A study on uterine lymphatic anatomy for standardization of pelvic sentinel lymph node detection in endometrial cancer
(2017) In Gynecologic Oncology 145(2). p.256-261- Abstract
Objective: To describe the anatomy of uterine lymphatic drainage following cervical or fundal tracer injection to enable standardization of a pelvic sentinel lymph node (SLN) concept in endometrial cancer (EC). Methods: A prospective consecutive study of women with EC was conducted. A fluorescent dye (Indocyanine green) was injected into the cervix (n = 60) or the uterine fundus (n = 30). A systematic trans- and retroperitoneal mapping of uterine lymphatic drainage was performed. Positions of the pelvic SLNs, defined by afferent lymph vessels, and lymph node metastases were compared. Results: Two consistent lymphatic pathways with pelvic SLNs were identified irrespective of injection site; an upper paracervical pathway (UPP) with... (More)
Objective: To describe the anatomy of uterine lymphatic drainage following cervical or fundal tracer injection to enable standardization of a pelvic sentinel lymph node (SLN) concept in endometrial cancer (EC). Methods: A prospective consecutive study of women with EC was conducted. A fluorescent dye (Indocyanine green) was injected into the cervix (n = 60) or the uterine fundus (n = 30). A systematic trans- and retroperitoneal mapping of uterine lymphatic drainage was performed. Positions of the pelvic SLNs, defined by afferent lymph vessels, and lymph node metastases were compared. Results: Two consistent lymphatic pathways with pelvic SLNs were identified irrespective of injection site; an upper paracervical pathway (UPP) with draining medial external and/or obturator lymph nodes and a lower paracervical pathway (LPP) with draining internal iliac and/or presacral lymph nodes. Bilateral display of at least one pelvic pathway following cervical and fundal injection occurred in 98% and 80% respectively (p = 0.005). Bilateral display of both pelvic pathways occurred in 30% and 20% respectively (p = 0.6) as the LPP was less often displayed. Nearly one third of the 19% node positive patients had metastases along the LPP. No false negative SLNs were identified. Conclusions: Based on uterine lymphatic anatomy a bilateral detection of at least one SLN in both the UPP and LPP should be aimed for. Absence of display of the LPP may warrant a full presacral lymphadenectomy. Although pelvic pathways and positions of SLNs are independent of the tracer injection site, cervical injection is preferable due to a higher technical success rate.
(Less)
- author
- Nilsson Geppert, Barbara LU ; Lönnerfors, Céline LU ; Bollino, Michele ; Arechvo, Anastasija LU and Persson, Jan LU
- organization
- publishing date
- 2017
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Anatomy, Endometrial cancer, Indocyanine green, Lymphadenectomy, Lymphatic metastases, Lymphatic system, Sentinel lymph node biopsy
- in
- Gynecologic Oncology
- volume
- 145
- issue
- 2
- pages
- 256 - 261
- publisher
- Academic Press
- external identifiers
-
- scopus:85011995298
- pmid:28196672
- wos:000400954400008
- ISSN
- 0090-8258
- DOI
- 10.1016/j.ygyno.2017.02.018
- language
- English
- LU publication?
- yes
- id
- d36eedf7-e743-481d-ae12-1ac6155325d8
- date added to LUP
- 2017-03-02 11:55:37
- date last changed
- 2025-01-07 08:51:51
@article{d36eedf7-e743-481d-ae12-1ac6155325d8,
abstract = {{<p>Objective: To describe the anatomy of uterine lymphatic drainage following cervical or fundal tracer injection to enable standardization of a pelvic sentinel lymph node (SLN) concept in endometrial cancer (EC). Methods: A prospective consecutive study of women with EC was conducted. A fluorescent dye (Indocyanine green) was injected into the cervix (n = 60) or the uterine fundus (n = 30). A systematic trans- and retroperitoneal mapping of uterine lymphatic drainage was performed. Positions of the pelvic SLNs, defined by afferent lymph vessels, and lymph node metastases were compared. Results: Two consistent lymphatic pathways with pelvic SLNs were identified irrespective of injection site; an upper paracervical pathway (UPP) with draining medial external and/or obturator lymph nodes and a lower paracervical pathway (LPP) with draining internal iliac and/or presacral lymph nodes. Bilateral display of at least one pelvic pathway following cervical and fundal injection occurred in 98% and 80% respectively (p = 0.005). Bilateral display of both pelvic pathways occurred in 30% and 20% respectively (p = 0.6) as the LPP was less often displayed. Nearly one third of the 19% node positive patients had metastases along the LPP. No false negative SLNs were identified. Conclusions: Based on uterine lymphatic anatomy a bilateral detection of at least one SLN in both the UPP and LPP should be aimed for. Absence of display of the LPP may warrant a full presacral lymphadenectomy. Although pelvic pathways and positions of SLNs are independent of the tracer injection site, cervical injection is preferable due to a higher technical success rate.</p>}},
author = {{Nilsson Geppert, Barbara and Lönnerfors, Céline and Bollino, Michele and Arechvo, Anastasija and Persson, Jan}},
issn = {{0090-8258}},
keywords = {{Anatomy; Endometrial cancer; Indocyanine green; Lymphadenectomy; Lymphatic metastases; Lymphatic system; Sentinel lymph node biopsy}},
language = {{eng}},
number = {{2}},
pages = {{256--261}},
publisher = {{Academic Press}},
series = {{Gynecologic Oncology}},
title = {{A study on uterine lymphatic anatomy for standardization of pelvic sentinel lymph node detection in endometrial cancer}},
url = {{http://dx.doi.org/10.1016/j.ygyno.2017.02.018}},
doi = {{10.1016/j.ygyno.2017.02.018}},
volume = {{145}},
year = {{2017}},
}