Incorporation of a Sentinel Lymph Node Mapping Algorithm in Patients
with Clinical Stage I Endometrial Cancer
Abstract
Objective: Sentinel lymph node biopsy (SLNB) has emerged as an
alternative to complete lymph node dissection (PPALND) in the management
of endometrial cancers. The referenced data is published from
high-volume specialized institutions and PPALND is still performed by
many at smaller, non-specialized centers. Our aim is to demonstrate that
SLNB is feasible, reproducible, and sensitive without affecting
cancer-specific outcomes when implemented at a non-specialized center.
Setting: Patients with clinical stage I endometrial cancer were reviewed
from 2016 through 2020. Population: A total of 92 patients were
included: 69 stage IA, 12 stage IB, 3 stage II and 8 stage III.
Endometrioid (73%), followed by UPSC (15.0%), MMMT (5.0%) and CC
(4%). Methods: Endometrioid, uterine papillary serous (UPSC), malignant
mixed mesodermal tumor (MMMT), and clear cell (CC) histologies were
included. Complete PPALND was performed for patients with MMMT, UPSC or
CC. Sentinel lymph nodes (SLN) were evaluated using ultra-staging
protocols. The medical record was queried for evidence of recurrence.
Results: A total of 92 patients were included: 69 stage IA, 12 stage IB,
3 stage II and 8 stage III (2 IIIA, 2 IIIC1, 4 IIIC2). At least one SLN
was detected in 95.4% of cases. The bilateral SLN detection was 74.3%
and improved from 2017-2019: 70%-80%. Non-SLN were positive in 3
patients, all with high-risk histology. There have been no recurrences
to date. Conclusions: Our results are comparable to the rates reported
in literature and demonstrate that when applied at non-specialized
centers this approach is safe and reproducible. Funding: None