A prospective validation study of sentinel lymph node mapping for high-risk endometrial cancer

Abstract

Objective Sentinel lymph node (SLN) mapping continues to evolve in the surgical staging of endometrial cancer (EC). The purpose of this trial was to identify the sensitivity, false negative rate (FNR) and FN predictive value (FNPV) of SLN compared to complete pelvic and para-aortic lymphadenectomy (LAD) in women with high-risk EC. Methods Women with high-risk EC (grade 3, serous, clear cell, carcinosarcoma) were enrolled in this prospective surgical trial. All patients underwent preoperative PET/CT and intraoperative SLN biopsy followed by LAD. Patients with peritoneal disease on imaging or at the time of surgery were excluded. Patients were evaluable if SLN was attempted and complete LAD was performed. Results 123 patients were enrolled between 4/13 and 5/16; 101 were evaluable. At least 1 SLN was identified in 89% (90); bilateral detection 58%, unilateral pelvic 40%, para-aortic only 2%. Indocyanine green was used in 61%, blue dye in 28%, and blue dye and technetium in 11%. Twenty-three pts (23%) had ≥ 1 positive node. In 20/23, ≥ 1 SLN was identified and in 19/20 the SLN was positive. Only 1 patient had bilateral negative SLN and positive non-SLNs on final pathology. Overall, sensitivity of SLN was 95% (19/20), FNR was 5% (1/20) and FNPV was 1.4% (1/71). If side-specific LAD was performed when a SLN was not detected, the FNR decreased to 4.3% (1/23). Conclusion This prospective trial demonstrated that SLN biopsy plus side-specific LAD, when SLN is not detected, is a reasonable alternative to a complete LAD in high-risk endometrial cancer.

Preoperative PET/CT does not accurately detect extrauterine disease in patients with newly diagnosed high‐risk endometrial cancer: A prospective study

“…5 Cancer October 1, 2019 If peritoneal disease was encountered during surgery, sentinel lymph node mapping and lymphadenectomy were performed at the discretion of the surgeon.…”

“…This decision was based on prospective data published by the Gynecologic Oncology Group (GOG) that established a relationship between disease prognosis and surgically determined risk factors. 5,6 In an effort to predict extrauterine disease preoperatively and optimize surgical planning, a multitude of noninvasive techniques have been evaluated. Although complete lymphadenectomy is included in the FIGO staging of endometrial cancer, it remains controversial, especially in those patients with presumed early-stage disease.…”

Cancer of the corpus uteri

“…The sensitivity of sentinel lymph node mapping to detect metastases is higher than 90%, reaching almost 100% in a meta‐analysis . Randomized studies have suggested that sentinel lymph node mapping can safely replace lymphadenectomy in the staging of endometrial cancer …”

Current state of sentinel lymph nodes for women with endometrial cancer

“…The largest, dedicated clinical trial that has addressed this question was conducted by Soliman et al38 This single institution, prospective trial enrolled 101 evaluable patients with exclusively high-grade cancers. The authors defined high risk as serous, clear cell, carcinosarcoma and FIGO (International Federation of Gynecology and Obstetrics) grade 3 endometrioid histology, patients with biopsy-proven cervical involvement or deeply invasive (on imaging) grade 1 or 2 disease.…”