Laparoscopic sentinel node mapping with intracervical indocyanine green injection for endometrial cancer: the SENTIFAIL study – a multicentric analysis of predictors of failed mapping

Sozzi, Giulio; Fanfani, Francesco; Berretta, Roberto; Uccella, Stefano; Buono, Natalina; Giallombardo, Vincenzo; Donna, Mariano Catello Di; Monterossi, Giorgia; Restaino, Stefano; Capasso, Ilaria; Dinoi, Giorgia; Scambia, Giovanni; Chiàntera, Vito

doi:10.1136/ijgc-2020-001724

Cited by 38 publications

(36 citation statements)

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“…As already noticed by and Sozzi et al. ( 35 ) (age ≥ 65 OR: 1.8, 95% CI: 1.14–2.98, p = 0.012) and Tortorella et al. ( 20 ) (OR: 1.41 per 10-year increase in age, 95% CI: 1.08–1.84; p = 0.01), older age was linked to unsuccessful mapping but only at univariate analysis.…”

Section: Discussionsupporting

confidence: 70%

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Sentinel Lymph Node in Aged Endometrial Cancer Patients “The SAGE Study”: A Multicenter Experience

Cianci¹,

Rosati

Vargiu

et al. 2021

Front. Oncol.

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ObjectiveThe incidence of endometrial cancer is increasing in elderly people. Considering that aging progressively affects lymphatic draining function, we aimed to define its impact on IGC uptake during SLN mapping.MethodsA multicenter retrospective cohort of endometrial cancer patients with apparently early-stage endometrial cancer undergoing complete surgical staging with SLN dissection was identified in four referral cancer centers from May 2015 to March 2021. Patients were classified in Group 1 (<65 years old) and Group 2 (≥65 years old). The primary endpoint was the assessment of the overall, bilateral, and unsuccessful SLN mapping in the two groups. Secondary outcomes were the evaluation of SLN anatomical distribution and the identification of predictors for mapping failure applying a logistic regression.ResultsA total of 844 patients were enrolled in the study (499 in Group 1 and 395 in Group 2). The overall detection rate, the successful bilateral mapping, and the mapping failure rate of the SLN were 93.8% vs. 87.6% (p = 0.002), 77.1% vs. 66.8% (p = 0.001), and 22.9% vs. 33.2% (p = 0.001), respectively, in Group 1 vs. Group 2. The advanced age affects the anatomical distribution of the SLN leading to a stepwise reduction of “unexpected” mapping sites (left hemipelvis: p < 0.001; right hemipelvis: p = 0.058). At multivariate analysis age ≥ 65 (OR: 1.495, 95% CI: 1.095–2.042, p = 0.011), BMI (OR: 1.023, 95% CI: 1.000–1.046, p = 0.047), non-endometrioid histotype (OR: 1.619, 95% CI: 1.067–2.458, p = 0.024), and LVSI (OR: 1.407, 95% CI: 1.010–1.961, p = 0.044) represent independent predictors of unsuccessful mapping. Applying binomial logistic regression analysis, there was a 1.280-fold increase in the risk of failed mapping for every 10-year-old increase in age (OR: 1.280, 95% CI: 1.108–1.479, p = 0.001). A higher rate of surgical under-staging (0.9% vs. 3.3%, p = 0.012) and adjuvant undertreatment (p = 0.018) was reported in Group 2.ConclusionsOld age represents a risk factor for SLN mapping failure both intrinsically and in relation to the greater incidence of other independent risk factors such as LVSI, non-endometrioid histotype, and BMI. Surgeons should target the usual uptake along UPP during the SLN dissection in this subgroup of patients to minimize mapping failure and the consequent risk of surgical under-staging and adjuvant undertreatment.

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Section: Discussionsupporting

confidence: 70%

“…These two histopathological features, meanwhile represent independent predictors for mapping failure, as already emphasized by Sozzi et al. ( 35 ).…”

Section: Discussionmentioning

confidence: 63%

Sentinel Lymph Node in Aged Endometrial Cancer Patients “The SAGE Study”: A Multicenter Experience

Cianci¹,

Rosati

Vargiu

et al. 2021

Front. Oncol.

