DOI QR코드

DOI QR Code

Accuracy of Sentinel Node in Detecting Lymph Node Metastasis in Primary Endometrial Carcinoma

  • Farghali, Mohamed M ;
  • Allam, Ihab S ;
  • Abdelazim, Ibrahim A ;
  • El-Kady, Osama S ;
  • Rashed, Ahmed R ;
  • Gareer, Waheed Y ;
  • Sweed, Mohammed S
  • Published : 2015.10.06

Abstract

Background: Endometrial carcinoma is the most common gynecological cancer and its treatment is still controversial, especially in its early stages. There are conflicting data about the efficacy of retroperitoneal lymphadenectomy during abdominal hysterectomy and bilateral salpingoophrectomy treatment. Lymphadenectomy carries a risk of severe complications, especially in women with co-morbidities. Selective lymphadenectomy has been widely employed for staging evaluation of endometrial carcinoma because it is simple and seems to provide reliable data regarding nodal metastasis. This study was designed to evaluate accuracy of sentinel node sampling in detecting lymph node metastasis in primary endometrial carcinoma during staging laparotomy. Materials and Methods: Ninety-three women with endometrial carcinoma at high-risk for nodal metastasis were studied. During laparotomy, methylene blue dye was injected into sub-serosal myometrium, then retroperitoneal spaces were opened and blue lymph nodes within pelvic and para-aortic regions were removed as separate specimens for histopathological examination (sentinel lymph nodes = SLNs). Hysterectomy and selective lymphadenectomy then performed for all women included in this study. Results: Deposition of methylene dye into at least one lymph node was observed in 73.1% (68/93) of studied cases. 18.3% (17/93) of studied women had positive lymph node metastasis and 94.1% (16/17) of them had positive metastasis in SLNs. In this study, SNLs had 94.4% sensitivity and 100% specificity in prediction of lymph node metastasis. Mean number of lymph nodes removed from each case decreased when SLNs biopsy were taken. Conclusions: SLNs are the key lymph nodes in endometrial tumor metastasis and their involvement could be an indicator for whether or not complete systematic lymphadenectomy is needed during staging laparotomy.

