Abstract
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.
Highlights
Endometrial cancer represents the sixth diagnosed cancer among women, representing 382,069 new cases and 89,929 deaths in 2018 worldwide [1]
A consensus conference including three different European learned societies (ESMO-ESGO-ESTRO) established new recommendations in order to standardize the management of early stage endometrial cancer and one of the main points is the emergence of a new subgroup of patients at risk of recurrence to better define the indications for initial treatment [2]
We aimed to assess and review the value of sentinel lymph node (SLN) sampling in high risk endometrial cancer according to the ESMO-ESGO-ESTRO classification in comparison to conventional lymphadenectomy
Summary
Endometrial cancer represents the sixth diagnosed cancer among women, representing 382,069 new cases and 89,929 deaths in 2018 worldwide [1]. This cancer usually affects women after menopause, with the average age of patients at diagnosis being 68 years. It affects an elderly population, sometimes with serious comorbidities that must be taken into account in surgical management. A consensus conference including three different European learned societies (ESMO-ESGO-ESTRO) established new recommendations in order to standardize the management of early stage endometrial cancer and one of the main points is the emergence of a new subgroup of patients at risk of recurrence (high-intermediate risk group) to better define the indications for initial treatment [2]. Several randomized studies have demonstrated the absence of benefits in terms of long-term survival and recurrence-free survival from performing systematic lymphadenectomy [9] in stage I endometrial cancers, especially since it causes morbidity and long-term complications, such as lymphoceles and lymphoedema [10,11,12,13]
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