Abstract
Endometrial carcinoma is the most common gynecological cancer in Europe, with 130,000 new cases per year, and the incidence has been rising with aging and increased obesity of the population. Most women with endometrial cancer will present with early-stage disease, with a tumor confined to the uterus and without metastasis, and the first approach is surgery. Approximately 10% to 15% of these patients have a metastatic nodal disease, which is why guidelines have always emphasized the importance of lymphadenectomy to stratify the risk and tailor adjuvant treatment. However, comprehensive lymphadenectomy is related to significant morbidity and seems not to improve either progression-free or overall survival in these patients. Lymphatic mapping with sentinel lymph node biopsy has emerged as an alternative and an optimal compromise instead of systematic lymphadenectomy. This review presents the current evidence supporting sentinel lymph node biopsy in patients with endometrial cancer.
Highlights
Endometrial carcinoma is the most common gynecological cancer in Europe [1], accounting for approximately 130,000 newly diagnosed cases in 2020
The FIRES trial, a large prospective, multicentre study, investigated the negative predictive value (NPV) and sensitivity of sentinel lymph node (SLN) in patients with clinical stage I endometrial cancer undergoing robotic staging with SLN biopsy followed by completion bilateral lymphadenectomy [21]
These results suggest that SLN algorithm may replace lymphadenectomy in high-risk endometrial cancer avoiding para-aortic dissection
Summary
Endometrial carcinoma is the most common gynecological cancer in Europe [1], accounting for approximately 130,000 newly diagnosed cases in 2020. The FIRES trial, a large prospective, multicentre study, investigated the NPV and sensitivity of SLN in patients with clinical stage I endometrial cancer undergoing robotic staging with SLN biopsy followed by completion bilateral lymphadenectomy [21]. Similar results were shown by 97.4% detection rate per patient (proportion of patients in whom a sentinel lymph node mapped) and by 99% NPV of the SLN algorithm in the SENTOR trial [26]. These results suggest that SLN algorithm may replace lymphadenectomy in high-risk endometrial cancer avoiding para-aortic dissection
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