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A Prospective Study of Role of Sentinel Lymph Node Biopsy in Low-Risk/Intermediate-Risk Early-Stage Endometrial Carcinoma Using Dual-Dye and Dual-Site and Injection Technique

  • Vikas Singh
  • Amish Chaudhary
  • Kanika Batra ModiEmail author
  • Lourembam Sunil Singh
  • Lahori Roy
  • Pankaj Dougall
  • Gurpreet Makkar
  • Andleeb Abrari
  • Harit Chaturvedi
Original Article
  • 23 Downloads

Abstract

This is a prospective study aimed to identify the role of sentinel lymph node biopsy in low-/intermediate-risk early-stage endometrial carcinoma and its correlation with pathological findings using dual-dye and dual-site and injection technique.

Materials and Methods

It is a prospective observational study conducted in a tertiary cancer care centre for treatment of endometrial carcinoma in the period from June 2015 to June 2017. All the patients qualifying preoperative inclusion criteria for the study with biopsy-proven case of endometrial carcinoma were enrolled. Dual-dye and dual-site intervention: both radiotracer dye (Tc 99 nanocolloidal albumin dye) and methylene blue was selected for injection at two sites—cervix and subserosal.

Results

A total of 32 patients were enrolled. The median age of patients was 58.5 years (range 25–72). Histological tumour grade was available at preoperative histology in 25 of the 32 patients included in the protocol (78%). Detection rate using combined cervical and subserosal injection per patient was 96.8%. Among the patient with SLN detected in pelvic area, detection was unilateral in 6 patients (19%) and bilateral in 25 cases (78%). Sentinel lymph node detection in right and left hemi-pelvis was 81% (26 cases) and 94% (30 cases), respectively. At least one sentinel lymph node is identified in 31 of 32 patients. Metastasis was noted in 6 patients out of 32 patients. Sentinel lymph nodes are identified in all 6 of these patients.

Conclusion

The present study suggests that sentinel node biopsy is an adequate technique to evaluate lymph node status in early-stage disease with detection rate more than 95%, sensitivity of 100% and false negative rate of zero. With the low morbidity of the SLNB procedure, it might be desirable if all women with low- and intermediate-risk early-stage disease could undergo SLNB to help in the selecting those who actually benefits from comprehensive lymphadenectomy. The use of both cervical and subserosal techniques of injection of dye is associated with high overall and para-aortic SLN detection rate than either of them separately.

