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A study on uterine lymphatic anatomy for standardization of pelvic sentinel lymph node detection in endometrial cancer

Nilsson Geppert, Barbara LU ; Lönnerfors, Céline LU ; Bollino, Michele; Arechvo, Anastasija LU and Persson, Jan LU (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.

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author
organization
publishing date
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
  • 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
2018-01-07 11:53:37
@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},
  keyword      = {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},
  volume       = {145},
  year         = {2017},
}