Comparison Study of Laparoscopic Sentinel Lymph Node Mapping in Endometrial Carcinoma Using Carbon Nanoparticles and Lymphatic Pathway Verification

• Published in: Journal of minimally invasive gynecology Vol. 26; no. 6; p. 1125
• Main Authors: Zuo, Jing, Wu, Ling Ying, Cheng, Min, Bai, Ping, Lei, Cheng Zhi, Li, Ning, Zhang, Gong Yi, Zhao, Dan, Li, Bin
• Format: Journal Article
• Language: English
• Published: United States 01.09.2019
• Subjects: Adult; Aged; Carbon - administration & dosage; Carbon - pharmacokinetics; Carcinoma, Endometrioid - diagnosis; Carcinoma, Endometrioid - pathology; Carcinoma, Endometrioid - surgery; Endometrial Neoplasms - diagnosis; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Female; Humans; Hysterectomy - methods; Laparoscopy - methods; Lymph Nodes - pathology; Lymphatic Metastasis; Lymphatic Vessels - diagnostic imaging; Lymphatic Vessels - pathology; Lymphatic Vessels - surgery; Middle Aged; Nanoparticles - administration & dosage; Neoplasm Staging - methods; Predictive Value of Tests; Reproducibility of Results; Salpingo-oophorectomy; Sentinel Lymph Node - diagnostic imaging; Sentinel Lymph Node - pathology; Sentinel Lymph Node Biopsy - methods; Lymphatic pathway; Endometrioid endometrial cancer; Carbon nanoparticles; Sentinel lymph node
• ISSN: 1553-4669
• DOI: 10.1016/j.jmig.2018.11.002

To evaluate the detection rate and accuracy of sentinel lymph node (SLN) mapping using cervical and fundal injections of carbon nanoparticles (CNPs) in laparoscopic surgery of endometrioid endometrial cancer (EC) and to identify uterine lymphatic drainage pathways validated by mapping. A prospective consecutive study (Canadian Task Force classification II-2). An academic research center. Consecutive patients with a pathologic diagnosis of early-stage EC scheduled for primary laparoscopic-assisted staging surgery (laparoscopic hysterectomy, bilateral salpingo-oophorectomy, or comprehensive lymphadenectomy). Enrolled patients underwent laparoscopic SLN mapping with a 50-mg CNP tracer injection. Fifty patients received fundal subserosal injections at 4 sites (the fundal group), whereas 65 patients received cervical submucosal injections at 2 sites (the cervical group). After SLN mapping, all patients underwent laparoscopic staging surgery. No allergic reactions to CNPs were observed in either group. The overall SLN detection rates were 100% and 92% in the cervical and fundal groups, and the bilateral SLN detection rates were 97% and 68% (p < .001), respectively. A total of 12 metastatic SLNs were accurately detected in 5 patients. The sensitivity of metastatic lymph node detection was 100% in the cervical group, which is higher than that in the fundal group (80%). The false-negative rates were 0% and 20%, respectively, in the cervical and fundal groups. Furthermore, we verified 3 uterine lymphatic pathways using the 2 injection methods. The upper paracervical pathway was the most common drainage pathway in both groups (91.4% in the cervical group vs 80.24% in the fundal group), whereas the infundibulopelvic pathway was observed only in the fundal group (15.11%). SLN mapping by CNPs in laparoscopic surgery for EC is a safe and effective alternative, with a higher detection rate and better accuracy with cervical injections than fundal injections. The upper paracervical pathway was the most common lymphatic pathway, whereas the infundibulopelvic pathway was only displayed in fundal injections.