Laparoscopic sentinel node mapping using combined detection for endometrial cancer: a study of 33 cases--is it a promising technique?
ABSTRACT To evaluate the feasibility of a laparoscopic sentinel node (SN) procedure based on combined method in patients with endometrial cancer.
Thirty-three patients (median age 66.1 years) with endometrial cancer of apparent stage I or stage II underwent a laparoscopic SN procedure based on combined radiocolloid and patent blue injected pericervically. After the SN procedure, all the patients underwent laparoscopic bilateral pelvic lymphadenectomy.
SNs were identified in only 27 patients (81.8%). The mean number of SNs was 2.5 per patient (range 1-5). Only 18 patients (54.5%) had an identified bilateral SN. The most common site of the SNs was the medial external iliac region (67.6%). Fourteen SNs (19.7%) from 8 patients (24.2%) were found to be metastatic at the final histological assessment. No false-negative SN results were observed.
A SN procedure based on a combined detection and laparoscopic approach is feasible in patients with early endometrial cancer. However, because of a low rate of bilateral and global SN detections and problems of injection site using pericervical injection of radiocolloid and blue dye, alternative methods should be explored. Pericervical injections should be avoided.
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ABSTRACT: The accurate harvesting of a sentinel node in gynaecological cancer (i.e. vaginal, vulvar, cervical, endometrial or ovarian cancer) includes a sequence of procedures with components from different medical specialities (nuclear medicine, radiology, surgical oncology and pathology). These guidelines are divided into sectione entitled: Purpose, Background information and definitions, Clinical indications and contraindications for SLN detection, Procedures (in the nuclear medicine department, in the surgical suite, and for radiation dosimetry), and Issues requiring further clarification. The guidelines were prepared for nuclear medicine physicians. The intention is to offer assistance in optimizing the diagnostic information that can currently be obtained from sentinel lymph node procedures. If specific recommendations given cannot be based on evidence from original scientific studies, referral is made to "general consensus" and similar expressions. The recommendations are designed to assist in the practice of referral to, and the performance, interpretation and reporting of all steps of the sentinel node procedure in the hope of setting state-of-the-art standards for high-quality evaluation of possible metastatic spread to the lymphatic system in gynaecological cancer. The final result has been discussed by a group of distinguished experts from the EANM Oncology Committee and the European Society of Gynaecological Oncology (ESGO). The document has been endorsed by the SNMMI Board.European Journal of Nuclear Medicine 03/2014; · 4.53 Impact Factor
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ABSTRACT: The aim of this study is to evaluate the effectiveness of a combined technique for sentinel lymph node (SLN) localization and surgical staging of endometrial carcinoma.International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 06/2014;
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ABSTRACT: The objective of this study was to evaluate long-term oncological outcomes of laparoscopic management of endometrial carcinoma (EC) in a large series of consecutive patients from two referral cancer centres. The study is a large retrospective study with 15-year follow-up. The clinical records of 207 consecutive women with clinical stage I EC managed by laparoscopy between 1990 and 2005 were reviewed. Laparoscopy included peritoneal washing, inspection of abdominal cavity, total laparoscopic hysterectomy + bilateral salpingo-oophorectomy and pelvic/para-aortic lymphadenectomy depending on the preoperative histology or frozen section results. Data collected included conversion rate, operative time, hospital stay, surgical complications, FIGO 1988 stage and 5-year survival. Laparoscopic procedures were converted to laparotomy in nine (4.3%) cases. Mean operative time was 173.2 min (70–300 min). Mean hospital stay was 5 days. The mean number of lymph nodes removed was 10 (2–25). Lymphadenectomy was considered not feasible in 20 cases (12.9%) due to technical difficulties. Intraoperative and postoperative complications were seen in 11 (5.6%) and 13 (6.6%) women, respectively. Histopathological results led to upstaging in 11.6% of cases. After a mean follow-up of 74.8 months (14–204 months), 5-year cause-specific and disease-free survival rates were 93.2% and 89.3%, respectively. Twenty-one (10.6%) patients developed recurrences. No port site metastases were identified. Laparoscopic management of EC is feasible, reproducible and does not worsen patient prognosis. It allows comprehensive surgical staging and the option of lymphadenectomy in a single surgical procedure without compromising the oncological radicality required. Our results show minimal morbidity and similar long-term outcomes than those obtained by laparotomy in the literature.Gynecological Surgery 01/2011;