Synapse - Sentinel lymph node mapping for grade 1 endometrial cancer: Is it the answer to the surgical staging dilemma?

Sentinel lymph node mapping for grade 1 endometrial cancer: Is it the answer to the surgical staging dilemma? Journal Article

Authors:	Abu-Rustum, N. R.; Khoury-Collado, F.; Pandit-Taskar, N.; Soslow, R. A.; Dao, F.; Sonoda, Y.; Levine, D. A.; Brown, C. L.; Chi, D. S.; Barakat, R. R.; Gemignani, M. L.
Article Title:	Sentinel lymph node mapping for grade 1 endometrial cancer: Is it the answer to the surgical staging dilemma?
Abstract:	Objective: To describe the accuracy of SLN mapping in patients with a preoperative diagnosis of grade 1 endometrial cancer. Methods: A prospective, non-randomized study of women with a preoperative diagnosis of endometrial cancer and clinical stage I disease was conducted. A subset analysis of patients with a preoperative diagnosis of grade 1 endometrial endometrioid cancer was performed. All patients had preoperative lymphoscintigraphy with Tc99m on the day of or day before surgery followed by an intraoperative injection of 2 cm<sup>3</sup> of isosulfan or methylene blue dye deep into the cervix or both cervix and fundus. All patients underwent hysterectomy, bilateral salpingo-oophorectomy, and regional nodal dissection. Hot and/or blue nodes were labeled as SLNs and sent for histopathological analysis. Results: Forty-two patients with a preoperative diagnosis of grade 1 endometrial carcinoma treated from 3/06 to 8/08 were identified. Twenty-five (60%) had laparoscopic surgery; 17 (40%) were treated by laparotomy. Preoperative lymphoscintigraphy visualized SLNs in 30 patients (71%); intraoperative localization of the SLN was possible in 36 patients (86%). A median of 3 SLNs (range, 1-14) and 14.5 non-SLNs (range, 4-55) were examined. In all, 4/36 (11%) had positive SLNs-3 seen on H&E and 1 as cytokeratin-positive cells on IHC. All node-positive cases were picked up by the SLN; there were no false-negative cases. The sensitivity of the SLN procedure in the 36 patients who had an SLN identified was 100%. Conclusion: Sentinel lymph node mapping using a cervical injection with combined Tc and blue dye is feasible and accurate in patients with grade 1 endometrial cancer and may be a reasonable option for this select group of patients. Regional lymphadenectomy remains the gold standard in many practices, particularly for the approximately 15% of cases with failed SLN mapping. © 2009 Elsevier Inc. All rights reserved.
Keywords:	adult; clinical article; human tissue; aged; aged, 80 and over; middle aged; histopathology; endometrial cancer; staging; cancer diagnosis; hysterectomy; lymph node dissection; endometrial neoplasms; lymph nodes; lymphatic metastasis; neoplasm staging; grade 1; laparoscopy; sentinel lymph node mapping; isosulfan blue; methylene blue; technetium 99m; analysis; cancer grading; diagnostic accuracy; endometrium cancer; gold standard; laboratory diagnosis; laparoscopic surgery; laparotomy; lymphoscintigraphy; preoperative evaluation; prospective study; salpingooophorectomy; sensitivity and specificity; sentinel lymph node; intraoperative care; lymph node excision; prospective studies; radiopharmaceuticals; rosaniline dyes; sentinel lymph node biopsy; technetium tc 99m sulfur colloid
Journal Title:	Gynecologic Oncology
Volume:	113
Issue:	2
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2009-05-01
Start Page:	163
End Page:	169
Language:	English
DOI:	10.1016/j.ygyno.2009.01.003
PUBMED:	19232699
PROVIDER:	scopus
PMCID:	PMC3959736
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-63749130362&partnerID=40&md5=2bc89859e4411261cb3baf2e8c43538e
Notes:	--- - "Cited By (since 1996): 11" - "Export Date: 30 November 2010" - "CODEN: GYNOA" - "Source: Scopus"