Keywords

Sentinel lymph node;endometrial;carcinoma;lymph nodemetastasis;prediction

References

  1. Aksoy RT, Turan AT, Boran N, et al (2014). Lack of relation of survivin gene expression with survival and surgical prognostic factors in endometrial carcinoma patients. Asian Pac J Cancer Prev, 15, 6905-10. https://doi.org/10.7314/APJCP.2014.15.16.6905
  2. Altgassen C, Pagenstecher J, Hornung D, et al (2007). A new approach to label sentinel nodes in endometrial cancer. Gynecol Oncol, 105, 457-61. https://doi.org/10.1016/j.ygyno.2007.01.021
  3. American College of Obstetricians and Gynecologists (2005). ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005, management of endometrial cancer. Obstet Gynecol, 106, 413-25. https://doi.org/10.1097/00006250-200508000-00050
  4. ASTEC study group, Kitchener H, Swart AM, et al (2009). Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial), a randomised study. Lancet, 373, 125-36. https://doi.org/10.1016/S0140-6736(08)61766-3
  5. Ballester M, Dubernard G, Lecuru F, et al (2011). Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer, a prospective multicentre study (SENTI-ENDO). Lancet Oncol, 12, 469-76. https://doi.org/10.1016/S1470-2045(11)70070-5
  6. Barranger E, Darai E (2004). Relevance of the sentinel node procedure in endometrial cancer. Gynecol Oncol, 94, 861-2.
  7. Barranger E, Uzan S, Darai E (2005). Lymphatic mapping for endometrial cancer, is hysteroscopic injection a safe technique for sentinel lymph node biopsy? Am J Obstet Gynecol, 193, 1880-1.
  8. Baser E, Togrul C, Ozgu E, et al (2013). Sperm-associated antigen 9 is a promising marker for early diagnosis of endometrial cancer. Asian Pac J Cancer Prev, 14, 7635-8. https://doi.org/10.7314/APJCP.2013.14.12.7635
  9. Bass SS, Cox CE, Reintgen DS (1999). Learning curves and certification for breast cancer lymphatic mapping. Surg Oncol Clin N Am, 8, 497-509.
  10. Burke TW, Levenback C, Tornos C, et al (1996). Intraabdominal lymphatic mapping to direct selective pelvic and paraaortic lymphadenectomy in women with high-risk endometrial cancer, results of a pilot study. Gynecol Oncol, 62, 169-73. https://doi.org/10.1006/gyno.1996.0211
  11. Cetinkaya K, Atalay F, Bacinoglu A (2014). Risk factors of lymph node metastases with endometrial carcinoma. Asian Pac J Cancer Prev, 15, 6353-6. https://doi.org/10.7314/APJCP.2014.15.15.6353
  12. Christopher H Mann, Javier Zamora, Khalid S Khan (2008). A systematic review of tests for lymph node status in primary endometrial cancer. BMC Womens Health, 8, 8. https://doi.org/10.1186/1472-6874-8-8
  13. Creasman WT, Morrow CP, Bundy BN, et al (1987). Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer, 60, 2035-41. https://doi.org/10.1002/1097-0142(19901015)60:8+<2035::AID-CNCR2820601515>3.0.CO;2-8
  14. Creasman WT, Odicino F, Maisonneuve P, et al (2006). Carcinoma of the corpus uteri, FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet, 95, 105-43. https://doi.org/10.1016/S0020-7292(06)60031-3
  15. Delaloye JF, Pampallona S, Chardonnens E, et al (2007). Intraoperative lymphatic mapping and sentinel node biopsy using hysteroscopy in patients with endometrial cancer. Gynecol Oncol, 106, 89-93. https://doi.org/10.1016/j.ygyno.2007.03.003
  16. Echt ML, Finan MA, Hoffman MS, et al (1999). Detection of sentinel lymph nodes with lymphazurin in cervical, uterine, and vulvar malignancies. South Med J, 92, 204-8. https://doi.org/10.1097/00007611-199902000-00008
  17. Fersis N, Gruber I, Relakis K, et al (2004). Sentinel node identification and intraoperative lymphatic mapping. First results of a pilot study in patients with endometrial cancer. Eur J Gynaecol Oncol, 25, 339-42.
  18. Frumovitz M, Bodurka DC, Broaddus RR, et al (2007). Lymphatic mapping and sentinel node biopsy in women with high-risk endometrial cancer. Gynecol Oncol, 104, 100-3. https://doi.org/10.1016/j.ygyno.2006.07.033
  19. Gargiulo T, Giusti M, Bottero A, et al (2003). Sentinel Lymph Node (SLN) laparoscopic assessment early stage in endometrial cancer. Minerva Ginecol, 55, 259-62.