Keywords

Endometrial cancer Sentinel lymph node Minimally invasive 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. Lancet. 2005;366:491.CrossRefGoogle Scholar
  2. 2.
    Mais V, Cirronis MG, Piras B, Silvetti E, Cossu E, Melis GB. Intraoperative lymphatic mapping techniques for endometrial cancer. Expert Rev Anticancer Ther. 2011;11:83–7.CrossRefGoogle Scholar
  3. 3.
    Wolfson AH, Sightler SE, Markoe AM, Schwade JG, Averette HE, Ganjei P, et al. The prognostic significance of surgical staging for carcinoma of the endometrium. Gynecol Oncol. 1993;45:142–6 [PubMed: 1592280].CrossRefGoogle Scholar
  4. 4.
    Greven KM, Lanciano RM, Corn B, Case D, Randall ME. Pathologic stage III endometrial carcinoma: prognostic factors and patterns of recurrence. Cancer. 1993;71:3697–702 [PubMed: 8490920].CrossRefGoogle Scholar
  5. 5.
    Mariani A, Webb MJ, Rao SK, Lesnick TG, Podratz KC. Significance of pathologic patterns of pelvic lymph node metstatses in endometrial cancer. Gynecol Oncol. 2001;80:113–20 [PubMed: 11161847].CrossRefGoogle Scholar
  6. 6.
    Creasman W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet. 2009;105(2):109.CrossRefGoogle Scholar
  7. 7.
    Mikuta JJ. International federation of gynecology and obstetrics staging of endometrial cancer 1988. Cancer. 1993;71(4 Suppl):1460–3.CrossRefGoogle Scholar
  8. 8.
    Kwon JS, Carey MS, Cook EF, Qui F, Paszat L. Patterns of practice and outcomes in intermediate and high-risk stage I and II endometrial cancer: a population based study. Int J Gynecol Cancer. 2007;17:433–40.CrossRefGoogle Scholar
  9. 9.
    DiSaia PJ, Creasman WT, Boronow RC, Blessing JA. Risk factors and recurrent patterns in stage I endometrial cancer. Am J Obstet Gynecol. 1985;151:1009–15 [Pub-Med: 3985062].CrossRefGoogle Scholar
  10. 10.
    Tada H, Teramukai S, Fukushima M, Sasaki H. Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma. BMC Cancer. 2009;9:47.CrossRefGoogle Scholar
  11. 11.
    Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer: a Gynecologic Oncology Group Study. Cancer. 1987;60:20–35.CrossRefGoogle Scholar
  12. 12.
    Abu Rustum NR, Alektiar K, Iasonos A, Lev G, Sonoda Y, Aghajanian C, et al. The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center. Gyne-col Oncol. 2006;103:714–8.CrossRefGoogle Scholar
  13. 13.
    Maggino T, Romagnolo C, Zola P, Sartori E, Landoni F, Gadducci A. An analysis of approaches to the treatment of endometrial cancer in western Europe: a CTF study. Eur J Cancer. 1995;31A:1993–8.CrossRefGoogle Scholar
  14. 14.
    Creasman WT, Odicino F, Maisonneuve P, Beller U, Benedet JL, Heintz AP, et al. Carcinoma of the corpus uteri. J Epidemiol Biostat. 2001;6:47–86.PubMedGoogle Scholar
  15. 15.
    Zivanovie O, Khoury-Collado F, Abu-Rustam NR, Gemignani ML. Sentinel lymph node biopsy in the management of vulvar carcinoma, cervical cancer, and endometrial cancer. Oncologist. 2009;14(7):695–705.CrossRefGoogle Scholar
  16. 16.
    Barlin JN, Khoury-Collado F, Kim CH, Leitao MM Jr, Chi DC, Sonoda Y, et al. The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. Gynecol Oncol. 2012;125:531–5.CrossRefGoogle Scholar
  17. 17.
    Kadkhodayan S, Shiravani Z, Hasanzadeh M, Sharifi N, Yousefi Z, Fattahi A, et al. Lymphatic mapping and sentinel node biopsy in endometrial cancer—a feasibility study using cervical injection of radiotracer and blue dye. Nuclear Med Rev. 2014;17(2):55–8.CrossRefGoogle Scholar
  18. 18.
    Khoury-Collado F, Glaser GE, Zivanovic O, Sonoda Y, Levine DA, Chi DS, et al. Improving sentinel lymph node detection rates in endometrial cancer: how many cases are needed? Gynecol Oncol. 2009;115:453–5.CrossRefGoogle Scholar
  19. 19.
    Kitchener H, Swart AM, Qian Q, Parmar MK, Amos C, Buckley CH, ASTEC Study Group, authors. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125–36.CrossRefGoogle Scholar
  20. 20.
    Delpech Y, Coutant C, Darai E, Barranger E. Sentinel lymph node evaluation in endometrial cancer and the importance of micrometastases. Surg Oncol. 2008;17(3):237–45.CrossRefGoogle Scholar
  21. 21.
    Ballester M, Dubernard G, Lécuru F, Heitz H, Mathevet P, Marret M, et al. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol. 2011;12(5):469–76.CrossRefGoogle Scholar
  22. 22.
    Kang S, Yoo HJ, Hwang JH, Lim MC, Seo SS, Park SY, et al. Sentinel lymph node biopsy in endometrial cancer: meta-analysis of 26 studies. Gynecol Oncol. 2011;123(3):522–7.CrossRefGoogle Scholar
  23. 23.
    Fersis N, Gruber I, Relakis K, Friedrich M, Becker S, Wallwiener D, et al. Sentinel node identification and intraoperative lymphatic mapping: first results of a pilot study in patients with endometrial cancer. Eur J Gynaecol Oncol. 2004;25:339–42.PubMedGoogle Scholar
  24. 24.
