6. Significances of SLNM in EC
Numerous clinical and experimental studies have confirmed the positive significances of SLNM in endometrial cancer. Evidence of the high accuracy and feasibility of SLNM has been presented in the retrospective study of Barlin et al .[46]. After the application of surgical SLN algorithm recommended in NCCN guideline, the sensitivity could reach 98.1%, together with a clinically acceptably low false negative rate of 1.9%. Furthermore, there is an obvious contrast of the incidence of intraoperative complications such as lymphedema between systematic lymphadenectomy and SLNM. According to a perioperative study performed by Geppert et al. , the incidence of having lower leg lymphedema in SLN group (1.3%) is astonishingly lower than in the group receiving infrarenal paraaortic and pelvic lymphadenectomy (18.1%)[70]. Another noticeable superiority of SLNM lies in the reality that it did not compromise the survival prognosis of endometrial cancer patients. In line with a comparative study launched by two Italian institutions, no statistically significant difference of disease-free survival was observed between SLNM group and SLAD group among a total of 802 patients with early-stage endometrial cancer[71]. Coincidentally, Eriksson et al. carried out research by respectively applying SLNM algorithm and complete pelvic and para-aortic lymphadenectomy, eventually obtaining a similar survival prognosis [72].
7.Conclusion and Perspective
In conclusion, as a guided procedure for clinical decision of lymph node resection, SLNM is cumulatively maturing and its application in endometrial cancer becomes pyramidally promising. Nowadays, based on studies and guidelines, ICG is the most recommended tracer while cervical injection is favored due to its operational simplicity, reproducibility and high detection rate. Besides, maintaining a low false-negative rate is a major priority in any SLNM program. However, controversies pertaining to the application of SLN detection in patients with endometrial cancer still exist and await to be tackled with, such as the standard clinical application of SLN detection in high-risk endometrial cancer, the best algorithm for SLN, and the clinical significance of low-volume metastasis. Therefore, more profound studies are still needed to clarify these extant contentions and more large-scale clinical research are expected to guide the application of SLNM in endometrial cancer.