Aortic sentinel node detection in endometrial cancer: 6 year prospective study

Gorostidi, Mikel; Ruiz, Rubén; Cespedes, Juan Carlos; Jaunarena, Ibón; Cobas, Paloma; Lekuona, Arantxa; Díez, Irene Díaz

doi:10.1016/j.jogoh.2023.102584

Cited by 4 publications

(1 citation statement)

References 25 publications

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“…In the same vein, there are some novel reports in the literature on the active search for the para-aortic sentinel lymph nodes through the IPP. In light of various meta-analyses, we injected carbon dye into the cervix due to its easy applicability and high detection rates of pelvic sentinel lymph nodes [ 21 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

Sentinel lymph node biopsy with carbon dye in endometrial cancer: a single center, prospective cohort study

Minareci,

Sozen,

Altinkara Hacioglu

et al. 2024

Surg Endosc

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Background Many agents have been used for the detection of sentinel lymph nodes in endometrial cancer. Carbon dye, which has a strong staining ability and high contrast due to its dark black color, identifies the lymph nodes efficiently. Our aim was to evaluate the safety and efficacy of carbon dye for the detection of sentinel lymph nodes in endometrial cancer. Methods We conducted a single-center, prospective, cohort study in 89 patients with early-stage endometrial cancer between September 2021 and August 2022. The procedure was performed under laparoscopy. Results The sensitivity and negative predictive value of the sentinel lymph node biopsy (SLNB) with carbon dye injection were 83.3% and 98.8%, respectively. Mapping identified at least one sentinel lymph node in 84 patients (94.4%) on one pelvic side and at least one sentinel lymph node in 73 patients (82.0%) on each pelvic side out of 89 patients. In addition, no carbon dye-associated allergic reaction was detected. Conclusion Carbon dye is a non-allergenic, inexpensive, and effective agent for SLNB with a satisfying sensitivity and a negative predictive value. In addition, both unilateral and bilateral detection rates were sufficient. Accordingly, carbon dye may be a promising tracer and a considerable option, particularly for low-income countries.

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Section: Discussionmentioning

confidence: 99%

Sentinel lymph node biopsy with carbon dye in endometrial cancer: a single center, prospective cohort study

Minareci,

Sozen,

Altinkara Hacioglu

et al. 2024

Surg Endosc

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Role of sentinel lymph node biopsy with indocyanine green and site of injection in endometrial cancer

Raimondo,

Raffone,

Aguzzi

et al. 2024

Current Opinion in Oncology

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Purpose of review The aim of the present narrative review is to summarize the state of art on sentinel lymph node biopsy (SLNB) in endometrial cancer, with a special focus on indocyanine green (ICG) as adopted tracer. Recent findings Over the years, the surgical nodal staging in patients with endometrial cancer has been intensively investigated. Traditionally, systematic pelvic and para-aortic lymphadenectomy represented the gold standard surgical treatment to assess nodal involvement of the tumor. Through the last two decades, SLNB has gradually replaced lymphadenectomy as a more targeted procedure. A great heterogeneity of tracers and injection techniques have been proposed to perform SLNB. However, no universally accepted recommendations are still available. Summary SLNB has nowadays almost replaced pelvic lymphadenectomy in low-risk endometrial cancers, offering a better safety profile while being related to a comparable nodal involvement sensitivity. Currently, ICG is considered to be the most used tracer among others. Different injection sites have been proposed, with different detection features. While ICG cervical injection is nowadays the suggested technique for SLNB, noncervical injection techniques, such as hysteroscopic and combined procedures, seem to have a better accuracy in para-aortic nodal assessment, which have a role in high-risk endometrial cancers.

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Link between isolated para-aortic lymph node metastasis and intrauterine cancer site in early stage endometrial cancer

Cosma,

Ferraioli,

Borella

et al. 2024

Int J Gynecol Cancer

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ObjectiveMissing occult para-aortic lymph node metastasis is one of the primary concerns of sentinel lymph node biopsy in endometrial cancer. Our study aimed to evaluate the relationship between intrauterine cancer site and isolated para-aortic lymph node metastasis to tailor treatment and reduce the false negative rate of the sentinel lymph node procedure.MethodsA retrospective, multicenter, case control study was performed in four international centers. All patients with positive lymph nodes who had complete surgical staging with pelvic and para-aortic lymphadenectomy, between January 2013 and December 2023, were included. Detailed descriptions of the cancer location within the uterine cavity on the cranio-caudal plane and the myometrial wall involvement on the cranio-caudal and ventro-dorsal planes were collected, as were clinical data and cancer histological features. Patients with isolated para-aortic lymph node metastasis were allocated to group 1; patients with pelvic lymph node metastasis and those with both pelvic and para-aortic lymph node metastasis were allocated to group 2. The groups were compared according to the variables collected.Results200 preoperative early stage endometrial cancer patients with postoperative International Federation of Gynecology and Obstetrics 2009/2023 stage IIIC1/IIIC2 were included in our study: 42 patients (21%) with isolated para-aortic lymph node metastasis were allocated to group 1 and the remaining patients to group 2. The two groups had comparable clinical and pathological characteristics (p>0.05): mean age was 66.5±10.3 (group 1) and 63.5±11.9 (group 2); endometrioid histotype was the predominant one for both groups (50%); most patients had myometrial infiltration >50% (80.9% and 79.7%), grade 3 (61.9% and 63.9%), and lymph vascular space invasion (78.5% and 82.2%). Cancers involving the fundal uterine cavity, the fundal myometrial wall, or the anterior myometrial wall were 3.11 (1.04–9.27), 3.03 (1.12–8.21), and 2.12 (0.77–5.80) times more likely to metastasize only to para-aortic lymph nodes compared with cancers located in other uterine sites.ConclusionsIn this study, the intrauterine location of the cancer determined the site of lymph node metastasis. When the tumor involved the fundus (cavity or wall) and infiltrated exclusively the anterior wall, the baseline risk of spreading only into the para-aortic area increased significantly in selected patients at risk of nodal disease.

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Aortic sentinel node detection in endometrial cancer: 6 year prospective study

Cited by 4 publications

References 25 publications

Sentinel lymph node biopsy with carbon dye in endometrial cancer: a single center, prospective cohort study

Sentinel lymph node biopsy with carbon dye in endometrial cancer: a single center, prospective cohort study

Role of sentinel lymph node biopsy with indocyanine green and site of injection in endometrial cancer

Link between isolated para-aortic lymph node metastasis and intrauterine cancer site in early stage endometrial cancer

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