Pelvic sentinel lymph node biopsy in endometrial cancer—a simplified algorithm based on histology and lymphatic anatomy
| Autor: | Michele Bollino, Sahar Salehi, Jan Persson, Celine Lönnerfors, Barbara Geppert, Henrik Falconer |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Indocyanine Green medicine.medical_treatment Sentinel lymph node Lymphatic System chemistry.chemical_compound Biopsy Humans Medicine Coloring Agents Aged Neoplasm Staging Aged 80 and over medicine.diagnostic_test Sentinel Lymph Node Biopsy business.industry Endometrial cancer Obstetrics and Gynecology Histology Anatomy Perioperative Middle Aged medicine.disease Endometrial Neoplasms body regions Lymphatic system Oncology chemistry Lymph Node Excision Female Lymphadenectomy Neoplasm Grading Sentinel Lymph Node business Carcinoma Endometrioid Indocyanine green Algorithm Algorithms |
| Zdroj: | International Journal of Gynecologic Cancer. 30:339-345 |
| ISSN: | 1525-1438 1048-891X |
| DOI: | 10.1136/ijgc-2019-000935 |
| Popis: | ObjectiveTo achieve the full potential of sentinel lymph node (SLN) detection in endometrial cancer, both presumed low- and high-risk groups should be included. Perioperative resource use and complications should be minimized. Knowledge on distribution and common anatomical sites for metastatic SLNs may contribute to optimizing the concept while maintaining sensitivity. Proceeding from previous studies, simplified algorithms based on histology and lymphatic anatomy are proposed.MethodsData on mapping rates and locations of pelvic SLNs (metastatic and non-metastatic) from two previous prospective SLN studies in women with endometrial cancer were retrieved. Cervically injected indocyanine green was used as a tracer and an ipsilateral re-injection was performed in case of non-display of the upper and/or lower paracervical pathways. A systematic surgical algorithm was followed with clearly defined SLNs depicted on an anatomical chart. In high-risk endometrial cancer patients, removal of SLNs was followed by a pelvic and para-aortic lymphadenectomy.Results423 study records were analyzed. The bilateral mapping rates of the upper and lower paracervical pathways were 88.9% and 39.7%, respectively. 72% of all SLNs were typically positioned along the upper paracervical pathway (interiliac and/or proximal obturator fossa) and 71 of 75 (94.6%) of pelvic node positive women had at least one metastatic SLN at either of these positions. Women with grade 1–2 endometroid cancers (n=275) had no isolated metastases along the lower paracervical pathway compared with two women with high-risk histologies (n=148).ConclusionSLNs along the upper paracervical pathway should be identified in all endometrial cancer histological subtypes; removal of nodes at defined typical positions along the upper paracervical pathway may replace a site-specific lymphadenectomy in case of non-mapping despite tracer re-injection. Detection of SLNs along the lower paracervical pathway can be restricted to high-risk histologies and a full pre-sacral lymphadenectomy should be performed in case of non-display. |
| Databáze: | OpenAIRE |
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