Sentinel lymph node mapping in patients with endometrial hyperplasia: A practice to preserve or abandon? Journal Article
| Authors: | Mueller, J. J.; Rios-Doria, E.; Park, K. J.; Broach, V. A.; Alektiar, K. M.; Jewell, E. L.; Zivanovic, O.; Sonoda, Y.; Abu-Rustum, N. R.; Leitao, M. M. Jr; Gardner, G. J. |
| Article Title: | Sentinel lymph node mapping in patients with endometrial hyperplasia: A practice to preserve or abandon? |
| Abstract: | Objectives: To compare outcomes of patients with premalignant endometrial pathology undergoing hysterectomy with or without sentinel lymph node (SLN) removal. Outcomes of interest included surgical adverse events (AEs), cancer status on final pathology, postoperative treatment, and The Cancer Genome Atlas (TCGA) molecular risk profiles. Methods: We retrospectively identified patients with premalignant pathology on preoperative endometrial biopsy who underwent hysterectomy with or without SLN mapping/excision at our institution from 01/01/2017–12/31/2021. Clinical, pathologic, surgical, and TCGA profiling data were abstracted. Appropriate statistical tests were used. Results: Of 221 patients identified, 161 (73%) underwent hysterectomy with SLN excision and 60 (27%) underwent hysterectomy without SLN excision. Median age and body mass index were similar between groups. Median operative time was 130 min for those who underwent SLN mapping/excision versus 136 min for those who did not (p = 0.6). Thirty-day postoperative AE rates were 9% (n = 15/161) and 13% (n = 8/60), respectively (p = 0.9). Ninety-eight (44%) of 221 patients had grade 1–2 endometrioid endometrial cancer on final pathology (4 [4%] were stage IB or higher). Ten (10%) of 98 patients, all within the SLN group, received adjuvant treatment. Among all patients, of 33 (15%) with TCGA molecular classification data, 27 (82%) had copy number-low, 3 (9%) microsatellite instability-high, 2 (6%) POLE-ultramutated, and 1 (3%) copy number-high disease. Conclusions: SLN assessment appears safe, detects a small number of occult nodal metastases for those upstaged, and provides additional staging information that can guide adjuvant treatment. SLN mapping should be discussed in preoperative counseling and offered using a shared decision-making approach. © 2022 Elsevier Inc. |
| Keywords: | adult; controlled study; human tissue; treatment outcome; aged; major clinical study; paclitaxel; adjuvant therapy; postoperative care; chemotherapy; endometrial cancer; hysterectomy; endometrium cancer; sentinel lymph node; carboplatin; multiple cycle treatment; retrospective study; postoperative complication; electronic medical record; body mass; minimally invasive surgery; frozen section; lynch syndrome; endometrium biopsy; endometrial hyperplasia; endometrium hyperplasia; international federation of gynecology and obstetrics; open surgery; indocyanine green; very elderly; human; female; article |
| Journal Title: | Gynecologic Oncology |
| Volume: | 168 |
| ISSN: | 0090-8258 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2023-01-01 |
| Start Page: | 1 |
| End Page: | 7 |
| Language: | English |
| DOI: | 10.1016/j.ygyno.2022.10.017 |
| PUBMED: | 36334496 |
| PROVIDER: | scopus |
| PMCID: | PMC10184678 |
| DOI/URL: | |
| Notes: | Article -- The NIH/NCI Cancer Center Support Grant P30 CA008748 is acknowledged via PubMed and the PDF -- Corresponding author is MSK author Jennifer J. Mueller -- Export Date: 1 December 2022 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work