The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: Beyond removal of blue nodes Journal Article


Authors: Barlin, J. N.; Khoury-Collado, F.; Kim, C. H.; Leitao, M. M.; Chi, D. S.; Sonoda, Y.; Alektiar, K.; DeLair, D. F.; Barakat, R. R.; Abu-Rustum, N. R.
Article Title: The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: Beyond removal of blue nodes
Abstract: Objective: To determine the false-negative rate of a surgical sentinel lymph node (SLN) mapping algorithm that incorporates more than just removing SLNs in detecting metastatic endometrial cancer. Methods: A prospective database of all patients who underwent lymphatic mapping for endometrial cancer was reviewed. Cervical injection of blue dye was used in all cases. The surgical algorithm is as follows: 1) peritoneal and serosal evaluation and washings; 2) retroperitoneal evaluation including excision of all mapped SLNs and suspicious nodes regardless of mapping; and 3) if there is no mapping on a hemi-pelvis, a side-specific pelvic, common iliac, and interiliac lymph node dissection (LND) is performed. Paraaortic LND is performed at the attendings' discretion. The algorithm was retrospectively applied. Results: From 9/2005 to 4/2011, 498 patients received a blue dye cervical injection for SLN mapping. At least one LN was removed in 95% of cases (474/498); at least one SLN was identified in 81% (401/498). SLN correctly diagnosed 40/47 patients with nodal metastases who had at least one SLN mapped, resulting in a 15% false-negative rate. After applying the algorithm, the false-negative rate dropped to 2%. Only one patient, whose LN spread would not have been caught by the algorithm, had an isolated positive right paraaortic LN with a negative ipsilateral SLN and pelvic LND. Conclusions: Satisfactory SLN mapping in endometrial cancer requires adherence to a surgical SLN algorithm and goes beyond just the removal of blue SLNs. Removal of any suspicious node along with side-specific lymphadenectomy for failed mapping are an integral part of this algorithm. Further validation of the false-negative rate of this algorithm is necessary. © 2012 Elsevier Inc. All rights reserved.
Keywords: adult; aged; major clinical study; conference paper; cancer staging; endometrial cancer; lymph node dissection; paraaortic lymph node; pelvis lymph node; sentinel lymph node mapping; endometrium cancer; sensitivity and specificity; sentinel lymph node; metastasis; false negative result; algorithm; surgery; predictive value; classification algorithm; sentinel lymph node mapping algorithm; sentinel lymph node metastasis
Journal Title: Gynecologic Oncology
Volume: 125
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2012-06-01
Start Page: 531
End Page: 535
Language: English
DOI: 10.1016/j.ygyno.2012.02.021
PROVIDER: scopus
PUBMED: 22366409
DOI/URL:
Notes: --- - "Export Date: 4 June 2012" - "CODEN: GYNOA" - "Source: Scopus"
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MSK Authors
  1. Richard R Barakat
    629 Barakat
  2. Dennis S Chi
    596 Chi
  3. Kaled M Alektiar
    287 Alektiar
  4. Yukio Sonoda
    370 Sonoda
  5. Mario Leitao
    442 Leitao
  6. Joyce Nuqui Barlin
    23 Barlin
  7. Christine Heesun Kim
    13 Kim
  8. Deborah F DeLair
    104 DeLair