Anatomic Asymmetry in Sentinel Lymph Node Detection in Endometrial Cancer

Tal, Ori; Grinstein, Ehud; Goshen, Elinor; Oksman, Yakov; Lorberboym, Mordechai; Elyashiv, Osnat; Shem, Erez Ben; Peled, Ofri; Levy, Tally

doi:10.1016/j.jmig.2020.12.029

Cited by 8 publications

(5 citation statements)

References 21 publications

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“…It has been reported as the most common drainage pathway in EC [22]. It was detected in most cases during SLN mapping in EC, regardless of the injection site (cervical or fundal injection of tracers) [23]. In our study, cervical injection was done in all cases.…”

Section: Discussionmentioning

confidence: 74%

Comparison of sentinel lymph node distribution and lymphatic drainage pathway between high- and low-risk endometrial cancers

Chen

Liang

et al. 2023

Arch Gynecol Obstet

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This study aimed to compare the distribution and drainage pathway of sentinel lymph nodes between high-and low-risk endometrial cancers. MethodsIn total, 429 patients with endometrial cancer who underwent sentinel lymph node biopsy in Peking University People's Hospital from July 2015 to April 2022 were retrospectively enrolled. There were 148 patients in the high-risk group and 281 patients in the low-risk group. ResultsThe unilateral and bilateral detection rates of sentinel lymph nodes were 86.5% and 55.9%, respectively.The highest detection rate was achieved in the subgroup with a combined use of Indocyanine green (ICG) and Carbon nanoparticles (CNP) (94.9% for unilateral detection and 66.7% for bilateral detection). The upper paracervical pathway (UPP) was detected in 93.3% of cases in the high-risk group and 96.0% of cases in the low-risk group (p = 0.261). The lower paracervical pathway (LPP) was detected in 10.0% of cases in the high-risk group and 17.9% of cases in the low-risk group (p = 0.048). Remarkably increased detection rates of SLN in the common iliac (7.5%) and para-aortic or precaval areas (2.9%) were observed in the high-risk group. In contrast, a markedly decreased detection rate of SLN in the internal iliac area (1.9%) was observed in the high-risk group. ConclusionThe combined use of ICG and CNP improved the bilateral detection rate of SLN in the high-risk group. The detection of UPP is important for both high-risk and low-risk cases, while LPP detection plays a more important role in the low-risk group. Lymphadenectomy in the common iliac and para-aortic or precaval areas is essential for patients with high-risk EC. Removal of internal iliac lymph nodes is essential for patients with low-risk EC, in case of ineffective SLN mapping.

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Section: Discussionmentioning

confidence: 74%

Comparison of sentinel lymph node distribution and lymphatic drainage pathway between high- and low-risk endometrial cancers

Chen

Liang

et al. 2023

Arch Gynecol Obstet

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“…We had better detection rates with ICG, though our detection rates with the double tracer were lower than the one published in the meta-analysis; this trend was similarly seen in terms of bilateral detection rates (74% vs. 59% vs. 57%, respectively), although not achieving our bilateral rates or significance. In addition, a study [ 26 ] that compared Tc99m alone vs. ICG + Tc99m, with a lower number of patients, had a non-significant better bilateral rate with the combination of both tracers than ICG alone (87.3% vs. 75%). In comparison with our study, we had a significant difference in favor of ICG alone and higher percentages of detection of approximately 99% and 90%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Few papers have been published comparing ICG with Tc99m + ICG, but in a study [ 26 ] that compared Tc99m alone vs. ICG + Tc99m, the total bilateral detection rate was 72.1%, without significant differences between ICG as a single tracer and Tc99m + ICG (75% vs. 87.3%, respectively; p = 0.1). In a recent meta-analysis [ 27 ], researchers showed that SLN mapping with ICG has a high overall detection rate of 95.6% (95% CI = 92.4–97.9%) and a bilateral detection rate of 76.5% (95% CI = 68.1–84.0) in low- and intermediate-risk endometrial cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Personalized Sentinel Node Mapping in Endometrial Cancer by the Indocyanine Green Implementation as Single Tracer: A Case Control Study