    Bremond A, Bataillard A, Thomas L, Achard JL, Fervers B, Fondrinier E, et al. Standards, options and recommendations 2000 for the management of patients with endometrial cancer (non-metastatic); a bridged report. Gynecol Obstet Fertil. 2002;30:902–16.CrossRefGoogle Scholar
  25. 25.
    Lécuru FMP, Querleu D, Leblanc E, Morice P, Daraï E, Marret H, et al. Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol. 2011;29(13):1686–91.CrossRefGoogle Scholar
  26. 26.
    Singletary SE, Allred C, Ashley P, Bassett LW, Berry D, Bland KI, et al. Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol. 2002;20(17):3628–36.CrossRefGoogle Scholar
  27. 27.
    Rossi EC, Kowalski LD, Scalici J, Cantrell L, Schuler K, Hanna RK, et al. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol. 2017;18(3):384–92.CrossRefGoogle Scholar
  28. 28.
    Cormier B, Rozenholc AT, Gotlieb W, Plante M, Giede C, Communities of Practice (CoP) Group of Society of Gynecologic Oncology of Canada (GOC). Sentinel lymph node procedure in endometrial cancer: a systematic review and proposal for standardization of future research. Gynecol Oncol. 2015;138:478–85.CrossRefGoogle Scholar
  29. 29.
    Ansari M, Rad MA, Hassanzadeh M, Gholami H, Yousefi Z, Dabbagh VR, et al. Sentinel node biopsy in endometrial cancer: systematic review and meta-analysis of the literature. Eur J Gynaecol Oncol. 2013;34(5):387–401.PubMedGoogle Scholar
  30. 30.
    Kang S, Yoo HJ, Hwang JH, Lim MC, Seo SS, Park SY, et al. Sentinel lymph node biopsy in endometrial cancer: meta-analysis of 26 studies. Gynecol Oncol. 2011;123(3):522–7.CrossRefGoogle Scholar
  31. 31.
    Barlin JN, Khoury-Collado F, Kim CH, Leitao MM Jr, Chi DC, Sonoda Y, et al. The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. Gynecol Oncol. 2012;125:531–5.CrossRefGoogle Scholar
  32. 32.
    Echt ML, Finan MA, Hoffman MS, Kline RC, Roberts WS, Fiorica JV, et al. Detection of sentinel lymph nodes with lymphazurin in cervical, uterine, and vulvar malignancies. South Med J. 1999;92:204–8.CrossRefGoogle Scholar
  33. 33.
    Holub Z, Kliment L, Lukac J, Voracek J. Laparoscopically assisted intraoperative lymphatic mapping in endometrial cancer: preliminary results. Eur J Gynaecol Oncol. 2001;22(2):118–21.PubMedGoogle Scholar
  34. 34.
    Abu-Rustum NR, Khoury-Collado F, Pandit-Taskar N, Soslow RA, Dao F, Sonoda Y, et al. Sentinel lymph node mapping for grade 1 endometrial cancer: is it answer to the surgical staging dilemma? Gynecol Oncol. 2009;113(2):163–9.CrossRefGoogle Scholar
  35. 35.
    Khoury-Collado F, Abu-Rustum NR. Lymphatic mapping in endometrial cancer: a literature review of current techniques and results. Int J Gynecol Cancer. 2008;18(6):1163–8.CrossRefGoogle Scholar
  36. 36.
    Oonk MH, Van de Nieuwenhof HP, De Hullu JA, Van der Zee AG. The role of sentinel node biopsy in gynecological cancer: a review. Curr Opin Oncol. 2009;21(5):425–32.CrossRefGoogle Scholar
  37. 37.
    Eltabbakh GH, Shamonki J, Mount SL. Surgical stage, final grade, and survival of women with endometrial carcinoma whose pre-operative endometrial biopsy shows well-differentiated tumors. Gynecol Oncol. 2005;99:309–12.CrossRefGoogle Scholar
  38. 38.
    Wang X, Zhang H, Di W, Li W. Clinical factors affecting the diagnostic accuracy of assessing dilation and curretage vs frozen section specimen for histologic grade and depth of myometrial invasion in endometrial carcinoma. Am J Obstet Gynecol. 2009;201(194):e1–10.Google Scholar
  39. 39.
    Frumovitz M, Singh DK, Meyer L, Smith DH, Wetheim I, Resnik E, et al. Predictors of final histology in patients with endometrial cancer. Gynecol Oncol. 2004;95:463–8.CrossRefGoogle Scholar
  40. 40.
    Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB, et al. Surgical pathologic spread patterns of endometrial cancer: a Gynecologic Oncology Group Study. Cancer. 1987;60(8 Suppl):2035–41.CrossRefGoogle Scholar
  41. 41.
    Ballester M, Dubernard G, Lécuru F, Heitz H, Mathevet P, Marret M, et al. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol. 2011;12(5):469–76.CrossRefGoogle Scholar

Copyright information

© Association of Gynecologic Oncologists of India 2019

Authors and Affiliations

  1. 1.Department of Surgical OncologyMax Institute of Cancer CareSaketIndia
  2. 2.Department of Gynaecologic OncologyMax Institute of Cancer Care, Max Super Speciality HospitalSaketIndia
  3. 3.Department of Obstetrics and GynaecologyAnandlok HospitalKolkataIndia
  4. 4.Department of Nuclear MedicineMax Institute of Cancer CareSaketIndia
  5. 5.Department of RadiologyMax Institute of Cancer CareSaketIndia
  6. 6.Department of PathologyMax Institute of Cancer CareSaketIndia
  7. 7.Max Group of Oncology, Surgical OncologyMax Institute of Cancer CareSaketIndia

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