Evaluation of Sentinel Lymph Node Sampling in Complex Atypical Hyperplasia

Abstract

<h3>Study Objective</h3> Primary objective - to evaluate safety and efficacy of sentinel lymph node (SLN) sampling during robot assisted total laparoscopic hysterectomy and bilateral salpingo-oophorectomy (TLH/BSO) of patients with complex atypical hyperplasia (CAH). Secondary objective - to determine the risk of endometrial carcinoma in patients with preoperative diagnosis of CAH. <h3>Design</h3> Retrospective chart review performed from May 2012 to February 2020 of CAH patients who underwent TLH/BSO. Demographic data, operative data, histopathology, SLN ultra-staging data collected. Intra-operative and 30-day postoperative complications evaluated using Clavien-Dindo classification. <h3>Setting</h3> Single institution. <h3>Patients or Participants</h3> Inclusion criteria was preoperative diagnosis of CAH, ages 18-90, robotic assisted TLH/BSO. 74 charts reviewed 57 patients included. <h3>Interventions</h3> Of 57 patients, 25 patients underwent SLN sampling under near infra-red light after cervical injection of indocyanine green dye. 32 patients in control group that did not have lymph node sampling. <h3>Measurements and Main Results</h3> Two-sided t-test, Chi squared test and Fisher's exact test used in data analysis. The incidence of cancer was 32/57 (56.1%). Thirteen (52%) patients in SLN group had cancer vs 19 (59.4%) in the control group. The rate of deep (>50%) myometrial invasion in SLN group was 30.8% vs 5.3% in control group (P=0.05). The map rate of SLN was 100% (76% Bilateral, 24% Unilateral). Zero SLN sampled were positive for metastatic disease. 30-day complication rate in SLN group was 0% vs 6.3% in control group (P=0.5). Sixteen (28%) patients had borderline (bordering on carcinoma) pathology on preoperative sampling. Eight (50%) had SLN sampling. Twelve (75%) had a postoperative diagnosis of cancer. There were no identified preoperative risk factors for cancer. <h3>Conclusion</h3> The incidence of endometrial cancer in patients with preoperative diagnosis of CAH was 56%. Zero patients had metastatic disease to SLN. SLN dissection was not associated with more operative time or complications. Patients with a preoperative borderline pathology seem to have a higher risk of cancer.