Quevedo

Cristóbal

Gracia

et al. 2023

JPM

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The main objective was to analyze the rate of bilateral sentinel lymph node (SLN) detection in endometrial cancer using indocyanine green (ICG) as a unique tracer compared to Technetium99 + ICG. As secondary objectives, we analyzed the drainage pattern and factors that might affect the oncological outcomes. A case-control ambispective study was carried out on consecutive patients at our center. Data on the SLN biopsy with ICG collected prospectively were compared to retrospective data on the use of a double-tracer technique including Technetium99 + ICG. In total, 194 patients were enrolled and assigned to both groups, in which the group with both tracers (controls) included 107 (54.9%) patients and the ICG-alone group (cases) included 87 (45.1%) patients. The rate of bilateral drainage was significantly higher in the ICG group (98.9% vs. 89.7%; p = 0.013). The median number of nodes retrieved was higher in the control group (three vs. two nodes; p < 0.01). We did not find survival differences associated with the tracer used (p = 0.85). We showed significant differences in terms of disease-free survival regarding the SLN location (p < 0.01), and obturator fossa retrieved nodes showed better prognosis compared to external iliac. The use of ICG as a single tracer for SLN detection in endometrial cancer patients seemed to obtain higher rates of bilateral detection with similar oncological outcomes.

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“…Several tracers for identification of the SLN and techniques for their application have been reported ( 16 , 17 , 18 , 19 , 20 ). The total detection rate varies and it is lowest for blue dye as a single tracer 71-76% ( 14 , 16 ), while the best results are obtained using the double-tracer (dual detection) method, which combines radiocolloid and indocyanine green, with a detection rate of 91-100% and a bilateral detection rate of 69-87.3% ( 17 , 18 , 19 ). Furthermore, future studies concerning SLN biopsy in EC with hybrid tracer (fluorescent and radioactive tracer) would be beneficial as this tracer contains advantages of both compounds.…”

Section: Discussionmentioning

confidence: 99%

The Evaluation of Sentinel Lymph Node Biopsy Using Radiocolloid in First Stage Endometrial Cancer

Jankulovska¹,

Stojanoski²,

Stojcevski³

et al. 2023

Mirt

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Objectives: Detection of a sentinel lymph node (SLN) in patients with endometrial cancer (EC) reduces the rate of unnecessary systemic lymph dissection. The aim of this study was to assess the SLN detection rate, accuracy of the method using Tc-99m-SENTI-SCINT and the rate of metastatic nodal involvement in patients with preoperative first stage EC. Methods: A prospective study of SLN biopsy of 41 patients with stage I EC was conducted after cervical application of 4mCi Tc-99m-SENTI-SCINT. Planar lymphoscintigraphy and single-photon emission computed tomography/computed tomography (SPECT/CT) of the pelvis were performed, followed by site-specific lymphadenectomy in intermediate-risk patients if no SLN was detected per hemipelvis and pelvic lymphadenectomy in all high-risk patients. Results: Pre-operative detection rate of planar lymphoscintigraphy was 80.49 [95% confidence interval (CI): 68.36-92.62] and of SPECT/CT 95.12 (95% CI: 88.52-101.7). The total intraoperative SLN detection rate was 95.12 (95% CI: 88.52-101.7) per patient and 26.83 (95% CI: 19.91-33.75) bilaterally. The average number of SLNs removed was 1.6±0.8. The most common anatomical location of SLN was the right external iliac region. The SLN metastatic rate was 17%. Both sensitivity and negative predictive value regarding metastatic involvement were 100%. Conclusion: The SLN detection rate, sensitivity and negative predictive value using Tc-99m-SENTI-SCINT in patients with EC in our study were high. The application of ultra-staging in the histopathological analysis of SLN increases the detection of nodal metastases and improves the staging in these patients.

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Anatomic Asymmetry in Sentinel Lymph Node Detection in Endometrial Cancer

Cited by 8 publications

References 21 publications

Comparison of sentinel lymph node distribution and lymphatic drainage pathway between high- and low-risk endometrial cancers

Comparison of sentinel lymph node distribution and lymphatic drainage pathway between high- and low-risk endometrial cancers

Personalized Sentinel Node Mapping in Endometrial Cancer by the Indocyanine Green Implementation as Single Tracer: A Case Control Study

The Evaluation of Sentinel Lymph Node Biopsy Using Radiocolloid in First Stage Endometrial Cancer

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