Sentinel lymph node mapping in endometrial cancer: an updated review
DOI:
https://doi.org/10.12809/hkjgom.22.2.08Keywords:
Endometrial neoplasms, Lymph node excision, Neoplasm staging, Sentinel lymph nodeAbstract
Sentinel lymph node mapping (SLNM) is widely used in staging of both low- and high-risk early-stage endometrial cancer. It has a high detection rate, high sensitivity, high negative predictive value, and low false negative rate in detection of lymph node metastasis. Cervical injection of indocyanine green for SLNM is the preferred method. SLNM reduces the number of lymph node removal and reduces complications from lymphadenectomy without compromising oncological safety. This review discusses the latest evidence of SLNM in endometrial cancer staging in terms of technique, accuracy, limitations, impact on lymphadenectomy complications, and cancer survival.
References
Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin 2021;71:7-33.
Hong Kong Cancer Registry. Available from: https://www3.ha.org.hk/cancereg/. Assessed 16 April 2022.
Rungruang B, Olawaiye AB. Comprehensive surgical staging for endometrial cancer. Rev Obstet Gynecol 2012;5:28-34.
Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 2009;105:103-4.
Randall ME, Filiaci VL, Muss H, et al. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol 2006;24:36-44.
de Boer SM, Powell ME, Mileshkin L, et al. Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): final results of an international, open-label, multicentre, randomised, phase 3 trial. Lancet Oncol 2018;19:295-309.
Cetinkaya K, Atalay F, Bacinoglu A, et al. To what extent is risk grouping method successful in deciding surgical staging in endometrial cancer? Tumori 2016;102:422-5.
Mariani A, Webb MJ, Keeney GL, et al. Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol 2000;182:1506-19.
Renz M, Diver E, English D, et al. Sentinel lymph node biopsies in endometrial cancer: practice patterns among gynecologic oncologists in the United States. J Minim Invasive Gynecol 2020;27:482-8.
Casarin J, Multinu F, Abu-Rustum N, et al. Factors influencing the adoption of the sentinel lymph node technique for endometrial cancer staging: an international survey of gynecologic oncologists. Int J Gynecol Cancer 2019;29:60-7.
Todo Y, Kato H, Kaneuchi M, et al. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 2010;375:1165-72.
Trimble EL, Kosary C, Park RC. Lymph node sampling and survival in endometrial cancer. Gynecol Oncol 1998;71:340-3.
Kilgore LC, Partridge EE, Alvarez RD, et al. Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol 1995;56:29-33.
ASTEC study group; Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 2009;373:125-36.
Benedetti Panici P, Basile S, Maneschi F, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 2008;100:1707-16.
Dowdy SC, Borah BJ, Bakkum-Gamez JN, et al. Prospective assessment of survival, morbidity, and cost associated with lymphadenectomy in low-risk endometrial cancer. Gynecol Oncol 2012;127:5-10.
Holloway RW, Abu-Rustum NR, Backes FJ, et al. Sentinel lymph node mapping and staging in endometrial cancer: a Society of Gynecologic Oncology literature review with consensus recommendations. Gynecol Oncol 2017;146:405-15.
Frumovitz M, Slomovitz BM, Singh DK, et al. Frozen section analyses as predictors of lymphatic spread in patients with early-stage uterine cancer. J Am Coll Surg 2004;199:388-93.
Antonsen SL, Jensen LN, Loft A, et al. MRI, PET/CT and ultrasound in the preoperative staging of endometrial cancer: a multicenter prospective comparative study. Gynecol Oncol 2013;128:300-8.
Burke TW, Levenback C, Tornos C, et al. Intraabdominal lymphatic mapping to direct selective pelvic and paraaortic lymphadenectomy in women with high-risk endometrial cancer: results of a pilot study. Gynecol Oncol 1996;62:169-73.
Ballester M, Dubernard G, Lécuru F, et al. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTIENDO). Lancet Oncol 2011;12:469-76.
Papadia A, Gasparri ML, Buda A, et al. Sentinel lymph node mapping in endometrial cancer: comparison of fluorescence dye with traditional radiocolloid and blue. J Cancer Res Clin Oncol 2017;143:2039-48.
Du J, Li Y, Wang Q, et al. Sentinel lymph node mapping in gynecological oncology. Oncol Lett 2017;14:7669-75.
Martinelli F, Ditto A, Bogani G, et al. Sentinel lymph node mapping in endometrial cancer: performance of hysteroscopic injection of tracers. Int J Gynecol Cancer 2020;30:332-8.
