Sentinel Lymph Node Mapping Algorithm Research Articles

Can mismatch repair status be added to sentinel lymph node mapping algorithm in endometrioid endometrial cancer?

ObjectiveTo evaluate the relation between mismatch repair (MMR) status and the risk of lymph node metastasis in endometrial cancer, and whether this additional data can be incorporated to current SLN (sentinel lymph node) algorithm. MethodsWe included a series of 332 women that underwent SLN mapping ± systematic lymphadenectomy from January 2013 to December 2021. Protein expressions of MLH1, MSH2, MSH6, PMS2 were examined by immuno-histochemistry and considered MMRd (deficient) when at least one protein was not expressed. ResultsMMRd was noted in 20.8% of cases and correlated to grade 3 (p = 0.018) and presence of lymphovascular space invasion (p = 0.032). Moreover, MMRd was an independent risk factor for lymph node metastasis (OR 2.76, 95% CI 1.36–5.62). Notably, 21.7% (15/69) cases with MMRd had lymph node metastasis compared to 9.5% (25/263) of cases with MMRp (proficient) (p = 0.005). The overall and bilateral SLN detection rates were 91.9% and 75.9%, respectively. Of the 80 (24%) cases of non-bilateral SLN detection, 66.2% had low-grade tumors (G1/G2) and myometrial invasion <50%. Considering MMR status an independent prognostic factor for lymph node metastasis, a systematic lymphadenectomy (side specific or bilateral) would forgo in 53.7% (43/80) of cases with non-bilateral detection, representing 13% (43/332) of all endometroid tumors. ConclusionMMR status was independently related to lymph node metastasis in endometrioid EC. Moreover, MMR status may help to select patients that can forgo systematic lymphadenectomy in case of undetected SLN.

Lymphatic Mapping and Sentinel Node Biopsy in High-Grade Uterine Cancers.

Sentinel lymph node (SLN) mapping has been adopted as an acceptable method of lymph node evaluation in the surgical staging for low-grade endometrial cancer. In this review, we analyze the literature on the utility of SLN mapping in high-grade endometrial cancer. SLN mapping in high-grade endometrial cancer demonstrates similar high detection rates and diagnostic accuracy as seen in low-grade endometrial cancers. However, obtaining sufficient operator experience (at least 30 cases) and following SLN mapping algorithm continues to be essential to preserving diagnostic accuracy. Although limited in retrospective study design and short-term follow-up, current studies have not demonstrated inferior survival outcomes of SLN mapping compared to traditional lymphadenectomy. SLN mapping is an acceptable and accurate method of lymph node evaluation in high-grade endometrial cancer. Future prospective studies are needed to evaluate long-term oncologic outcomes between SLN mapping and systematic lymphadenectomy in this patient population.

Omitting lymphadenectomy in obese endometrial cancer patients undergoing sentinel lymph node mapping: when more is less

