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: Noncanonical Wnts are largely believed to act as permissive cues for vertebrate cell movement via Frizzled (Fz). In addition to Fz, Wnt ligands are known to regulate neurite outgrowth through an alternative receptor related to tyrosine kinase (Ryk). However, Wnt-Ryk signaling during embryogenesis is less well characterized. In this study, we report a role for Wnt5b as an instructive cue to regulate gastrulation movements through Ryk. In zebrafish, Ryk deficiency impairs Wnt5b-induced Ca(2+) activity and directional cell movement. Wnt5b-Ryk signaling promotes polarized cell protrusions. Upon Wnt5b stimulation, Fz2 but not Ryk recruits Dishevelled to the cell membrane, suggesting that Fz2 and Ryk mediate separate pathways. Using co-culture assays to generate directional Wnt5b cues, we demonstrate that Ryk-expressing cells migrate away from the Wnt5b source. We conclude that full-length Ryk conveys Wnt5b signals in a directional manner during gastrulation.The Journal of Cell Biology 07/2010; 190(2):263-78. · 10.82 Impact Factor
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ABSTRACT: Endometrial cancer is the most common malignancy of the female genital tract in developed countries. The primary treatment for women with endometrial cancer is surgical, as well as the staging of the pathological spread pattern of this carcinoma outside of the uterus. A complete surgical staging should include both pelvic and para-aortic lymphadenectomy. The vast majority of endometrial cancers are diagnosed at a very early stage owing to the early presentation as abnormal uterine bleeding. In women with early-stage endometrial cancer the systematic pelvic and para-aortic lymphadenectomy may produce additional morbidity without the benefit of appropriate surgical staging. The procedure of sentinel lymph node (SLN) biopsy after lymphatic mapping has been introduced for patients with cancers of various organs in an effort to avoid complete systematic lymphadenectomy whenever possible. In the case of gynecological malignancies, the reliability of the SLN detection procedure has been extensively investigated in vulvar and cervical cancer. This article focuses on the peculiar aspects of intraoperative lymphatic mapping techniques and SLN procedures in endometrial cancer.Expert Review of Anti-infective Therapy 01/2011; 11(1):83-93. · 2.07 Impact Factor
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ABSTRACT: Gynecologic oncologists have sought to define adequate lymphadenectomy. The purpose of this study is to determine the probability of detecting lymph node metastasis by lymph node count compared to number of nodal stations sampled. This is a clinicopathologic review of surgically staged endometrial carcinoma patients from 2000 to 2008. Information was extracted from patients' medical records. Student t-test, Wilcoxon rank sum test, Chi-square and Fisher exact tests were used. Elimination logistic regression was performed to identify independent significant predictors of lymph node metastasis. p<.05 was considered significant for all tests. The study population consisted of 352 patients with a mean age of 65. Forty patients (11.36%) had lymph node metastasis. Number of nodes sampled was not associated with lymph node status on univariate analyses. Patients with lymph node metastases detected was increased when 8 or more nodal stations were sampled compared to less than 8 (19.4% vs. 9.8%, p=.04). More significance was seen when 9 or more stations were sampled (32% vs. 9.8%, p=.004). Multivariate logistic regression analysis, controlling for age, grade, depth of myometrial invasion, number of nodes sampled, and number of nodal stations sampled, found only grade (p=.002), depth of myometrial invasion (p<.0003), and sampling of 9 or more nodal stations (p=.03) to be independent predictors of node status. Lymph node count did not accurately predict risk of lymph node metastasis. Number of nodal stations sampled was a more precise predictor of lymph node metastases.Gynecologic Oncology 11/2010; 119(2):295-8. · 3.93 Impact Factor