Preliminary results of sentinel lymph node removal in the surgical treatment of endometrial cancer

• Published in: Zdravniški vestnik (Ljubljana, Slovenia : 1992) Vol. 88; no. 11-12; p. 509
• Main Authors: Čas, Sabina, Maček, Katja Jakopič, Borut Kobal, Starič, Kristina Drusany, Meglič, Leon, Barbič, Matija, Cvjetićanin, Branko, Blaganje, Mija
• Format: Journal Article
• Language: Slovenian
• Published: Ljubljana ZDRAVNISKI VESTNIK - SLOVENIAN MEDICAL JOURNAL 01.11.2019
• Subjects: Biopsy; Endometrial cancer; Lymphatic system; Ultrasonic imaging
• ISSN: 1318-0347; 1581-0024
• DOI: 10.6016/ZdravVestn.2875

Background: Preoperative assessment of the depth of endometrial cancer invasion is not reliable. Surgical treatment consists of hysterectomy and pelvic lymphadenectomy. Sentinel lymph node (SLN) biopsy can replace radical pelvic lymphadenectomy in patients with a low and intermediate risk of disease recurrence. Methods: From January 2016 to June 2017, 35 patients were included in the clinical audit of SLN biopsy at the UMC Ljubljana’s Division of Gynaecology and Obstetrics. We recorded the reliability of the preoperative histological and ultrasound estimates and the degree of surgical detection of the SLN with an intracervical application of indocyanine green (ICG). All the removed tissues were sent for histological examination by hematoxylin and eosine (H & E) staining method. Results: Unilateral and bilateral success rate of the surgical detection of SLN was 85.7 % (75 %–93 %) and 80.0 % (63 %–92 %) respectively. The sentinel lymph node was histologically positive in two cases. Ultrasound assessment of myometrial invasion had 100 % (15.8 %–100 %) sensitivity and 78.9 % (54.4 %–93.9 %) specificity, whereas the ultrasound assessment of cervical stromal invasion only had 33 % (0.8 %–90.6 %) sensitivity and 94.4 % (72.7 %–99.8 %) specificity. Postoperative histological differentiation was upgraded in 5.7 % and downgraded in 8.6 % of cases. Conclusion: SLN biopsy at the time of surgery allows a personalized treatment approach in patients with endometrial cancer and a secure abandonment of pelvic lymphadenectomy in patients at low and intermediate risk of recurrence. Its final inclusion in the treatment guidelines will require additional experience regarding patient selection, surgical treatment quality tracking, as well as urgent implementation of histological ultrastaging of the removed SLN.