Buda A, Papadia A, Zapardiel I, et al. From conventional radiotracer Tc-99(m) with blue dye to indocyanine green fluorescence: a comparison of methods towards optimization of sentinel lymph node mapping in early stage cervical cancer for a laparoscopic approach. Ann Surg Oncol 2016;23:2959-65.
Cabrera S, Barahona-Orpinell M, Almansa-González C, et al. Combined use of ICG and technetium does not improve sentinel lymph node detection in endometrial cancer: results of the COMBITEC study. Gynecol Oncol 2021;162:32-7.
Thevarajah S, Huston TL, Simmons RM. A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancer. Am J Surg 2005;189:236-9.
Rozenholc A, Samouelian V, Warkus T, et al. Green versus blue: randomized controlled trial comparing indocyanine green with methylene blue for sentinel lymph node detection in endometrial cancer. Gynecol Oncol 2019;153:500-4.
Papadia A, Gasparri ML, Radan AP, Stämpfli CAL, Rau TT, Mueller MD. Retrospective validation of the laparoscopic ICG SLN mapping in patients with grade 3 endometrial cancer. J Cancer Res Clin Oncol 2018;144:1385-93.
Bodurtha Smith AJ, Fader AN, Tanner EJ. Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol 2017;216:459-76.e10.
Pölcher M, Matz S, Braun M, Brambs C, Beer M, Hamann M. Sentinel lymph node mapping with indocyanine green compared to blue dye tracer in gynecologic malignancies: a single center experience of 218 patients. J Surg Oncol 2021;123:1092-8.
Eriksson AG, Beavis A, Soslow RA, et al. A comparison of the detection of sentinel lymph nodes using indocyanine green and near-infrared fluorescence imaging versus blue dye during robotic surgery in uterine cancer. Int J Gynecol Cancer 2017;27:743-7.
Zhai L, Zhang X, Cui M, et al. Sentinel lymph node mapping in endometrial cancer: a comprehensive review. Front Oncol 2021;11:701758.
Abu-Rustum NR. Sentinel lymph node mapping for endometrial cancer: a modern approach to surgical staging. J Natl Compr Canc Netw 2014;12:288-97.
Capozzi VA, Valentina C, Giulio S, et al. Sentinel node mapping in endometrial cancer: tips and tricks to improve bilateral detection rate. The sentitricks study, a monocentric experience. Taiwan J Obstet Gynecol 2021;60:31-5.
Cormier B, Rozenholc AT, Gotlieb W, et al. Sentinel lymph node procedure in endometrial cancer: a systematic review and proposal for standardization of future research. Gynecol Oncol 2015;138:478-85.
Ruiz R, Gorostidi M, Jaunarena I, et al. Sentinel node biopsy in endometrial cancer with dual cervical and fundal indocyanine green injection. Int J Gynecol Cancer 2018;28:139-44.
Ditto A, Casarin I, Pinelli C, et al. Hysteroscopic versus cervical injection for sentinel node detection in endometrial cancer: a multicenter prospective randomised controlled trial from the Multicenter Italian Trials in Ovarian cancer (MITO) study group. Eur J Cancer 2020;140:1-10.
Kim YN, Eoh KJ, Lee JY, et al. Comparison of outcomes between the one-step and two-step sentinel lymph node mapping techniques in endometrial cancer. Int J Gynecol Cancer 2020;30:318-24.
Rossi EC, Kowalski LD, Scalici J, et al. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol 2017;18:384-92.
Soliman PT, Westin SN, Dioun S, et al. A prospective validation study of sentinel lymph node mapping for high-risk endometrial cancer. Gynecol Oncol 2017;146:234-9.
Barlin JN, Khoury-Collado F, Kim CH, et al. The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. Gynecol Oncol 2012;125:531-5.
Uterine Neoplasms, Version 1.2021, NCCN Clinical Practice Guidelines in Oncology.
Bellaminutti S, Bonollo M, Gasparri ML, et al. Sentinel lymph node intraoperative analysis in endometrial cancer. J Cancer Res Clin Oncol 2020;146:3199-205.
Renz M, Marjon N, Devereaux K, et al. Immediate intraoperative sentinel lymph node analysis by frozen section is predictive of lymph node metastasis in endometrial cancer. J Robot Surg 2020;14:35-40.
Naoura I, Canlorbe G, Bendifallah S, et al. Relevance of sentinel lymph node procedure for patients with high-risk endometrial cancer. Gynecol Oncol 2015;136:60-4.
Touhami O, Grégoire J, Renaud MC, et al. Performance of sentinel lymph node (SLN) mapping in high-risk endometrial cancer. Gynecol Oncol 2017;147:549-53.
