Sentinel lymph node biopsy at robotic-assisted hysterectomy for atypical hyperplasia and endometrial cancer

Abstract

Lymph node (LN) evaluation in endometrial cancer is controversial. Sentinel lymph node biopsy (SLNB) allows for an accurate nodal assessment while minimising the risks of a full pelvic lymph node dissection (PLND). The aims of this study are to examine the characteristics and peri-operative outcomes of women with atypical hyperplasia (AH) or endometrial cancer undergoing robotic-assisted hysterectomy (RAH) ± SLNB or PLND; to examine the utilisation, feasibility and role of SLNB and compare their peri-operative outcomes. Retrospective cohort study from December 2018 to February 2021 of women who underwent RAH ± LN assessment for endometrial cancer or AH. 115 women underwent RAH. 59% had SLNB, 29% had no LN assessment, and 12% had PLND. The final diagnosis was mostly early stage low-grade disease; Stage 1A-50%, Grade 1 endometrioid adenocarcinoma (EAC)-56%. The detection rate was 90%. There was a statistically significant trend towards performing SLNB over time (P value 0.004). There was a statistically shorter length of stay, less estimated blood loss, and shorter surgical duration in the SLNB cohort, compared to the no LN assessment cohort (P values 0.02, 0.01, and 0.03, respectively). There was statistically significant less estimated blood loss and surgical duration in the SLNB compared to the PLND cohort (P values 0.03 and 0.001, respectively). SLNB at RAH was utilised and feasible. It was safe with a low complication rate and had advantages compared to PLND cohort. SLNB should be considered in suitable selected women undergoing surgery for endometrial cancer or AH.

Atypical Endometrial Hyperplasia and Concurrent Cancer: A Comprehensive Overview on a Challenging Clinical Condition

“…As shown in Table 6 , the selected articles were all retrospective studies and considered a total of 22,201 women [ 3 , 4 , 43 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ]. The rate of occult endometrial carcinoma in patients with a preoperative diagnosis of AHE ranged from 27.2 to 53.3%, consistent with the previous literature [ 1 , 2 ].…”

“…El-Achi et al conducted a retrospective study with 29 patients with a preoperative diagnosis of AEH and a rate of EC at the final histology of 41.9%. Thirteen patients had sentinel lymph node examinations, all of which were negative [ 61 ].…”

Mapping Lymph Node during Indocyanine Green Fluorescence-Imaging Guided Gastric Oncologic Surgery: Current Applications and Future Directions

“…Cabanas first put forward the concept of SLNs and believed that the metastasis of tumour cells was carried out sequentially from the primary site of the tumour to the nearest site of lymphatic drainage [ 20 ]. Hence, the concept of SLNs is vital for the establishment of LN status in patients with early-stage cancer [ 21 , 22 , 23 ]. As ICG-FI was found effective in tattooing lymph systems, it emerged as a novel technique for SLNs detection in gastric cancer [ 24 ].…”