Introduction:
Endometrial cancer is the most common gynecological malignancy in the United States, with 65,620 new cases estimated and 12,000 deaths predicted in the year 2020 [1]. Most women present with early stage disease, and surgical resection of the primary tumor along with a comprehensive lymph node dissection has traditionally been the mainstay of treatment. Historically, complete pelvic and paraaortic lymphadenectomy has been performed as part of surgical staging and to guide subsequent adjuvant therapies for women diagnosed with uterine cancer. Complete pelvic lymphadenectomy is not without surgical morbidity, and is associated with 20-47% risk of lymphedema in patients with endometrial cancer, as well as prolonged operative time, and increased risk of neurologic or vascular injuries [2]. Sentinel lymph node mapping has emerged as an alternate approach to comprehensive staging that allows surgeons to identify lymph node metastasis while reducing the surgical morbidity associated with a full pelvic and paraaortic lymphadenectomy [2].
Sentinel lymph node (SLN) mapping was initially described in breast cancer and cutaneous melanoma [3] and has more recently been incorporated into the staging of vulvar, cervix and endometrial cancers. Initial studies in endometrial cancers reported the use of blue dyes and radioactive colloid technetium-99, while more recent protocols have utilized indocyanine green, as near-infrared camera capabilities become more widely available. The majority of referenced studies were performed at cancer specialty centers with many surgeons in non-specialty centers continuing to perform comprehensive lymph node dissections. A survey performed by The Society of Gynecologic Oncology (SGO) several years ago reported that only 28.6% of respondents were routinely performing SLN mapping for endometrial cancers [4]. When performing SLN mapping, technique and expertise are critical and a learning curve of approximately 30 cases has previously been described [2]. The objective of this study is to demonstrate that SLNB is feasible, reproducible, and sensitive without affecting cancer-specific outcomes when implemented at a non-specialized center.