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.