrospective surgical trial from August 2016 to August 2018. All patients underwent intraoperative SLN biopsy, with ICG injection for laparoscopic staging; this was followed by pelvic and paraaortic lymphadenectomy (LAD). Outcomes included SLN detection rate, false-negative SLN algorithm rate, and the negative predictive value (NPV) of the SLN algorithm. The Chi-square test was used to analyze the relationship between SLN mapping and the risk factors. Then, we performed Kappa consistency check (P < 0.05 with Meaning), to estimate the consistency of SLN and lymph-node metastasis.ResultsSuccessful biopsy occurred in 94 patients (170 sides) among 98 patients (196 sides). At least 1 SLN was identified in 86.7% (170/196). Overall, the false-negative rate (FNR) was 11.8% (2/17), NPV was 97.3% (72/74), and sensitivity was 88.2% (15/17). 22/98 patients (22.4%) with high-risk EC had at least one metastatic lymph node identified. When the SLN algorithm was retrospectively applied, the FNR was 9.1% (2/22) and sensitivity was 90.9% (20/22). Considering the surgeon’s experience, 68 cases of EC (except for 30 patients), the detection rate was 89.7% (122/136), NPV was 98.1% (50/51), and the FNR was 5.6% (1/18). The factor significantly affecting the detection rate of SLNs was lymphovascular space invasion (LVSI) (P = 0.016). SLN metastasis of EC was associated with depth of myometrial invasion (P = 0.034). The analysis result of SLN and the consistency of pelvic lymph-node metastasis status. As detected by Kappa coefficient was 0.939 (P < 0.001), suggests highly consistency.ConclusionsOur SLN detection rate for high-risk EC was the same as previously reported. When SLN is not detected, better after 30 patients’ experience, is a reasonable alternative to complete LAD in high-risk EC. In addition, SLN shows high co-occurrence with pelvic lymph nodes. Therefore, SLN biopsy can be used to diagnose high-risk EC.
Highlights
Endometrial cancer (EC) is one of the most prevalent among gynecological malignant tumors, and has shown a steady increase in incidence; whether LAD is suitable for EC is a topic of ongoing debate
Between August 2016 and August 2018, Sentinel lymph node (SLN) mapping was performed for 132 patients; of these, 34 patients were excluded, because the patient consented only for SLN removal
The median time from ICG injection into the cervix and intraoperative SLN detection was 7 min, On SLN mapping, successful biopsy occurred in 94 patients (170 sides) among 98
Summary
Endometrial cancer (EC) is one of the most prevalent among gynecological malignant tumors, and has shown a steady increase in incidence; whether LAD is suitable for EC is a topic of ongoing debate. The lymph nodes that have not yet been transferred have the defensive function of blocking the proliferation of cancer cells, and in the future, immunotherapy is bound to be an important means of tumor treatment [5]. Published studies have described SLN detection rate to be as high as 85–100% with NPV being 90–99% [6, 7]. This technique has been first recommended as the priority treatment in the 2014 National Comprehensive Cancer Network (NCCN) staging guidelines and EMSO–ESGO–ESTRO Consensus conference on EC [8]. To consider SLN biopsy alone in women with high-risk EC, some validation studies requiring comprehensive surgical staging were needed
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