<h3>Objectives:</h3> Obese patients present unique surgical and technical challenges to their surgeons and anesthesiologists given their multiple comorbidities, difficult anatomy, and excessive weight. Thus, any surgical procedure that prolongs surgical time and potentially increases risk for complications in this population, needs to be carefully evaluated and minimized.The aim of this study is to evaluate the feasibility of sentinel lymph node (SLN) mapping in obese endometrial cancer patients, and to determine whether omitting lymph node dissection (LND) from surgical staging where SLN sampling is performed, impacts oncologic outcomes. <h3>Methods:</h3> Between December 2007 and August 2017, 722 patients with uterine cancer underwent surgical staging in our institution. We excluded patients with sarcomas (n=32), patients with stage 4 disease (n=9), patients who received neoadjuvant therapy (n=5) and patients whose body mass index (BMI) was below 35.0 kg/m² (n=453). The approach for LND at our center changed over the years: all surgeries from January 2008 to August 2014 included bilateral pelvic LND, with para-aortic LND at the surgeon's discretion (LND±SLN cohort). In addition to LND, all consecutive patients from December 2010 to August 2014 underwent SLN mapping with a cervical injection. With the establishment of SLN mapping algorithm feasibility, patients operated from August 2014 to August 2017 went through SLN mapping without LND (SLN cohort). <h3>Results:</h3> Out of 223 patients with a median BMI of 40.6 kg/m², 140 patients underwent LND (± SLN) and 83 patients underwent SLN. The median operative time for surgical staging in SLN only group was shorter in 47.5 minutes than for patients in the LND±SLN group (190.5 minutes (108-393) vs. 238 minutes (131-440), respectively, (p<0.001)), and they had reduced estimated blood loss (EBL) compared to the LND±SLN group (30 ml (0-300) vs. 40 ml (0-800ml), P=0.03). At a 24 months' follow-up cut-off, 98% of the patients were alive and 95.5% were free of disease, without significant differences in OS, DSS and PFS between the two groups (p=0.7, p=0.8 and p=0.4, respectively).Overall, 171 patients underwent SLN biopsy (±LND) and stratified by the tracer used for mapping (ICG versus blue dye). The ICG injected group had higher successful mapping and bilateral detection rates (92.8% vs 71.7%, p<0.001 and 80.2% vs 43.3%, p<0.001, respectfully). <h3>Conclusions:</h3> The obese population is at increased risk for intraoperative and postoperative complications associated with prolonged operative time from secondary to challenges in the surgical and anesthesia process. The advantage of minimizing the surgery towards SLN approach, as reflected in our results by shorter operative time and minimal bleeding is of particular importance in this set of patients. Omitting LND from surgical staging where SLN is performed was not associated with inferior survival outcomes. Given the higher successful detection and metastatic nodes rates with ICG and NIR fluorescence imaging compared to previously reported rates with blue dye based SLN, ICG should be the dye of choice in obese and morbid obese EC patients. Future studies should focus on molecular stratification of obese EC patients into risk groups for nodal disease, selecting patients for LND in cases of failed mapping.

Paraaortic sentinel lymph node detection in intermediate and high-risk endometrial cancer by transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR).

ObjectiveWe aimed to evaluate the accuracy of sentinel lymph node (SLN) mapping with transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR) to detect lymph node (LN) metastases, in patients with intermediate and high-risk endometrial cancer (EC), focusing on its performance to detect paraaortic involvement.MethodsProspective study including women with preoperative intermediate or high-risk EC, according to ESMO-ESGO-ESTRO consensus, who underwent SLN mapping using the TUMIR approach. SLNs were preoperatively localized by planar and single photon emission computed tomography/computed tomography images, and intraoperatively by gamma-probe. Immediately after SLN excision, all women underwent systematic pelvic and paraaortic lymphadenectomy by laparoscopy.ResultsThe study included 102 patients. The intraoperative SLN detection rate was 79.4% (81/102). Pelvic and paraaortic drainage was observed in 92.6% (75/81) and 45.7% (37/81) women, respectively, being exclusively paraaortic in 7.4% (6/81). After systematic lymphadenectomy, LN metastases were identified in 19.6% (20/102) patients, with 45.0% (9/20) showing paraaortic involvement, which was exclusive in 15.0% (3/20). The overall sensitivity and negative predictive value (NPV) of SLNs by the TUMIR approach to detect lymphatic involvement were 87.5% and 97.0%, respectively; and 83.3% and 96.9%, for paraaortic metastases. After applying the MSKCC SLN mapping algorithm, the sensitivity and NPV were 93.8% and 98.5%, respectively.ConclusionThe TUMIR method provides valuable information of endometrial drainage in patients at higher risk of paraaortic LN involvement. The TUMIR approach showed a detection rate of paraaortic SLNs greater than 45% and a high sensitivity and NPV for paraaortic metastases in women with intermediate and high-risk EC.

