Comparison of a sentinel lymph node and a selective lymphadenectomy algorithm in patients with endometrioid endometrial carcinoma and limited myometrial invasion Journal Article

   

Authors:	Eriksson, A. G. Z.; Ducie, J.; Ali, N.; McGree, M. E.; Weaver, A. L.; Bogani, G.; Cliby, W. A.; Dowdy, S. C.; Bakkum-Gamez, J. N.; Abu-Rustum, N. R.; Mariani, A.; Leitao, M. M. Jr
Article Title:	Comparison of a sentinel lymph node and a selective lymphadenectomy algorithm in patients with endometrioid endometrial carcinoma and limited myometrial invasion
Abstract:	Objectives To assess clinicopathologic outcomes between two nodal assessment approaches in patients with endometrioid endometrial carcinoma and limited myoinvasion. Methods Patients with endometrial cancer at two institutions were reviewed. At one institution, a complete pelvic and para-aortic lymphadenectomy to the renal veins was performed in select cases deemed at risk for nodal metastasis due to grade 3 cancer and/or primary tumor diameter > 2 cm (LND cohort). This is a historic approach at this institution. At the other institution, a sentinel lymph node mapping algorithm was used per institutional protocol (SLN cohort). Low risk was defined as endometrioid adenocarcinoma with myometrial invasion < 50%. Macrometastasis, micrometastasis, and isolated tumor cells were all considered node-positive. Results Of 1135 cases identified, 642 (57%) were managed with an SLN approach and 493 (43%) with an LND approach. Pelvic nodes (PLNs) were removed in 93% and 58% of patients, respectively (P < 0.001); para-aortic nodes (PANs) were removed in 14.5% and 50% of patients, respectively (P < 0.001). Median number of PLNs removed was 6 and 34, respectively; median number of PANs removed was 5 and 16, respectively (both P < 0.001). Metastasis to PLNs was detected in 5.1% and 2.6% of patients, respectively (P = 0.03), and to PANs in 0.8% and 1.0%, respectively (P = 0.75). The 3-year disease-free survival rates were 94.9% (95% CI, 92.4-97.5) and 96.8% (95% CI, 95.2-98.5), respectively. Conclusions Our findings support the use of either strategy for endometrial cancer staging, with no apparent detriment in adhering to the SLN algorithm. The clinical significance of disease detected on ultrastaging and the role of adjuvant therapy is yet to be determined. © 2016 Elsevier Inc. All rights reserved.
Keywords:	sentinel lymph node; endometrial carcinoma; ultrastaging; comprehensive lymphadenectomy; sentinel lymph node algorithm; sln algorithm
Journal Title:	Gynecologic Oncology
Volume:	140
Issue:	3
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2016-03-01
Start Page:	394
End Page:	399
Language:	English
DOI:	10.1016/j.ygyno.2015.12.028
PROVIDER:	scopus
PUBMED:	26747778
PMCID:	PMC4839486
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84959257886&partnerID=40&md5=f0d00cd910bfb02f6e33f11be9793c06
Notes:	Article -- Export Date: 4 April 2016 -- Source: Scopus

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