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.