Abstract
Sentinel lymph node (SLN) biopsy has emerged as an alternative staging approach in women with assumed early-stage endometrial carcinoma. Through image-guided surgery and pathologic ultrastaging, the SLN approach is introducing “precision medicine” to the surgical management of gynecologic cancers, providing a comprehensive evaluation of high-yield lymph nodes. This approach improves the surgeons’ ability to detect small-volume metastatic disease while reducing intraoperative and postoperative morbidity associated with lymphadenectomy. Although the majority of clinicians in Europe and the USA have recognized the value of SLN biopsy in endometrial carcinoma and introduced this as part of clinical practice, there is ongoing debate regarding its role in very low-risk patients as well as in patients at high risk of nodal metastasis. The significance of low-volume metastasis is not fully understood, and there is no consensus in regard to how the presence of isolated tumor cells should guide adjuvant therapy. Standardized protocols for histopathologic evaluation of SLNs are lacking. In this review article we aim to provide a framework for the introduction of SLN biopsy in endometrial cancer, give an updated overview of the existing literature, as well as discuss potential controversies and unanswered questions regarding this approach and future directions.
Highlights
Endometrial carcinoma is the most common gynecologic malignancy in Europe and North America
Since lymphadenectomy has not been associated with improved survival for women with apparent early-stage endometrial carcinoma [2,3], and carries risks of intra- and postoperative complications [4], sentinel lymph node (SLN) biopsy has emerged as an alternative staging approach thought to reduce potential complications associated with lymphadenectomy whilst still providing accurate staging
These results are comparable to rates found in breast cancer and melanoma where SLN biopsy is standard of care, and established the accuracy of SLN biopsy in endometrial carcinoma, importantly in women with high risk of nodal metastasis
Summary
Endometrial carcinoma is the most common gynecologic malignancy in Europe and North America. Evidence suggests that lymphadenectomy provides prognostic information and directs the use of appropriate adjuvant treatment in patients who are node-positive It eliminates the need for adjuvant treatment in low-risk patients with negative nodes and no extrauterine spread of disease. Since lymphadenectomy has not been associated with improved survival for women with apparent early-stage endometrial carcinoma [2,3], and carries risks of intra- and postoperative complications [4], sentinel lymph node (SLN) biopsy has emerged as an alternative staging approach thought to reduce potential complications associated with lymphadenectomy whilst still providing accurate staging. The prognostic role of very low-volume metastasis remains largely unknown, and there is a paucity of standardized histopathologic processing protocols for ultrastaging of SLNs. The purpose of this review article is to provide a background for the introduction of SLN biopsy in endometrial carcinoma, give an updated overview of the literature, and discuss potential controversies and unanswered questions regarding this approach
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