Sentinel lymph node biopsy in high-grade endometrial cancer: a systematic review and meta-analysis of performance characteristics

Marchocki, Zibi; Cusimano, Maria C.; Clarfield, Lauren; Kim, Soyoun Rachel; Fazelzad, Rouhi; Espin‐Garcia, Osvaldo; Bouchard-Fortier, Geneviève; Rossi, Emma; Stewart, K.I.; Soliman, Pamela T.; How, Jeffrey; Gotlieb, Walter H.; Holloway, Robert W.; Ianieri, Manuel Maria; Cabrera, Sílvia; Lim, Yong Kuei; Ferguson, Sarah E.

doi:10.1016/j.ajog.2021.05.034

Cited by 49 publications

(34 citation statements)

References 51 publications

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“…SLN should be performed at centres with sufficient surgical volume. In conclusion, the accuracy of sentinel lymph node biopsy to detect LNM also in patients with high-grade EC facilitates surgical staging with limited surgery-related morbidity [ 31 ].…”

Section: Factors Incorporated In Surgical Stagingmentioning

confidence: 99%

Risk Stratification of Endometrial Cancer Patients: FIGO Stage, Biomarkers and Molecular Classification

Kasius¹,

Pijnenborg

Lindemann

et al. 2021

Cancers

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Endometrial cancer (EC) is the most common gynaecologic malignancy in developed countries. The main challenge in EC management is to correctly estimate the risk of metastases at diagnosis and the risk to develop recurrences in the future. Risk stratification determines the need for surgical staging and adjuvant treatment. Detection of occult, microscopic metastases upstages patients, provides important prognostic information and guides adjuvant treatment. The molecular classification subdivides EC into four prognostic subgroups: POLE ultramutated; mismatch repair deficient (MMRd); nonspecific molecular profile (NSMP); and TP53 mutated (p53abn). How surgical staging should be adjusted based on preoperative molecular profiling is currently unknown. Moreover, little is known whether and how other known prognostic biomarkers affect prognosis prediction independent of or in addition to these molecular subgroups. This review summarizes the factors incorporated in surgical staging (i.e., peritoneal washing, lymph node dissection, omentectomy and peritoneal biopsies), and its impact on prognosis and adjuvant treatment decisions in an era of molecular classification of EC. Moreover, the relation between FIGO stage and molecular classification is evaluated including the current gaps in knowledge and future perspectives.

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Section: Factors Incorporated In Surgical Stagingmentioning

confidence: 99%

Risk Stratification of Endometrial Cancer Patients: FIGO Stage, Biomarkers and Molecular Classification

Kasius¹,

Pijnenborg

Lindemann

et al. 2021

Cancers

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“…The diagnostic accuracy of SLN mapping using ICG in high-grade EC was more recently evaluated in a systematic review and meta-analysis [ 72 ]. All the prospective studies of patients with clinical stage 1 high-grade EC undergoing SLN mapping with cervical injection of IGC and at least bilateral pelvic LND as the reference standard were identified.…”

Section: Accuracy Of Sentinel Lymph Node Mapping In High-grade Endome...mentioning

confidence: 99%

“…SLN mapping can accurately detect lymphatic spread, but whether recurrence-free and overall survival are compromised with this procedure compared to complete lymphadenectomy remains unclear [ 26 , 72 ]. There are no prospective data comparing the oncologic outcomes of SLN mapping compared to lymphadenectomy, but retrospective studies have failed to show any significant difference in survival in patients with confirmed nodal metastases undergoing SLN mapping versus traditional lymphadenectomy [ 75 , 76 ].…”

Section: Accuracy Of Sentinel Lymph Node Mapping In High-grade Endome...mentioning

confidence: 99%

Sentinel Lymph Node Mapping in High-Grade Endometrial Cancer

et al. 2022

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Sentinel lymph node (SLN) mapping is becoming an acceptable alternative to full lymphadenectomy for evaluating lymphatic spread in clinical stage I endometrial cancer (EC). While the assessment of pelvic and para-aortic lymph nodes is part of the surgical staging of EC, there is a long-standing debate over the therapeutic value of full lymphadenectomy in this setting. Although lymphadenectomy offers critical information on lymphatic spread and prognosis, most patients will not derive oncologic benefit from this procedure as the majority of patients do not have lymph node involvement. SLN mapping offers prognostic information while simultaneously avoiding the morbidity associated with an extensive and often unnecessary lymphadenectomy. A key factor in the decision making when planning for EC surgery is the histologic subtype. Since the risk of lymphatic spread is less than 5% in low-grade EC, these patients might not benefit from lymph node assessment. Nonetheless, in high-grade EC, the risk for lymph node metastases is much higher (20–30%); therefore, it is crucial to determine the spread of disease both for determining prognosis and for tailoring the appropriate adjuvant treatment. Studies on the accuracy of SLN mapping in high-grade EC have shown a detection rate of over 90%. The available evidence supports adopting the SLN approach as an accurate method for surgical staging. However, there is a paucity of prospective data on the long-term oncologic outcome for patients undergoing SLN mapping in high-grade EC, and more trials are warranted to answer this question.

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“…One endometrial cancer study showed a sensitivity of 96% and a negative predictive value of 99% for SLN detection of lymph node metastases, showing that SLN and lymphadenectomy were similar in diagnostic accuracy and prognosis for patients with high-grade endometrial cancer ( 47 , 48 ). A systematic review included data from 429 patients in nine prospective cohort studies to explore the value of SLN biopsy in high-grade endometrial cancer ( 49 ). All patients were clinically diagnosed with stage I high-grade endometrial cancers, and all of them were injected with indocyanine green at the cervix to detect SLNs ( 49 ).…”

Section: Introduction To Sentinel Lymph Node Techniquesmentioning

confidence: 99%

Sentinel Lymph Node Mapping: Current Applications and Future Perspectives in Gynecology Malignant Tumors

Wang

Shao

et al. 2022

Front. Med.

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The sentinel lymph nodes (SLNs) is a group of lymph nodes initially involved in the metastatic spread of cancer cells. SLN mapping refers to intraoperative localization and biopsy of SLNs with specific tracers to assess lymph node metastases. It is widely used in a variety of tumor surgeries for its high sensitivity and high negative predictive value. In the evaluation of the status of lymph node metastases in gynecological malignancies, it has received increasingly more attention due to its minor invasiveness, few complications, and high diagnosis rate. The National Comprehensive Cancer Network (NCCN) guidelines provide an excellent introduction to the indications and methods of SLN techniques in vulvar, cervical, and endometrial cancers, but they provide little explanation about some specific issues. In this review, we summarize different dyes and injection methods and discuss the indications of application and the clinical trials of SLN mapping in gynecological malignant tumors, aiming to provide a reference for the rational application of sentinel techniques in gynecology malignant tumors before relevant guidelines are updated.

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Sentinel lymph node biopsy in high-grade endometrial cancer: a systematic review and meta-analysis of performance characteristics

Cited by 49 publications

References 51 publications

Risk Stratification of Endometrial Cancer Patients: FIGO Stage, Biomarkers and Molecular Classification

Risk Stratification of Endometrial Cancer Patients: FIGO Stage, Biomarkers and Molecular Classification

Sentinel Lymph Node Mapping in High-Grade Endometrial Cancer

Sentinel Lymph Node Mapping: Current Applications and Future Perspectives in Gynecology Malignant Tumors

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