Survival in patients with uterine carcinosarcoma undergoing sentinel lymph node mapping

Schiavone, Maria B.; Zivanovic, Oliver; Zhou, Qin; Leitao, Mario M.; Alektiar, Kaled M.; Makker, Vicky; Iasonos, Alexia; Abu‐Rustum, Nadeem R.

doi:10.1016/j.ygyno.2015.01.500

Cited by 4 publications

(6 citation statements)

References 13 publications

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“…10,19 Other larger studies evaluating SLN mapping in this setting either included patients who did not undergo completion lymphadenectomy or did not distinguish false-negative rates between patients with low-versus high-grade disease. 9,20 The correlation between false-negative SLNs in patients with high-risk endometrial cancer (a population who often receives postoperative systemic chemotherapy) and an adverse impact on patient outcomes is not clear. The 2 patients with false-negative SLN mapping in our study were treated postoperatively with tumor-directed radiation in addition to systemic chemotherapy rather than systemic chemotherapy with VBT aloneVas would have occurred if they had not undergone backup lymphadenectomy.…”

Section: Discussionmentioning

confidence: 99%

“…This conclusion is further supported by data from Memorial Sloan Kettering Cancer Center, in which patients with uterine carcinosarcoma managed with SLN mapping according to the NCCN algorithm (ie, without universal systematic lymphadenectomy) had equivalent progression-free survival versus a matched cohort of patients undergoing complete lymphadenectomy managed at Mayo Clinic. 20 If systematic lymphadenectomy does not improve survival in this setting, we may hypothesize that the true value of SLN mapping in highgrade endometrial cancer is to identify patients who will benefit from tumor-directed radiation while minimizing harm to those who are node negative. In a population at extremely high risk of distant metastatic or recurrent disease who is likely to receive systemic postoperative therapy, our tolerability for falsenegative SLN may be different from that of lower-risk disease.…”

Section: Discussionmentioning

confidence: 99%

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The Utility of Sentinel Lymph Node Mapping in High-Grade Endometrial Cancer

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Ojalvo

Stone

et al. 2017

Int J Gynecol Cancer

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ObjectiveThe aim of this study was to report the utility and false-negative rates of sentinel lymph node (SLN) mapping during surgical staging of women with high-grade, apparent uterine-confined endometrial cancer.MethodsThis was a single-institution study performed at a high-volume academic center. From December 2012 to December 2015, women with high-grade endometrial cancer (grade 3 endometrioid, serous, clear cell, and carcinosarcoma) underwent SLN mapping via cervical injection followed by robot-assisted total laparoscopic hysterectomy and completion lymphadenectomy. Ultrastaging of SLNs was performed in patients with tumors with any degree of myoinvasion. Patient demographics, SLN test characteristics, treatment, and recurrence outcomes were prospectively evaluated for analysis.ResultsFifty-two patients with high-grade histologic findings underwent SLN mapping followed by completion lymphadenectomy. The median patient age was 64 years, and median body mass index was 31.8 kg/m2. Most patients had either serous (46%) or grade 3 endometrioid histology (27%) on preoperative biopsy. Nine patients had nodal metastases, 7 of whom had metastases identified in SLNs. No low-volume nodal metastases were identified on ultrastaging. Two patients had false-negative SLN mapping (22%). After a median follow-up of 15.6 months, 14 recurrences (27%) were diagnosed; all were distant or multisite relapses. Sentinel lymph node mapping did not impact the choice of adjuvant therapy or recurrence risk in node-positive patients.ConclusionsSentinel lymph node detection of metastases in patients with high-grade endometrial cancer is high, but false-negative results were encountered. More research is needed to determine whether SLN mapping can safely replace systemic lymphadenectomy in women with high-risk histologic findings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Utility of Sentinel Lymph Node Mapping in High-Grade Endometrial Cancer

Tanner

Ojalvo

Stone

et al. 2017

Int J Gynecol Cancer

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“…In a review of 136 patients with carcinosarcoma, 48 of whom had staging with SLN biopsy, 88 of whom had staging with complete lymphadenectomy, there was no difference in median progression-free survival observed 42. It should be noted that the lymphadenectomy group represented a historical cohort and had significantly longer duration of follow-up.…”

Section: Sln Biopsy For High-grade Cancersmentioning

confidence: 99%

Current state of sentinel lymph nodes for women with endometrial cancer

Rossi

2019

Int J Gynecol Cancer

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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.

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“…Four of the 5 studies comparing SLN mapping with standard of care (ie, pelvic and aortic lymphadenectomy by regional endometrial cancer guidelines) found that SLN mapping increased the use of adjuvant therapy (Table 4). 24,35,65,69,70 The sole study in which adjuvant therapy use did not increase with the performance of SLN mapping was in patients with uterine carcinosarcoma.…”

Section: Association Of Sln Mapping With Treatment and Survivalmentioning

confidence: 99%