Incorporation of a sentinel lymph node mapping algorithm in patients with clinical stage I endometrial cancer

Objective: Studies have demonstrated no therapeutic benefit to systemic pelvic and paraaortic lymphadenectomy (PPALND) for patients with endometrial cancer and increased morbidity in those who undergo PPALND. Sentinel lymph node biopsy (SLNB) is an alternative to PPALND, but the referenced data published are largely from high-volume specialized institutions, and a complete PPALND is still performed by many surgeons at smaller, nonspecialized centers. Our aim is to demonstrate that SLNB is feasible, reproducible, and sensitive without affecting cancer-specific outcomes when implemented at a nonspecialized center.

Implementation of a sentinel lymph node mapping algorithm for endometrial cancer: surgical outcomes and hospital charges

IntroductionThe purpose of this study was to compare operative times, surgical outcomes, resource utilization, and hospital charges before and after the implementation of a sentinel lymph node (SLN) mapping algorithm...

Implementation of a sentinel lymph node mapping algorithm for endometrial cancer: Surgical outcomes and hospital charges

Objective: At the completion of validating our sentinel lymph node (SLN) mapping procedure in endometrial cancer through a prospective trial (2013–2016), our institution implemented an SLN mapping algorithm. The purpose of this study was to compare operative times, surgical outcomes, resource utilization, and hospital charges before and after the implementation of a SLN algorithm.

Adipose-only sentinel lymph nodes: a finding during the adaptation of a sentinel lymph node mapping algorithm with indocyanine green in women with endometrial cancer.

To identify factors that affect successful adaptation of sentinel lymph node mapping and those that lead to unintended adipose-only sentinel lymph node identification. Surgical and pathological data were prospectively collected on patients with endometrial cancer who underwent sentinel lymph node mapping with indocyanine green with or without pelvic and/or para-aortic lymph node dissection between November 2013 and April 2017. All mapping cases were performed with the robotic system. Adipose-only specimens were defined as a sentinel lymph node without a pathologically identified lymph node after ultrastaging. A total of 202 patients were included: 83% had endometrioid pathology, 12% serous, 3% carcinosarcoma, and 2% clear cell, with mixed pathology noted in 2%. The bilateral sentinel lymph node detection rate was 66%, and the rate of mapping at least a unilateral sentinel lymph node was 86%. Neither the bilateral nor the unilateral sentinel lymph node mapping rate changed with increased surgeon experience. The rate of adipose-only sentinel lymph node identification was more frequent when comparing the first 10 cases (37%), cases 11 - 30 (28%), and > 30 cases (9%) (P = 0.006). Body mass index > 30 kg/m2, uterine fibroids, The International Federation of Gynecology and Obstetrics (FIGO) grade, and histology were not found to have a statistically significant impact on either sentinel lymph node identification or adipose-only sentinel lymph node identification. Adipose-only sentinel lymph nodes were more likely with increased time from cervical injection to identification of the sentinel lymph node in the right hemipelvis. The median range was 28 min (14-73) for true sentinel lymph node identification vs 33 min (23-74) for adipose-only sentinel lymph node identification (P = 0.02). Patient and surgeon factors did not impact the identification of sentinel lymph nodes over time. Adipose-only sentinel lymph nodes were more frequently identified in the initial cases and represent a potential complication to adapting sentinel lymph node biopsy without lymphadenectomy. The increase in adipose-only sentinel lymph node identification that was associated with time from cervical injection may represent delayed or disrupted uptake of indocyanine green.

The impact of the type of nodal assessment on prognosis in patients with high-intermediate and high-risk ESMO/ESGO/ESTRO group endometrial cancer. A multicenter Italian study

