Pelvic sentinel lymph node biopsy in endometrial cancer- A simplified algorithm based on histology and lymphatic anatomy
(2020) In International Journal of Gynecological Cancer 30(3). p.339-345- Abstract
Objective: To achieve the full potential of sentinel lymph node (SLN) detection in endometrial cancer, both presumed low- A nd high-risk groups should be included. Perioperative resource use and complications should be minimized. Knowledge on distribution and common anatomical sites for metastatic SLNs may contribute to optimizing the concept while maintaining sensitivity. Proceeding from previous studies, simplified algorithms based on histology and lymphatic anatomy are proposed. Methods: Data on mapping rates and locations of pelvic SLNs (metastatic and non-metastatic) from two previous prospective SLN studies in women with endometrial cancer were retrieved. Cervically injected indocyanine green was used as a tracer and an... (More)
Objective: To achieve the full potential of sentinel lymph node (SLN) detection in endometrial cancer, both presumed low- A nd high-risk groups should be included. Perioperative resource use and complications should be minimized. Knowledge on distribution and common anatomical sites for metastatic SLNs may contribute to optimizing the concept while maintaining sensitivity. Proceeding from previous studies, simplified algorithms based on histology and lymphatic anatomy are proposed. Methods: Data on mapping rates and locations of pelvic SLNs (metastatic and non-metastatic) from two previous prospective SLN studies in women with endometrial cancer were retrieved. Cervically injected indocyanine green was used as a tracer and an ipsilateral re-injection was performed in case of non-display of the upper and/or lower paracervical pathways. A systematic surgical algorithm was followed with clearly defined SLNs depicted on an anatomical chart. In high-risk endometrial cancer patients, removal of SLNs was followed by a pelvic and para-aortic lymphadenectomy. Results: 423 study records were analyzed. The bilateral mapping rates of the upper and lower paracervical pathways were 88.9% and 39.7%, respectively. 72% of all SLNs were typically positioned along the upper paracervical pathway (interiliac and/or proximal obturator fossa) and 71 of 75 (94.6%) of pelvic node positive women had at least one metastatic SLN at either of these positions. Women with grade 1-2 endometroid cancers (n=275) had no isolated metastases along the lower paracervical pathway compared with two women with high-risk histologies (n=148). Conclusion: SLNs along the upper paracervical pathway should be identified in all endometrial cancer histological subtypes; removal of nodes at defined typical positions along the upper paracervical pathway may replace a site-specific lymphadenectomy in case of non-mapping despite tracer re-injection. Detection of SLNs along the lower paracervical pathway can be restricted to high-risk histologies and a full pre-sacral lymphadenectomy should be performed in case of non-display.
(Less)
- author
- Bollino, Michele LU ; Geppert, Barbara LU ; Lönnerfors, Celine LU ; Falconer, Henrik ; Salehi, Sahar and Persson, Jan LU
- organization
- publishing date
- 2020-03-02
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- endometrial neoplasms, lymphatic system, lymphatic vessels, SLN and lympadenectomy
- in
- International Journal of Gynecological Cancer
- volume
- 30
- issue
- 3
- pages
- 7 pages
- publisher
- BMJ Publishing Group
- external identifiers
-
- scopus:85080873103
- pmid:32075897
- ISSN
- 1048-891X
- DOI
- 10.1136/ijgc-2019-000935
- language
- English
- LU publication?
- yes
- id
- 73247cba-82f1-4f58-a580-17b05f21e33b
- date added to LUP
- 2020-03-24 15:22:20
- date last changed
- 2024-06-12 10:49:42
@article{73247cba-82f1-4f58-a580-17b05f21e33b,
abstract = {{<p>Objective: To achieve the full potential of sentinel lymph node (SLN) detection in endometrial cancer, both presumed low- A nd high-risk groups should be included. Perioperative resource use and complications should be minimized. Knowledge on distribution and common anatomical sites for metastatic SLNs may contribute to optimizing the concept while maintaining sensitivity. Proceeding from previous studies, simplified algorithms based on histology and lymphatic anatomy are proposed. Methods: Data on mapping rates and locations of pelvic SLNs (metastatic and non-metastatic) from two previous prospective SLN studies in women with endometrial cancer were retrieved. Cervically injected indocyanine green was used as a tracer and an ipsilateral re-injection was performed in case of non-display of the upper and/or lower paracervical pathways. A systematic surgical algorithm was followed with clearly defined SLNs depicted on an anatomical chart. In high-risk endometrial cancer patients, removal of SLNs was followed by a pelvic and para-aortic lymphadenectomy. Results: 423 study records were analyzed. The bilateral mapping rates of the upper and lower paracervical pathways were 88.9% and 39.7%, respectively. 72% of all SLNs were typically positioned along the upper paracervical pathway (interiliac and/or proximal obturator fossa) and 71 of 75 (94.6%) of pelvic node positive women had at least one metastatic SLN at either of these positions. Women with grade 1-2 endometroid cancers (n=275) had no isolated metastases along the lower paracervical pathway compared with two women with high-risk histologies (n=148). Conclusion: SLNs along the upper paracervical pathway should be identified in all endometrial cancer histological subtypes; removal of nodes at defined typical positions along the upper paracervical pathway may replace a site-specific lymphadenectomy in case of non-mapping despite tracer re-injection. Detection of SLNs along the lower paracervical pathway can be restricted to high-risk histologies and a full pre-sacral lymphadenectomy should be performed in case of non-display.</p>}},
author = {{Bollino, Michele and Geppert, Barbara and Lönnerfors, Celine and Falconer, Henrik and Salehi, Sahar and Persson, Jan}},
issn = {{1048-891X}},
keywords = {{endometrial neoplasms; lymphatic system; lymphatic vessels; SLN and lympadenectomy}},
language = {{eng}},
month = {{03}},
number = {{3}},
pages = {{339--345}},
publisher = {{BMJ Publishing Group}},
series = {{International Journal of Gynecological Cancer}},
title = {{Pelvic sentinel lymph node biopsy in endometrial cancer- A simplified algorithm based on histology and lymphatic anatomy}},
url = {{http://dx.doi.org/10.1136/ijgc-2019-000935}},
doi = {{10.1136/ijgc-2019-000935}},
volume = {{30}},
year = {{2020}},
}