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“…At present, lymph vascular space invasion (LVSI), non-endometroid histology is seen as independent risk factors for failed mapping ( 75 ). The false negative SLN was more likely to appear in unilateral mapping failure patient.…”

Section: The Diagnostic Accuracy Of Slnmmentioning

confidence: 99%

Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review

et al. 2021

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Endometrial cancer (EC) is known as a common gynecological malignancy. The incidence rate is on the increase annually. Lymph node status plays a crucial role in evaluating the prognosis and selecting adjuvant therapy. Currently, the patients with high-risk (not comply with any of the following: (1) well-differentiated or moderately differentiated, pathological grade G1 or G2; (2) myometrial invasion< 1/2; (3) tumor diameter < 2 cm are commonly recommended for a systematic lymphadenectomy (LAD). However, conventional LAD shows high complication incidence and uncertain survival benefits. Sentinel lymph node (SLN) refers to the first lymph node that is passed by the lymphatic metastasis of the primary malignant tumor through the regional lymphatic drainage pathway and can indicate the involvement of lymph nodes across the drainage area. Mounting evidence has demonstrated a high detection rate (DR), sensitivity, and negative predictive value (NPV) in patients with early-stage lower risk EC using sentinel lymph node mapping (SLNM) with pathologic ultra-staging. Meanwhile, SLNM did not compromise the patient’s progression-free survival (PFS) and overall survival (OS) with low operative complications. However, the application of SLNM in early-stage high-risk EC patients remains controversial. As revealed by the recent studies, SLNM may also be feasible, effective, and safe in high-risk patients. This review aims at making a systematic description of the progress made in the application of SLNM in the treatment of EC and the relevant controversies, including the application of SLNM in high-risk patients.

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“…When we analysed the factors that potentially infl uence bilateral SLN detection in the entire cohort, we found that age was the only patient-related signifi cant variable, confi rmed at multivariable analysis. Most of the studies previously reported other variables signifi cantly related with bilateral SLN mapping, such as use of ICG, low BMI, no clinically enlarged lymph nodes, early FIGO stage, no lysis of adhesions at the beginning of surgery and surgeon's experience in SLN biopsy (Eriksson et al, 2016;Tanner et al, 2015;Tortorella et al, 2019;Body et al, 2018;Harold et al, 2019;Sozzi et al, 2020). The relationship between increased age and lymphatic dysfunction has been described: in particular, cell senescence, impaired contractile function and decrease of nitric oxide in aged lymphatic collectors, may lead to poor drainage of lymph, causing bilateral mapping failure (Shang et al, 2019).…”

Section: Resultsmentioning

confidence: 99%

Sentinel lymph node detection in endometrial cancer with indocyanine green: laparoscopic versus robotic approach.

Bizzarri

Restaino

Alletti

et al. 2021

Facts Views Vis ObGyn

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Background: The aims of the present study were to assess bilateral sentinel lymph node (SLN) mapping with laparoscopic versus robotic approach, to assess variables affecting bilateral detection rates and to assess survival difference in patients with no/unilateral, compared to bilateral SLN detection. Methods: This is a retrospective, single-centre, observational cohort study, including patients with endometrial cancer FIGO stage IA-IVB, treated with minimally invasive primary surgery and undergoing indocyanine green (ICG) injection to detect SLN, between January 2015 and December 2019. Results: Of the 549 included patients, 286 (52.1%) and 263 (47.9%) underwent the laparoscopic and robotic approach respectively. 387 (70.5%) patients had bilateral SLN mapping, 102 (18.6%) and 60 (10.9%) had unilateral and no mapping, respectively. Patients who underwent the robotic approach were older (median 61 versus 64 years, p=0.046) and had a higher BMI (median 26.0 versus 34.8 kg/m2, p<0.001). No difference in any SLN mapping or in SLN bilateral detection was evident between the laparoscopic or robotic approach (p=0.892 and p=0.507 respectively). Patients with bilateral SLN detection in the entire cohort were younger (p<0.001) and had a better 3-year disease-free survival (DFS) compared to patients with no/unilateral SLN mapping (77.0% versus 66.3%, respectively, p=0.036). No 3-year overall survival (OS) difference was reported (p=0.491). Conclusion: SLN mapping and bilateral SLN detection with ICG in endometrial cancer was not different in the laparoscopic and robotic approach, even though patients undergoing the robotic approach were older and more obese. Bilateral SLN detection was associated with improved 3-year DFS, but not with 3-year OS, compared to no and unilateral SLN detection.

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Laparoscopic sentinel node mapping with intracervical indocyanine green injection for endometrial cancer: the SENTIFAIL study – a multicentric analysis of predictors of failed mapping

Cited by 38 publications

References 25 publications

Sentinel Lymph Node in Aged Endometrial Cancer Patients “The SAGE Study”: A Multicenter Experience

Sentinel Lymph Node in Aged Endometrial Cancer Patients “The SAGE Study”: A Multicenter Experience

Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review

Sentinel lymph node detection in endometrial cancer with indocyanine green: laparoscopic versus robotic approach.

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