ObjectivesThe majority of endometrial cancers (EC) are discovered while the disease is confined to the uterine body. The presence of lymph nodes metastases impairs the prognosis. In this study, we evaluated the possible impact on survival of sentinel lymph node (SLN) mapping algorithm and selective lymphadenectomy (LD) in early stage EC, according to the ESMO-ESGO-ESTRO risk subgroup classification. MethodsWe retrospectively analyzed the database from two collaborative institutions including women with high-intermediate (HI) and high-risk (HR) ESMO/ESGO/ESTRO groups that underwent surgical staging with either SLN mapping, or selective LD. ResultsTwo-hundred and sixty-six women were overall identified, 121 in HI and 145 in HR group, respectively. LD was performed in 139 patients (52.5%), whereas SLN mapping algorithm in 61 patients (23%). Sixty-six patients in Rome center were not staged (24.8%). Aortic dissection was performed in 29 women (10.9%). The 3-year comparison did not show a significant difference between strategy adopted for nodal staging (SLN mapping, LD, and SLN + LD) on both disease-free survival [HR: 0.82; 95% CI 0.53–1.28; p = 0.390], and overall survival [HR: 0.78; 95% CI 0.47–1.31; p = 0.355]. ConclusionsIn this study focused on women in the HI and HR groups we did not find difference in the 3-years DFS and OS when comparing the SLN strategy with selective lymphadenectomy, or the SLN algorithm. The SLN strategy did not seem to not compromise the prognosis of high risk patients.

Lymph node evaluation in high-risk early stage endometrial cancer: A multi-institutional retrospective analysis comparing the sentinel lymph node (SLN) algorithm and SLN with selective lymphadenectomy

ObjectiveThe aim of this study was to determine the impact of the sentinel lymph node mapping algorithm (SLN-A) on the staging in high-risk endometrial cancer (EC) compared to SLN plus selective lymphadenectomy (S-LND). MethodsWe retrospectively analyzed the database from a multicenter collaboration that included women with high risk features who underwent primary surgical staging. ResultsOne-hundred and seventy-one women were identified (171), 66 in the SLN-A and 105 in the S-LND group, respectively. Pelvic LD was performed on 115 patients (67.2%) and aortic dissection was performed in 54/105 of the women in the S-LND group (51%). The 5-year comparison did not show a significant difference in the strategy adopted for nodal staging, regarding disease-free survival (DFS) [HR: 0.82; 95% CI 0.53–1.28; p = 0.390]. ConclusionsIn this study focusing on women with EC in the HR groups, we did not find a difference in the 5-year DFS when comparing the SLN-A strategy with S-LND. The SLN strategy did not seem to compromise the prognosis of patients with a higher risk of recurrence.

Retrospective validation of the laparoscopic ICG SLN mapping in patients with grade 3 endometrial cancer.

To evaluate the sensitivity, negative predictive value (NPV) and false-negative (FN) rate of the near infrared (NIR) indocyanine green (ICG) sentinel lymph node (SLN) mapping in patients with poorly differentiated endometrial cancer who have undergone a full pelvic and para-aortic lymphadenectomy after SLN mapping. We performed a retrospective analysis of patients with endometrial cancer undergoing a laparoscopic NIR-ICG SLN mapping followed by a systematic pelvic and para-aortic lymphadenectomy. Inclusion criteria were a grade 3 endometrial cancer or a high-risk histology (papillary serous, clear cell carcinoma, carcinosarcoma, and neuroendocrine carcinoma) and a completion pelvic and para-aortic lymphadenectomy to the renal vessels after SLN mapping. Overall and bilateral detection rates, sensitivity, NPV, and FN rates were calculated. From December 2012 until January 2017, 42 patients fulfilled inclusion criteria. Overall and bilateral detection rates were 100 and 90.5%, respectively. Overall, 23.8% of the patients had lymph node metastases. In one patient, despite negative bilateral pelvic SLNs, a metastatic non-SLN-isolated para-aortic metastasis was detected. This NSLN was clinically suspicious and sent to frozen section analysis during the surgery. FN rate, sensitivity, and NPV were 10, 90, and 97.1%, respectively. For the SLN mapping algorithm, FN rate, sensitivity, and NPV were 0, 100, and 100%, respectively. Laparoscopic NIR-ICG SLN mapping in high-risk endometrial cancer patients has acceptable sensitivity, FN rate, and NPV.

Use of a novel sentinel lymph node mapping algorithm reduces the need for pelvic lymphadenectomy in low-grade endometrial cancer.