  20. Gien LT, Kwon JS, Carey MS (2005). Sentinel node mapping with isosulfan blue dye in endometrial cancer. J Obstet Gynaecol Can, 27, 1107-12. https://doi.org/10.1016/S1701-2163(16)30393-0
  21. Greer BE, Koh WJ, Abu-Rustum N, et al (2009). Uterine neoplasms, clinical practice guidelines in oncology. J Natl Compr Canc Netw, 7, 498-531.
  22. Haltia UM, Butzow R, Leminen A, et al (2014). FIGO 1988 versus 2009 staging for endometrial carcinoma, a comparative study on prediction of survival and stage distribution according to histologic subtype. J Gynecol Oncol, 25, 30-5. https://doi.org/10.3802/jgo.2014.25.1.30
  23. Holub Z, Jabor A, Kliment L (2002). Comparison of two procedures for sentinel lymph node detection in patients with endometrial cancer, a pilot study. Eur J Gynaecol Oncol, 23, 53-7.
  24. Ilker S, Nilufer C, Firat CZ, et al (2015). Predicting lymphovascular space invasion in endometrial cancers with mucinous carcinomatous components. Asian Pac J Cancer Prev, 16, 4247-50. https://doi.org/10.7314/APJCP.2015.16.10.4247
  25. Jobo T, Sato R, Arai T, et al (2005). Lymph node pathway in the spread of endometrial carcinoma. Eur J Gynaecol Oncol, 26, 167-9.
  26. Kafshdooz T, Tabrizi AD, Mohaddes Ardabili SM, et al (2014). Polymorphism of p53 gene codon 72 in endometrial cancer, correlation with tumor grade and histological type. Asian Pac J Cancer Prev, 15, 9603-6. https://doi.org/10.7314/APJCP.2014.15.22.9603
  27. Kang S, Lee JM, Lee JK, et al (2012). How low is low enough? Evaluation of various risk-assessment models for lymph node metastasis in endometrial cancer, a Korean multicenter study. J Gynecol Oncol, 23, 251-6. https://doi.org/10.3802/jgo.2012.23.4.251
  28. Krusun S, Pesee M, Rasio W, et al (2014). Survival rate of early stage endometrioid adenocarcinoma of endometrium treated at Srinagarind Hospital. Asian Pac J Cancer Prev, 15, 2217-20. https://doi.org/10.7314/APJCP.2014.15.5.2217
  29. Lelievre L, Camatte S, Le Frere-Belda MA, et al (2004). Sentinel lymph node biopsy in cervical and endometrial cancers, a feasibility study. Bull Cancer, 91, 379-84.
  30. Maccauro M, Lucignani G, Aliberti G, et al (2005). Sentinel lymph node detection following the hysteroscopic peritumoural injection of 99mTc-labelled albumin nanocolloid in endometrial cancer. Eur J Nucl Med Mol Imaging, 32, 569-74. https://doi.org/10.1007/s00259-004-1709-4
  31. Mariani A, Webb MJ, Rao SK, et al (2001). Significance of pathologic patterns of pelvic lymph node metastases in endometrial cancer. Gynecol Oncol, 80, 113-20. https://doi.org/10.1006/gyno.2000.6050
  32. Niikura H, Okamoto S, Yoshinaga K, et al (2007). Detection of micro-metastases in the sentinel lymph nodes of patients with endometrial cancer. Gynecol Oncol, 105, 683-6. https://doi.org/10.1016/j.ygyno.2007.01.052
  33. Niikura H, Okamura C, Utsunomiya H, et al (2004). Sentinel lymph node detection in patients with endometrial cancer. Gynecol Oncol, 92, 669-74. https://doi.org/10.1016/j.ygyno.2003.10.039
  34. Pelosi E, Arena V, Baudino B, Bello M, et al (2003). Preoperative lymphatic mapping and intra-operative sentinel lymph node detection in early stage endometrial cancer. Nucl Med Commun, 24, 971-5. https://doi.org/10.1097/00006231-200309000-00005
  35. Raspagliesi F, Ditto A, Kusamura S, et al (2004). Hysteroscopic injection of tracers in sentinel node detection of endometrial cancer, a feasibility study. Am J Obstet Gynecol, 191, 435-9. https://doi.org/10.1016/j.ajog.2004.03.008
  36. SGO Clinical Practice Endometrial Cancer Working Group, Burke WM, Orr J, et al (2014). Endometrial cancer, A review and current management strategies, Part I. Gynecol Oncol, 134, 385-92. https://doi.org/10.1016/j.ygyno.2014.05.018
  37. Tangjitgamol S, Srijaipracharoen S, Manusirivithaya S, et al (2013). Endometrial carcinoma, clinical characteristic and survival rates by the new compared to the prior FIGO staging systems. J Med Assoc Thai, 96, 505-12.

Cited by

  1. A Quick and Inexpensive Alternative to Frozen Section for Diagnosing Myometrial Invasion in Endometrial Cancer vol.34, pp.2, 2018, https://doi.org/10.1089/gyn.2017.0084
  2. Sentinel node biopsy in endometrial cancer: an update vol.6, pp.2, 2018, https://doi.org/10.1007/s40336-018-0268-9