Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis

Smith, Anna Jo Bodurtha; Fader, Amanda N.; Tanner, Edward J.

doi:10.1016/j.ajog.2016.11.1033

Cited by 248 publications

(169 citation statements)

References 70 publications

Supporting

Mentioning

150

Contrasting

Unclassified

Order By: Relevance

“…The results of the SENTI-ENDO and FIRES studies were supported by a large meta-analysis study 37. Among nearly 5000 patients from 55 accumulative studies, the sensitivity of SLN mapping in detecting metastatic disease reached 96% with a pooled negative predictive value of 99.7%.…”

Section: Establishing the Accuracy Of Sln Biopsy For Endometrial Cancermentioning

confidence: 86%

Current state of sentinel lymph nodes for women with endometrial cancer

Rossi

2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

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.

show abstract

Section: Establishing the Accuracy Of Sln Biopsy For Endometrial Cancermentioning

confidence: 86%

Current state of sentinel lymph nodes for women with endometrial cancer

Rossi

2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

show abstract

“…Sentinel lymph node mapping has been introduced into the surgical staging of endometrial cancer with the goal to reduce morbidity associated with comprehensive lymphadenectomy and to obtain prognostic information from lymph node status. A recent meta‐analysis reported overall detection rates higher than 80%, with 50% bilateral pelvic node detection rate and 17% para‐aortic detection rate . Use of indocyanine green increases the bilateral detection rate compared with blue dye.…”

Section: Is Lymphadenectomy Therapeutic?mentioning

confidence: 99%

Cancer of the corpus uteri

Amant

Mirza

Koskas³

et al. 2018

Intl J Gynecology & Obste

331

231

View full text Add to dashboard Cite

Endometrial cancer is the most common gynecological malignancy in high‐income countries. Although the overall prognosis is relatively good, high‐grade endometrial cancers have a tendency to recur. Recurrence needs to be prevented since the prognosis for recurrent endometrial cancer is dismal. Treatment tailored to tumor biology is the optimal strategy to balance treatment efficacy against toxicity. Standard treatment consists of hysterectomy and bilateral salpingo‐oophorectomy. Lymphadenectomy (with ongoing studies of sentinel node biopsy) enables identification of lymph node positive patients who need adjuvant treatment, including radiotherapy and chemotherapy. Adjuvant radiotherapy is used for Stage I–II patients with high‐risk factors and Stage III lymph node negative patients. In advanced disease, a combination of surgery to no residual disease and chemotherapy results in the best outcome. Surgery for recurrent disease is only advocated in patients with a good performance status with a relatively long disease‐free interval.

show abstract

“…While SLN mapping is standard practice for other solid tumors such as breast cancer and melanoma, lymphatic mapping in endometrial cancer is not without controversy. This controversy stems from the wide variability of bilateral SLN mapping rates observed in the literature, as well as continued uncertainty about optimal injection strategy 3. In a recently completed prospective trial (FIRES) evaluating the false-negative rate of SLN mapping using indocyanine green dye for endometrial cancer, SLNs were identified bilaterally in only 52% of patients.…”

Section: Introductionmentioning

confidence: 99%

Risk of empty lymph node packets in sentinel lymph node mapping for endometrial cancer using indocyanine green

Thomaier

Jager

Stone

et al. 2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

ObjectiveTo determine whether the rate of sentinel lymph node (SLN) dissections that do not yield a lymph node on pathological analysis ('empty packet dissection') changes with increasing surgeon experience in the setting of patients undergoing minimally invasive hysterectomy and SLN mapping using indocyanine green dye for endometrial cancer.MethodsAll patients undergoing SLN mapping using indocyanine green dye at the time of minimally invasive hysterectomy for endometrial cancer or complex atypical hyperplasia were identified between January 2013 and September 2017 at our institution. All surgeons had prior experience performing SLN mapping for endometrial cancer using other methods. The rate of empty packet dissections and SLN counts were evaluated using a logistic regression model analysis.ResultsIn total, 236 patients undergoing SLN mapping for either endometrial cancer (85%) or complex atypical hyperplasia (15%) were identified from a prospectively maintained database. When examining all six surgeons together, the percentage of empty packet dissections decreased with increasing number of procedures performed. Each additional procedure was associated with a 3.6% reduction in the odds of an empty packet SLN dissection. After adjusting for individual surgeons, each additional procedure was associated with a 4.9% reduction in the odds of an empty packet. The expected odds of an empty packet after 10 additional procedures decreased by 40.1% (95% CI 12.4% to 58.6%). The addition of two covariates (age and body mass index) did not contribute significantly to the model (likelihood ratio test: X2=2.75, p=0.25). The rate of empty packets appeared to stabilize after approximately 30 procedures. The number of SLNs removed did not change with increasing surgeon experience.ConclusionThe rate of empty packet SLN dissections using indocyanine green dye decreases with increasing number of procedures. This stabilizes after 30 procedures, suggesting completion of a learning curve.

show abstract

Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis

Cited by 248 publications

References 70 publications

Current state of sentinel lymph nodes for women with endometrial cancer

Current state of sentinel lymph nodes for women with endometrial cancer

Cancer of the corpus uteri

Risk of empty lymph node packets in sentinel lymph node mapping for endometrial cancer using indocyanine green

Contact Info

Product

Resources

About