To evaluate the capability of a novel sentinel lymph node (SLN) mapping algorithm to reduce the need for pelvic lymphadenectomy (PLND) in patients with low-grade (G1-2) endometrial cancer (LGEC). Patients with LGEC underwent evaluation according to a novel lymphatic assessment algorithm during hysterectomy with SLN biopsy at two academic gynecologic oncology programs. Side-specific PLND was only performed if ipsilateral SLN mapping failed and high-risk uterine features were identified on frozen section (FS). Side-specific and PLND rates were compared to theoretical PLND rates based on the NCCN EC SLN mapping algorithm. Since 11/2015, 113 LGEC patients have been managed according to the algorithm. SLN mapping was bilateral (81%), unilateral (12%), or neither (6%). Nine patients (8.0%) had LN metastases identified. Of the 21 patients requiring intraoperative FS due to failed SLN mapping, high-risk uterine features were identified in eight (38%). These patients underwent either bilateral (2) or unilateral (6) PLND. Side-specific and overall PLND rates were 5.3% and 7.1%, respectively. If all patients with failed mapping had undergone PLND according to the NCCN algorithm, side-specific and overall PLND rates would have been higher, 12.4% and 18.6%, respectively (P=0.01). All patients who failed to map and did not undergo side-specific PLND had low-risk uterine features on final pathology. Lymphatic assessment using SLN mapping followed by selective FS to determine need for PLND is feasible. When compared to the NCCN algorithm, this novel "Reflex Frozen Section" strategy eliminates PLND in patients at lowest risk for metastasis without compromising identification of metastatic nodal disease.

Comparison of a sentinel lymph node mapping algorithm and comprehensive lymphadenectomy in the detection of stage IIIC endometrial carcinoma at higher risk for nodal disease.

To determine if a sentinel lymph node (SLN) mapping algorithm will detect metastatic nodal disease in patients with intermediate-/high-risk endometrial carcinoma. Patients were identified and surgically staged at two collaborating institutions. The historical cohort (2004-2008) at one institution included patients undergoing complete pelvic and paraaortic lymphadenectomy to the renal veins (LND cohort). At the second institution an SLN mapping algorithm, including pathologic ultra-staging, was performed (2006-2013) (SLN cohort). Intermediate-risk was defined as endometrioid histology (any grade), ≥50% myometrial invasion; high-risk as serous or clear cell histology (any myometrial invasion). Patients with gross peritoneal disease were excluded. Isolated tumor cells, micro-metastases, and macro-metastases were considered node-positive. We identified 210 patients in the LND cohort, 202 in the SLN cohort. Nodal assessment was performed for most patients. In the intermediate-risk group, stage IIIC disease was diagnosed in 30/107 (28.0%) (LND), 29/82 (35.4%) (SLN) (P=0.28). In the high-risk group, stage IIIC disease was diagnosed in 20/103 (19.4%) (LND), 26 (21.7%) (SLN) (P=0.68). Paraaortic lymph node (LN) assessment was performed significantly more often in intermediate-/high-risk groups in the LND cohort (P<0.001). In the intermediate-risk group, paraaortic LN metastases were detected in 20/96 (20.8%) (LND) vs. 3/28 (10.7%) (SLN) (P=0.23). In the high-risk group, paraaortic LN metastases were detected in 13/82 (15.9%) (LND) and 10/56 (17.9%) (SLN) (%, P=0.76). SLN mapping algorithm provides similar detection rates of stage IIIC endometrial cancer. The SLN algorithm does not compromise overall detection compared to standard LND.

Use of a novel sentinel lymph node mapping algorithm reduces pelvic lymphadenectomy rates in patients with low-grade endometrial cancer

Use of a novel sentinel lymph node mapping algorithm reduces pelvic lymphadenectomy rates in patients with low-grade endometrial cancer

Survival of Patients with Serous Uterine Carcinoma Undergoing Sentinel Lymph Node Mapping.

