Impact of sentinel lymph node mapping on recurrence patterns in endometrial cancer

How, Jeffrey; Gauthier, Caroline; Abitbol, Jeremie; Salvador, Shannon; Gotlieb, Raphael; Pelmus, Manuela; Ferenczy, Alex; Probst, Stephan; Brin, Sonya; Fatnassi, Asma

doi:10.1016/j.ygyno.2017.01.013

Cited by 43 publications

(30 citation statements)

References 24 publications

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“…Consistent with the findings above, a Canadian group retrospectively evaluated the oncologic outcomes of 472 cases of endometrial cancer surgeries which included their most current 275 patients who had undergone staging with SLN biopsy, and a historical cohort of 197 patients who had undergone systematic lymphadenectomy 45. They observed no difference in recurrence-free survival between the two groups but a significantly lower incidence of pelvic side-wall recurrences in the SLN group (30% vs 71%).…”

Section: Survival Outcomes In Sln Biopsy Patientsmentioning

confidence: 69%

Current state of sentinel lymph nodes for women with endometrial cancer

Rossi

2019

Int J Gynecol Cancer

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Sentinel lymph node (SLN) biopsy has been investigated as an alternative to conventional pelvic and para-aorticlymphadenectomy for the surgical staging of endometrial cancer. Clinical trials have established the accuracy of sentinel nodes in the detecting metastatic disease. Novel advancements in tracers from the historically favored blue dyes and radio labeled colloids to near infrared imaging of fluorescent dyes has improved the ability to detect sentinel nodes and increased options for surgeons. The uterine cervix has been shown to be a feasible and accurate injection site for tracer, though the potential for under-evaluation of the para-aortic nodes remains a controversy, particularly for high-risk cancers. Additionally, sentinel node evaluation provides qualitatively different information than traditional staging techniques by identifying lymph nodes outside of traditional sampling locations and through the identification of very low volume meta static disease implants, such as isolated tumor cells. It is unclear how this altered staging information should be interpreted, guide the prescription of adjuvant therapy and its impact on long term clinical outcomes such as recurrence and survival. In this review we will discuss the evidence that has supported the use of the SLN technique in the staging of endometrial cancer, the options for surgical technique and the implications of managing the results of staging pathology.

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Section: Survival Outcomes In Sln Biopsy Patientsmentioning

confidence: 69%

Current state of sentinel lymph nodes for women with endometrial cancer

Rossi

2019

Int J Gynecol Cancer

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“…In addition, the possibility of the detection of sentinel lymph nodes within the framework of paraaortic localisation is controversial. Based on references, about 10% of sentinel lymph nodes are localised in this region . The incidence of isolated metastases in this region, that is, without the involvement of pelvic lymph nodes, is reported to be about 1% to 3% .…”

Section: Discussionmentioning

confidence: 99%

One‐step nucleic acid amplification vs ultrastaging in the detection of sentinel lymph node metastasis in endometrial cancer patients

Kosťun

Pešta

Sláma

et al. 2018

Journal of Surgical Oncology

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Background and Objectives Utilisation of the one‐step nucleic acid amplification (OSNA) molecular biology method for the detection of the metastatic involvement of sentinel lymph nodes (SLNs) in endometrial cancer (EC) patients. A comparison with histopathological ultrastaging and a description of the clinical consequences. Methods Surgically treated EC patients underwent detection of SLNs. Nodes greater than 5 mm were cut into sections 2‐mm thick parallel to the short axis of the node. Odd sections were examined according to the OSNA method, while even ones according to an appropriate ultrastaging protocol. Nodes less than or equal to 5 mm were cut into halves along the longitudinal axis with one half examined according to the OSNA method and the other half by ultrastaging. Results Fifty‐eight patients were included and 135 SLNs were acquired. Both ultrastaging and OSNA agreed on 116 results. According to the OSNA method, 20.69% more patients were classified into International Federation of Gynecology and Obstetrics (FIGO) stage III. When comparing the results of the OSNA method to the conclusions of ultrastaging as a reference method, sensitivity of 90.9%, specificity of 85.5% and concordance of 85.9% were attained. Conclusions The results of the OSNA method showed a higher frequency of detection of micrometastases and included 20.69% more patients into FIGO stage III.

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“…The use of the SLN technique allows metastatic lymph nodes to be found with a less radical surgery 26. How et al27 also described a lower incidence of lateral pelvic disease recurrences of up to 68%. Since the risk of finding metastasis in non-SLN patients is small, an accurate intra-operative analysis of the SLNs could be an opportunity to individualize the surgical management and adjuvant treatment of the patient.…”

Section: Discussionmentioning

confidence: 99%

Intra-operative assessment of sentinel lymph node status by one-step nucleic acid amplification assay (OSNA) in early endometrial cancer: a prospective study

Monterossi

Buca

Dinoi

et al. 2019

Int J Gynecol Cancer

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BackgroundSentinel node mapping has been proposed to reduce surgical side effects, maintaining the accuracy in nodal status assessment for endometrial cancer.ObjectiveTo investigate the role of one-step nucleic acid amplification assay (OSNA) analysis, in the intra-operative tailoring of full nodal dissection, and to analyze the correlation between the type of sentinel node metastasis and the risk of non-sentinel node metastasis.MethodsSurgical and pathological data were collected from 141 consecutive, clinical stage I patients with endometrial cancer undergoing surgical staging. Patients were excluded if they had previous pelvic or abdominal radiotherapy, chemotherapy, abdominal cancer, pelvic or abdominal lymphadenectomy, or contraindications to indocyanine green. All sentinel nodes were analyzed by OSNA, and full lymphadenectomy was performed in positive cases. Statistical analysis was performed using Χ2 and Fisher's exact test to determine whether any of these characteristics could accurately predict the non-sentinel nodes status in positive sentinel node patients.ResultsA total of 141 patients were included in the analysis. Bilateral sentinel nodes were identified in 104 (73.8%) patients, with a median number of 2 (range 2–6) sentinel nodes per patient. In the remaining 37 patients (26.2%), a unilateral sentinel node was obtained, with a median of 1 (range 1–3) sentinel node per patient. Thirty-three (12.0%) positive nodes were found in 24 (17.0%) patients: micro-metastases and macro-metastases were detected in 22 and 2 patients, respectively. At final pathology, all patients with positive non-sentinel nodes had macro-metastases in the sentinel node, whereas in micro-metastatic sentinel nodes no other positive nodes were found at full lymphadenectomy (p<0.001).ConclusionsOur results showed a correlation between the type of metastasis in the sentinel lymph node (SLN) and the incidence of positive non-SLNs. These data suggest a potential role of OSNA analysis in the surgical tailoring of patients with early endometrial cancer, with the goal of definitive risk stratification and a better individualization of adjuvant therapy.

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Impact of sentinel lymph node mapping on recurrence patterns in endometrial cancer

Cited by 43 publications

References 24 publications

Current state of sentinel lymph nodes for women with endometrial cancer

Current state of sentinel lymph nodes for women with endometrial cancer

One‐step nucleic acid amplification vs ultrastaging in the detection of sentinel lymph node metastasis in endometrial cancer patients

Intra-operative assessment of sentinel lymph node status by one-step nucleic acid amplification assay (OSNA) in early endometrial cancer: a prospective study

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