5.2 SLNM in high-risk endometrial cancer
Compared
with
low-risk
endometrial
cancer, when it comes to high-risk endometrial cancer,
the
application value of SLNM still vary
wildly.
On the one hand,
SLNM
may increase the risk of missed diagnosis of isolated para-aortic lymph
node
metastases,
which appears to be unacceptable in clinical practice[66].
Yet
on the contrary, a meta-analysis showed that SLNM can accurately detect
lymph node metastasis in high-risk endometrial cancer, and
its
performance characteristics (detection rate, false negative rate,
sensitivity, etc. ) were not statistically different from those of
low-risk endometrial cancer[67].
Conformably,
Gu et al. thought that in high-risk endometrial cancer, SLNM’s
evaluation effect of para-aortic lymph nodes was by no means inferior to
that in low-risk endometrial cancer[68].
Meanwhile, increasing evidence have manifested the feasibility of
applying SLNM in high-risk endometrial cancer[69].
The application of SLNM can shorten the time of
laparotomy
and
laparoscopic
surgery
as well. Beyond this, the 2022 NCCN guidelines further proposed that
SLNM
can be considered as a method for surgical staging in patients with no
extra-uterine metastatic lesion.
This
suggests that this edition of the NCCN guidelines recognizes the
potential
application value of SLNM in high-risk endometrial cancer patients.
More
large-scale, multicenter prospective studies are still needed to further
settle this controversy.