The aim of this study was to determine progression-free survival (PFS) in patients with serous uterine carcinoma undergoing sentinel lymph node (SLN) mapping compared with patients undergoing standard lymphadenectomy. We retrospectively reviewed all uterine cancer patients treated at our institution from 2005 to 2015. Patients were separated into two cohorts: those who underwentSLN mapping at the time of staging (SLN) and those who underwent routine lymphadenectomy (thenon-SLNgroup). SLN mapping was performed according to institutional protocol, incorporating a surgical algorithm and pathologic ultrastaging. Overall, 248 patients were identified-153 SLN mappings and 95 routine lymphadenectomies (pelvic and/or paraaortic lymph node dissection). No significant difference in age or body mass index was observed between the groups (p=0.08 and p=0.9, respectively). Minimally invasive surgery was utilized in 117/153 (77%) SLN patients and 30/95 (32%) non-SLN patients (p=<0.001). Stage distribution for the SLN and non-SLN cohorts demonstrated 106/153 (69%) and 59/95 (62%) patients with stage I/II disease, respectively, and 47/153 (31%) and 36/95 (38%) patients with stage III/IV disease, respectively (p=0.3). The median number of nodes removed was 12 (range, 1-50) in the SLN cohort versus 21 (range, 1-75) in the non-SLN cohort (p=<0.001). Adjuvant chemotherapy alone or with radiation therapy was administered in 122/153 (80%) SLN patients and 79/95 (83%) non-SLN patients; radiotherapy alone was administered in 12/153 (8%) SLN patients and 7/95 (7%) non-SLN patients (p=0.8). At amedian follow-up of 40 months, the2-year PFS rates were 77% (95% confidence interval [CI], 68-83%) in the SLN group and 71% (95% CI, 61-79%) in the non-SLN group (p=0.3). Incorporation of the SLN mapping algorithm into the staging of uterine serous cancer is feasible and does not appear to compromise prognosis. PFS in patients with uterine serous carcinoma undergoing SLN mapping, followed by adjuvant therapy, was similar to PFS in patients undergoing standard lymphadenectomy and adjuvant therapy.

Sentinel lymph node mapping for early-stage cervical cancer: A single institution's experience

Objectives: Lymph node assessment remains a key part of surgical evaluation for patients with early-stage cervical cancer, and provides important prognostic information to determine appropriate adjuvant therapy. We aim to compare our experience with sentinel lymph node (SLN) mapping in patients with early-stage cervical cancer with a historical cohort of patients at our institution. Methods: We searched an institutional database for patients with cervical cancer between 1982 and 2014. Pertinent clinical and pathologic data were abstracted from the medical records. A historical cohort included patients from 1982 to 2009 who underwent selective lymph node (LN) sampling. An SLN mapping algorithm was performed according to institutional protocol in a cohort of patients from 2005 to 2014 (SLN cohort). Isolated tumor cells, micrometastases, and macrometastases were considered positive. Only patients with stage IB1 or IB2 squamous cell carcinoma or adenocarcinoma of the cervix were included. Appropriate statistical tests were performed. Results: We identified 531 patients with cervical cancer who underwent surgical evaluation at our institution: 123 (23.2%) patients in the SLN cohort and 408 (76.8%) in the historical cohort. Median of the 2 groups was similar (SLN: median 36.5 years, range 20–77 years; historical cohort: median 40 years, range 20–92 years; P = .052). Most patients had stage IB1 disease (91.1% in the SLN and 90.4% in the historical cohort). More patients in the historical cohort had squamous cell carcinoma (43 [35%] in the SLN vs 208 (51%) in the historical cohort, P = .002). Patients received adjuvant radiation at a similar rate in both groups (28.5% in the SLN vs 27.2% in the historical cohort, P = .05). Fewer LNs were removed (19 [range, 2–70] vs 27 [range, 1–80], P < .0001) and more positive LNs were detected in the SLN cohort (23 [18.7%] vs 51 [12.5%], P = .03]. Median follow-up was similar between the 2 groups (51.6 months [range, 0.5–109] in the SLN vs 56.5 months [range, 1.0–338.8], P = .22 in the historical cohort). Median recurrence-free (RFS), disease-specific (DSS), and overall survival (OS) was not reached in either group. Five-year RFS (100% vs 93.1% ± 1.4%, P = .006), DSS (97.7% ± 1.6% vs 91.3% ± 1.6%, P = .047), and OS (95.1% ± 2.2% vs 87.2% ± 1.8%, P = .027) were greater in the SLN cohort. Conclusions: Patients undergoing SLN mapping have fewer total LNs removed but a higher detection rate of positive LNs compared with a historical cohort. In this single institution comparison, SLN mapping did not compromise the detection of positive LNs or outcome of patients with squamous cell or adenocarcinoma of the cervix.

