Open AccessA Prospective Study of Sentinel Lymph Node Mapping for Endometrial Cancer: Is It Effective in High‐Risk Subtypes?
Author(s) -
Ye Lei,
Li ShuangDi,
Lu Wen,
He QiZhi,
Li YiRan,
Li BiLan,
Wang XiaoJun,
Yan Qin,
Wan XiaoPing
Publication year - 2019
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2019-0113
Subject(s) - medicine , endometrial cancer , sentinel lymph node , lymphadenectomy , prospective cohort study , cervical cancer , stage (stratigraphy) , confidence interval , indocyanine green , lymph node , radiology , oncology , gynecology , cancer , breast cancer , surgery , paleontology , biology
Background The efficacy of sentinel lymph node (SLN) mapping for high‐risk endometrial cancer remains unclear. This prompted us to evaluate the sensitivity, negative predictive value (NPV), and false‐negative (FN) rate of cervical injection of indocyanine green (ICG) SLN mapping in patients with endometrial cancer. Materials and Methods This prospective interventional study was performed at a single university teaching hospital. Consecutive patients with early‐stage endometrial cancer who underwent laparoscopic surgical staging were included. Cervical injection of ICG and near‐infrared SLN identification and biopsy were performed for all study patients followed by systematic pelvic lymphadenectomy, whereas para‐aortic lymphadenectomy was performed in all patients with high‐risk histologies. SLN detection rates, sensitivity, NPV, and FN rates were calculated. Results Between July 2016 and July 2018, 131 patients were enrolled. The overall SLN detection rate was 93.1%, with a bilateral detection rate of 61.8%. Four positive SLNs were identified in four patients. Lymph node metastasis was observed in four additional patients without positive SLNs. These four patients belonged to a group of patients with a high‐risk subtype. Three of the four patients had isolated para‐aortic node metastases. In low‐risk endometrial cancers, the sensitivity of the SLN technique to identify nodal metastatic disease was 100% (95% confidence interval [CI] 31.0–100), with an NPV and FN rate of 100% (95% CI 95.1–100) and 0%, respectively. In high‐risk endometrial cancers, the sensitivity, NPV, and FN rate were 20% (95% CI 1.0–70.1), 83.3% (95% CI 61.8–94.5), and 80%, respectively. Conclusion Cervical injection of ICG and SLN mapping yielded a low sensitivity and a high FN rate for the identification of node metastasis in endometrial cancer with high‐risk histologies. Implications for Practice The efficacy of sentinel lymph node (SLN) mapping for high‐risk endometrial cancer remains unclear. This study enrolled 131 patients with early‐stage endometrial cancer who underwent cervical injection of indocyanine green SLN mapping followed by systematic pelvic lymphadenectomy and para‐aortic lymphadenectomy. The key result was that SLN mapping yielded a low sensitivity and a high false‐negative rate for the identification of node metastasis in endometrial cancer with high‐risk histologies. The SLN strategy in these patients may increase the risk of missed diagnosis of isolated para‐aortic node metastases and seems to be unacceptable in clinical practice.