Persson J, Salehi S, Bollino M, Lönnerfors C, Falconer H, Geppert B. Pelvic sentinel lymph node detection in high-risk endometrial cancer (SHREC-trial)-the final step towards a paradigm shift in surgical staging. Eur J Cancer 2019;116:77-85.
Cusimano MC, Vicus D, Pulman K, et al. Assessment of sentinel lymph node biopsy vs lymphadenectomy for intermediate- and high-grade endometrial cancer staging. JAMA Surg 2021;156:157-64.
Marchocki Z, Cusimano MC, Clarfield L, et al. Sentinel lymph node biopsy in high-grade endometrial cancer: a systematic review and meta-analysis of performance characteristics. Am J Obstet Gynecol 2021;225:367.e1-367.e39.
Eriksson AG, Montovano M, Beavis A, et al. Impact of obesity on sentinel lymph node mapping in patients with newly diagnosed uterine cancer undergoing robotic surgery. Ann Surg Oncol 2016;23:2522-8.
Khoury-Collado F, Glaser GE, Zivanovic O, et al. Improving sentinel lymph node detection rates in endometrial cancer: how many cases are needed? Gynecol Oncol 2009;115:453-5.
Eitan R, Sabah G, Krissi H, et al. Robotic blue-dye sentinel lymph node detection for endometrial cancer - Factors predicting successful mapping. Eur J Surg Oncol 2015;41:1659-63.
Kim S, Ryu KJ, Min KJ, et al. Learning curve for sentinel lymph node mapping in gynecologic malignancies. J Surg Oncol 2020;121:599-604.
Tucker K, Staley SA, Gehrig PA, et al. Defining the learning curve for successful staging with sentinel lymph node biopsy for endometrial cancer among surgeons at an academic institution. Int J Gynecol Cancer 2020;30:346-51.
Volpi L, Sozzi G, Capozzi VA, et al. Long term complications following pelvic and para-aortic lymphadenectomy for endometrial cancer, incidence and potential risk factors: a single institution experience. Int J Gynecol Cancer 2019;29:312-9.
Beesley VL, Rowlands IJ, Hayes SC, et al, Australian National Endometrial Cancer Study Group. Incidence, risk factors and estimates of a woman’s risk of developing secondary lower limb lymphedema and lymphedema-specific supportive care needs in women treated for endometrial cancer. Gynecol Oncol 2015;136:87-93.
Ma X, Wang Y, Fan A, et al. Risk factors, microbiology and management of infected lymphocyst after lymphadenectomy for gynecologic malignancies. Arch Gynecol Obstet 2018;298:1195-203.
Zahl Eriksson AG, Ducie J, Ali N, et al. Comparison of a sentinel lymph node and a selective lymphadenectomy algorithm in patients with endometrioid endometrial carcinoma and limited myometrial invasion. Gynecol Oncol 2016;140:394-9.
Geppert B, Lönnerfors C, Bollino M, et al. Sentinel lymph node biopsy in endometrial cancer-Feasibility, safety and lymphatic complications. Gynecol Oncol 2018;148:491-8.
Diniz TP, Drizlionoks E, Faloppa CC, et al. Impact of sentinel node mapping in decreasing the risk of lymphocele in endometrial cancer. Ann Surg Oncol 2021;28:3293-9.
Imboden S, Mereu L, Siegenthaler F, et al. Oncological safety and perioperative morbidity in low-risk endometrial cancer with sentinel lymph-node dissection. Eur J Surg Oncol 2019;45:1638-43.
Liu CY, Elias KM, Howitt BE, et al. Sentinel lymph node mapping reduces practice pattern variations in surgical staging for endometrial adenocarcinoma: a before and after study. Gynecol Oncol 2017;145:248-255.
Brugger S, Hamann M, Mosner M, et al. Endometrial cancer-how
many patients could benefit from sentinel lymph node dissection? World J Surg Oncol 2018;16:95.
Holloway RW, Gupta S, Stavitzski NM, et al. Sentinel lymph node mapping with staging lymphadenectomy for patients with endometrial cancer increases the detection of metastasis. Gynecol Oncol 2016;141:206-10.
Buda A, Di Martino G, Restaino S, et al. The impact on survival of two different staging strategies in apparent early stage endometrial cancer comparing sentinel lymph nodes mapping algorithm and selective lymphadenectomy: an Italian retrospective analysis of two reference centers. Gynecol Oncol 2017;147:528-34.
