Sentinel node mapping decreases the risk of failed detection of isolated positive para-aortic lymph node in endometrial cancer.

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  • Additional Information
    • Source:
      Publisher: BMJ Country of Publication: England NLM ID: 9111626 Publication Model: Electronic Cited Medium: Internet ISSN: 1525-1438 (Electronic) Linking ISSN: 1048891X NLM ISO Abbreviation: Int J Gynecol Cancer Subsets: MEDLINE
    • Publication Information:
      Publication: 2019- : [London] : BMJ
      Original Publication: Cambridge, MA, USA : Blackwell Scientific Publications, c1991-
    • Subject Terms:
      Endometrial Neoplasms*/pathology ; Endometrial Neoplasms*/surgery ; Lymphatic Metastasis* ; Sentinel Lymph Node*/pathology ; Sentinel Lymph Node*/surgery ; Lymph Nodes*/pathology ; Lymph Nodes*/surgery; Humans ; Female ; Middle Aged ; Retrospective Studies ; Aged ; Sentinel Lymph Node Biopsy/methods ; Lymph Node Excision/methods ; Adult ; Aorta/pathology
    • Abstract:
      Background: Isolated positive para-aortic lymph node metastasis in endometrial cancer is an uncommon event, ranging from 1% to 3%.
      Objective: Our aim was to evaluate the impact of sentinel lymph node (SLN) mapping on the risk of isolated positive para-aortic lymph node metastasis.
      Methods: We retrospectively evaluated a series of 426 patients who underwent SLN mapping with at least one SLN detected from January 2013 to December 2021 (SLN group) compared with a historical series of 209 cases who underwent a systematic pelvic and para-aortic lymphadenectomy between June 2007 and April 2015 (LND group). Isolated para-aortic lymph node metastasis recurrences were included in the SLN group analysis.
      Results: In the SLN group, 168 cases (39.4%) had backup systematic lymphadenectomy, and 56 (13.1%) had positive lymph nodes compared with 34 (16.3%) in LND group (p=0.18). The SLN group had higher rates of minimally invasive surgeries (p<0.001) and presence of lymphovascular space invasion (p<0.001). Moreover, SLN group had fewer other uterine risk factors, such as high-grade tumors (p<0.001), and deep myometrial invasion (p<0.001). We found that SLN mapped outside the pelvis at pre-sacral, common iliac areas, and para-aortic regions in 2.8% (n=12), 11.5% (n=49), and 1.6% (n=7) of cases, respectively. Overall, 52 (12.2%) patients had positive SLNs, and 3 (5.7%) positive SLNs were found outside the pelvis-one in the pre-sacral region, one in the common iliac area, and one in the para-aortic region. An isolated para-aortic lymph node was found in only 2 (0.5%) cases in the SLN group compared with 7 (3.3%) cases in the LND group (p=0.004).
      Conclusions: SLN protocol accurately predicts lymph node status and may decrease the risk of failed identification of isolated para-aortic lymph node metastasis compared with systematic lymphadenectomy.
      Competing Interests: Competing interests: GB reports honoraria and consulting from Astra Zeneca, GSK, and MSD.
      (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
    • Contributed Indexing:
      Keywords: Endometrial Neoplasms; Lymph Nodes; Lymphatic Metastasis; Retroperitoneal Space; Sentinel Lymph Node
    • Publication Date:
      Date Created: 20240808 Date Completed: 20241007 Latest Revision: 20241007
    • Publication Date:
      20241008
    • Accession Number:
      10.1136/ijgc-2024-005778
    • Accession Number:
      39117377