Sentinel lymph node mapping in patients with endometrial hyperplasia: A practice to preserve or abandon?

Mueller, Jennifer J.; Rios-Doria, Eric; Park, Kay J.; Broach, Vance; Alektiar, Kaled M.; Jewell, Elizabeth L.; Zivanovic, Oliver; Sonoda, Yukio; Abu‐Rustum, Nadeem R.; Leitao, Mario M.; Gardner, Ginger J.

doi:10.1016/j.ygyno.2022.10.017

Cited by 21 publications

(20 citation statements)

References 22 publications

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“…The available pieces of evidence about the topic are scarce and the existing studies are based on small cohorts. Nevertheless, a usefulness of molecular classification in the prognostic staging of EC was observed in Mueller et al study, despite the small sample analyzed [57]. Ongoing studies are assessing the impact of molecular classification in patients with low-volume EC disease and determine factors that predict recurrences in those patients.…”

Section: Resultsmentioning

confidence: 96%

Evolution of retroperitoneal staging in endometrial cancer: narrative review and overview of literature

Cuccu¹,

Sgamba²,

Cannicchio³

et al. 2023

Ital J Gynaecol Obstet

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Endometrial cancer (EC) is the most common female genital tract malignant cancer. Lymphatic staging is a major prognostic factor and the main predictor of recurrence. The aim of this review is to explore lymph nodal management in EC up to this day and understand how the new molecular EC classification may affect lymph nodal management. A search was conducted in December 2022 to find all relevant trials and shows how,over the years, staging techniques have evolved, becoming more accurate and less invasive. In 1996, a less invasive staging method was found: the Sentinel Lymph Node (SLN), more safer and reliable in detecting metastatic disease. To date, the available pieces of evidence suggests that lymphadenectomy should not be performed in all patients with EC because it does not increase Overall Survival (OS) or Disease Free Survival (DFS) compared to standard surgery without lymphadenectomy, while it actually increases the risk of postoperative complications,in all EC risk classes. In addition, SLN and lymphadenectomy do not have any difference in terms of Recurrence Free Survival (RFS) in patients with low volume disease. Moreover, data available in literature highlight that the molecular classification may play a more accurate prognostic role than histological analysis. Even though some studies showed that the molecular mutations were not significant predictors of recurrence, several large ongoing trials may set new treatment standards. In conclusion, we can state that SLN mapping is an optimal method of EC staging with good sensibility,specificity and decreased surgical complications. Instead, more studies are needed to understand how molecular mutations can affect lymph nodal management.

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Section: Resultsmentioning

confidence: 96%

Evolution of retroperitoneal staging in endometrial cancer: narrative review and overview of literature

Cuccu¹,

Sgamba²,

Cannicchio³

et al. 2023

Ital J Gynaecol Obstet

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“…PubMed/MEDLINE, Embase, PubMed Central, Scopus, and Web of Science databases, as well as ClinicalTrials.gov were searched review the current evidence as well as further perspective on the role of retroperitoneal staging in endometrial cancer. Several studies assessed the safety and effectiveness of sentinel node mapping [ 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 ].…”

Section: Body Of Evidencementioning

confidence: 99%

Sentinel node mapping in endometrial cancer

Bogani,

Giannini,

Vizza

et al. 2024

J Gynecol Oncol

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Nodal status is one of the most important prognostic factors for patients with apparent early stage endometrial cancer. The role of retroperitoneal staging in endometrial cancer is controversial. Nodal status provides useful prognostic data, and allows to tailor the need of postoperative treatments. However, two independent randomized trials showed that the execution of (pelvic) lymphadenectomy increases the risk of having surgery-related complication without improving patients’ outcomes. Sentinel node mapping aims to achieve data regarding nodal status without increasing morbidity. Sentinel node mapping is the removal of first (clinically negative) lymph nodes draining the uterus. Several studies suggested that sentinel node mapping is not inferior to lymphadenectomy in identifying patients with nodal disease. More importantly, thorough ultrastaging sentinel node mapping allows the detection of low volume disease (micrometastases and isolated tumor cells), that are not always detectable via conventional pathological examination. Therefore, the adoption of sentinel node mapping guarantees a higher identification of patients with nodal disease than lymphadenectomy. Further evidence is needed to assess the value of various adjuvant strategies in patients with low volume disease and to tailor those treatments also on the basis of the molecular and genomic characterization of endometrial tumors.

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“…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 ].…”

Section: Data On Lymph Node Status Assessment In Atypical Endometrial...mentioning

confidence: 99%

“…Data showed that SLNB does not increase operative time nor intra- and extra-operative complications and reduces the concerns of patients with a diagnostic upstaging. Despite these advantages, the SLNB increases procedural costs [ 66 ].…”

Section: Data On Lymph Node Status Assessment In Atypical Endometrial...mentioning

confidence: 99%

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

Giannella,

Grelloni,

Bernardi

et al. 2024

Cancers

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The present review regarding atypical endometrial hyperplasia (AEH) focused on the main debated factors regarding this challenging clinical condition: (i) predictive variables of occult endometrial cancer (EC); (ii) the rate of EC underestimation according to different endometrial sampling methods; and (iii) the appropriateness of lymph node status assessment. When cancer is detected, approximately 90% of cases include low-risk EC, although intermediate/high-risk cases have been found in 10–13% of women with cancer. Older age, diabetes, high BMI, and increased endometrial thickness are the most recurrent factors in women with EC. However, the predictive power of these independent variables measured on internal validation sets showed disappointing results. Relative to endometrial sampling methods, hysteroscopic endometrial resection (Hys-res) provided the lowest EC underestimation, ranging between 6 and 11%. Further studies, including larger sample sizes of women undergoing Hys-res, are needed to confirm these findings. These data are urgently needed, especially for female candidates for conservative treatment. Finally, the evaluation of lymph node status measured on 660 of over 20,000 women showed a lymph node positivity of 2.3%. Although there has been an increase in the use of this procedure in AEH in recent years, the present data cannot recommend this option in AEH based on a cost/risk/benefit ratio.

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Sentinel lymph node mapping in patients with endometrial hyperplasia: A practice to preserve or abandon?

Cited by 21 publications

References 22 publications

Evolution of retroperitoneal staging in endometrial cancer: narrative review and overview of literature

Evolution of retroperitoneal staging in endometrial cancer: narrative review and overview of literature

Sentinel node mapping in endometrial cancer

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

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