Baiocchi G, Mantoan H, Kumagai LY, et al. The impact of sentinel node-mapping in staging high-risk endometrial cancer. Ann Surg Oncol 2017;24:3981-7.
Bogani G, Murgia F, Ditto A, et al. Sentinel node mapping vs. lymphadenectomy in endometrial cancer: a systematic review and meta-analysis. Gynecol Oncol 2019;153:676-83.
Euscher E, Sui D, Soliman P, et al. Ultrastaging of sentinel lymph nodes in endometrial carcinoma according to use of 2 different methods. Int J Gynecol Pathol 2018;37:242-51.
Grassi T, Dell’Orto F, Jaconi M, et al. Two ultrastaging protocols for the detection of lymph node metastases in early-stage cervical and endometrial cancers. Int J Gynecol Cancer 2020;30:1404-10.
Mueller JJ, Pedra Nobre S, Braxton K, et al. Incidence of pelvic lymph node metastasis using modern FIGO staging and sentinel lymph node mapping with ultrastaging in surgically staged patients with endometrioid and serous endometrial carcinoma. Gynecol Oncol 2020;157:619-23.
Plante M, Stanleigh J, Renaud MC, et al. Isolated tumor cells identified by sentinel lymph node mapping in endometrial cancer: does adjuvant treatment matter? Gynecol Oncol 2017;146:240-6.
Ignatov A, Lebius C, Ignatov T, et al. Lymph node micrometastases and outcome of endometrial cancer. Gynecol Oncol 2019;154:475-9.
Tschernichovsky R, Diver EJ, Schorge JO, et al. The role of lymphadenectomy versus sentinel lymph node biopsy in early-stage endometrial cancer: a review of the literature. Am J Clin Oncol 2016;39:516-21.
Raimond E , Ballester M , Hudry D, et al. Impact of sentinel lymph node biopsy on the therapeutic management of early-stage endometrial cancer: results of a retrospective multicenter study. Gynecol Oncol 2014;133:506-11.24642092
Daraï E, Dubernard G, Bats AS, et al. Sentinel node biopsy for the management of early stage endometrial cancer: long-term results of the SENTI-ENDO study. Gynecol Oncol 2015;136:54-9.
Basaran D, Bruce S, Aviki EM, et al. Sentinel lymph node mapping alone compared to more extensive lymphadenectomy in patients with uterine serous carcinoma. Gynecol Oncol 2020;156:70-6.
Bogani G, Casarin J, Leone Roberti Maggiore U, et al. Survival outcomes in endometrial cancer patients having lymphadenectomy, sentinel node mapping followed by lymphadectomy and sentinel node mapping alone: long-term results of a propensity-matched analysis. Gynecol Oncol 2020;158:77-83.
How J, Gauthier C, Abitbol J, et al. Impact of sentinel lymph node mapping on recurrence patterns in endometrial cancer. Gynecol Oncol 2017;144:503-9.
Kogan L, Matanes E, Wissing M, et al. The added value of sentinel node mapping in endometrial cancer. Gynecol Oncol 2020;158:84-91.
Koh WJ, Abu-Rustum NR, Bean S, et al. Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2018;16:170-99.
Touhami O, Trinh XB, Gregoire J, et al. Predictors of non-sentinel lymph node (non-SLN) metastasis in patients with sentinel lymph node (SLN) metastasis in endometrial cancer. Gynecol Oncol 2015;138:41-5.
Holloway RW, Ahmad S, Kendrick JE, et al. A prospective cohort study comparing colorimetric and fluorescent imaging for sentinel lymph node mapping in endometrial cancer. Ann Surg Oncol 2017;24:1972-9.
Bogani G, Papadia A, Buda A, et al. Sentinel node mapping vs. sentinel node mapping plus back-up lymphadenectomy in high-risk endometrial cancer patients: results from a multiinstitutional study. Gynecol Oncol 2021;161:122-9.
Kumar S, Podratz KC, Bakkum-Gamez JN, et al. Prospective assessment of the prevalence of pelvic, paraaortic and high paraaortic lymph node metastasis in endometrial cancer. Gynecol Oncol 2014;132:38-43.
Chiang AJ, Yu KJ, Chao KC, Teng NN. The incidence of isolated para-aortic nodal metastasis in completely staged endometrial cancer patients. Gynecol Oncol 2011;121:122-5.
Multinu F, Casarin J, Cappuccio S, et al. Ultrastaging of negative pelvic lymph nodes to decrease the true prevalence of isolated paraaortic dissemination in endometrial cancer. Gynecol Oncol 2019;154:60-4.
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