Comparison of a sentinel lymph node and a selective lymphadenectomy algorithm in patients with endometrioid endometrial carcinoma and limited myometrial invasion

ObjectivesTo assess clinicopathologic outcomes between two nodal assessment approaches in patients with endometrioid endometrial carcinoma and limited myoinvasion. MethodsPatients with endometrial cancer at two institutions were reviewed. At one institution, a complete pelvic and para-aortic lymphadenectomy to the renal veins was performed in select cases deemed at risk for nodal metastasis due to grade 3 cancer and/or primary tumor diameter>2cm (LND cohort). This is a historic approach at this institution. At the other institution, a sentinel lymph node mapping algorithm was used per institutional protocol (SLN cohort). Low risk was defined as endometrioid adenocarcinoma with myometrial invasion <50%. Macrometastasis, micrometastasis, and isolated tumor cells were all considered node-positive. ResultsOf 1135 cases identified, 642 (57%) were managed with an SLN approach and 493 (43%) with an LND approach. Pelvic nodes (PLNs) were removed in 93% and 58% of patients, respectively (P<0.001); para-aortic nodes (PANs) were removed in 14.5% and 50% of patients, respectively (P<0.001). Median number of PLNs removed was 6 and 34, respectively; median number of PANs removed was 5 and 16, respectively (both P<0.001). Metastasis to PLNs was detected in 5.1% and 2.6% of patients, respectively (P=0.03), and to PANs in 0.8% and 1.0%, respectively (P=0.75). The 3-year disease-free survival rates were 94.9% (95% CI, 92.4–97.5) and 96.8% (95% CI, 95.2–98.5), respectively. ConclusionsOur findings support the use of either strategy for endometrial cancer staging, with no apparent detriment in adhering to the SLN algorithm. The clinical significance of disease detected on ultrastaging and the role of adjuvant therapy is yet to be determined.

Sentinel lymph node mapping with pathologic ultrastaging: A valuable tool for assessing nodal metastasis in low-grade endometrial cancer with superficial myoinvasion

ObjectiveTo report the incidence of nodal metastases in patients presenting with presumed low-grade endometrioid adenocarcinomas using a sentinel lymph node (SLN) mapping protocol including pathologic ultrastaging. MethodsAll patients from 9/2005 to 12/2011 who underwent endometrial cancer staging surgery with attempted SLN mapping for preoperative grade 1 (G1) or grade 2 (G2) tumors with <50% invasion on final pathology, were included. All lymph nodes were examined with hematoxylin and eosin (H&E). Negative SLNs were further examined using an ultrastaging protocol to detect micrometastases and isolated tumor cells. ResultsOf 425 patients, lymph node metastasis was found in 25 patients (5.9%) on final pathology—13 cases on routine H&E, 12 cases after ultrastaging. Patients whose tumors had a DMI <50% were more likely to have positive SLNs on routine H&E (p<0.005) or after ultrastaging (p=0.01) compared to those without myoinvasion. ConclusionsApplying a standardized SLN mapping algorithm with ultrastaging allows for the detection of nodal disease in a presumably low-risk group of patients who in some practices may not undergo any nodal evaluation. Ultrastaging of SLNs can likely be eliminated in endometrioid adenocarcinoma with no myoinvasion. The long-term clinical significance of ultrastage-detected nodal disease requires further investigation as recurrences were noted in some of these cases.

The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: Beyond removal of blue nodes

The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: Beyond removal of blue nodes

Impact of sentinel lymph node mapping algorithm on identification of stage IIIC endometrial cancer

Impact of sentinel lymph node mapping algorithm on identification of stage IIIC endometrial cancer