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Sentinel lymph node mapping in endometrial cancer: A comparison of main national and international guidelines
Author(s) -
Dick Aharon,
Perri Tamar,
Kogan Liron,
Brandt Benny,
Meyer Raanan,
Levin Gabriel
Publication year - 2023
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.14307
Subject(s) - medicine , endometrial cancer , lymphadenectomy , lymph node , sentinel lymph node , gynecologic oncology , consensus conference , general surgery , indocyanine green , gynecology , cancer , radiology , oncology , surgery , breast cancer
Objectives To compare national and international guidelines regarding sentinel lymph node (SLN) mapping in endometrial cancer. Methods A descriptive comparative study of the National Comprehensive Cancer Network (NCCN), the Society of Gynecologic Oncology (SGO), the European Society of Gynecological Oncology (ESGO), the British Gynecological Cancer Society (BGCS), and the Japan Society of Gynecologic Oncology (JSGO) guidelines. Results There is a broad consensus that SLN mapping is an appropriate alternative to pelvic lymphadenectomy for uterine‐confined endometrioid endometrial cancer (five of five guidelines). It is broadly accepted that a full lymphadenectomy should be performed in case of failed SLN mapping (four of five guidelines), and that mapping with the fluorescent dye indocyanine green is superior to other methods (four of five guidelines). It is agreed that the cervix is the preferable site for dye injection (four of five guidelines), and pathology ultrastaging is advocated by most guidelines (three of five guidelines). Regarding high‐risk patients (i.e., high‐grade histology and non‐endometroid carcinomas), some guidelines accept (three of five), but others currently do not advocate (one of five guidelines), SLN mapping as a sole method for lymph node evaluation. There is no consensus regarding para‐aortic lymph node evaluation in pelvic SLN‐positive patients. Conclusion Guidelines for SLN mapping are comparable with regards to surgical technique, ultrastaging, and management in case of failed mapping. Nevertheless, some variations exist regarding the management of high‐grade histology and positive pelvic lymph nodes.