Laparoscopic sentinel node mapping using combined detection for endometrial cancer: a study of 33 cases--is it a promising technique?

Department of Gynecologic and Breast cancers, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, 4 rue de Chine, 75020 Paris, France.
American journal of surgery (Impact Factor: 2.36). 07/2008; 197(1):1-7. DOI: 10.1016/j.amjsurg.2007.10.021
Source: PubMed

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: Beside the classical applications of sentinel lymph node mapping, some new procedures are emerging and showing feasibility and clinical utility. In this chapter, we will report on sentinel lymph node mapping in 1) malignancies of the female reproductive system (cervical cancer, endometrial cancer, vulvar cancer and ovarian cancer); 2) malignancies of the male reproductive system (prostate cancer, penile cancer and testicular cancer); 3) malignancies in kidney and bladder. This paper presents the uncommon applications of sentinel lymph node mapping in urogenital neoplasms.
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    ABSTRACT: Objective 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. Methods This is a single-center prospective observational study carried out from September 2011 to December 2013 including women with a diagnosis of endometrial cancer and scheduled for surgery. A regional lymph node mapping was obtained using SPECT-CT (cervical injection of Tc-99m) the day before surgery. On the day of surgery, methylene blue was injected in the cervical tissue. The SLNs were identified intraoperatively guided both by a -probe and visual inspection of the blue dye. A pelvic and/or para-aortic lymphadenectomy was completed. A histological analysis was performed on all the removed lymph nodes. We calculated the detection rate for SLN and its negative predictive value (NPV) for malignancy. Results Fifty patients underwent surgery. The SLN was isolated in 46 patients with detection rate of 92% (95% confidence interval, 80.77-97.78). The mean number of detected SLNs per patient was 1.54 (range, 1-5); the average number of non-SLNs removed was 17 (5-34) per patient. The most common SLN location was the external iliac lymph node chain, 33 (46.47%). Five SLNs (7.1%) were isolated in the para-aortic chain. Three SLN cases (5.9%) were positive for malignant cells; the totality of the remaining non-SLNs was negative. The NPV of the SLN was 100% (95% confidence interval, 89.79-99.79). Finally, pathologic findings were 42 endometrioid types (84%), 3 carcinosarcomas (6%), 4 clear cell (8%), and 1 serous papillary tumor (2%). Conclusions The SLN analysis may be useful to assess the presence or absence of lymph node metastases. Its high NPV may be used as criteria to avoid unnecessary lymphadenectomies in endometrial cancer patients.
    International Journal of Gynecological Cancer 06/2014; 24(6). DOI:10.1097/IGC.0000000000000158 · 1.95 Impact Factor
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