Uterine Cancer pp 179-191 | Cite as

Sentinel Node Evaluation in Endometrial Cancer


Comprehensive surgical staging is meant to serve as a guide to appropriate postoperative adjuvant therapy for endometrial cancer. However, lymphadenectomy is not without complications and has been associated with increased risk of blood vessel and nerve damage,lymphedema, and lymphocyst formation. In addition, some have questioned the therapeutic value of systematic lymphadenectomy. Two recent, large randomized control trials revealed that systematic lymphadenectomy was not associated with improved overall recurrence or survival rates [2–4].However, the methodologies of both these studies were the subject of criticism [5, 6], and thus,not everyone is quite ready to discontinue lymphadenectomies. Recently, sentinel lymph node (SLN) mapping has emerged as a promising compromise to the ongoing debate.


Sentinel Lymph Node Endometrial Cancer Myometrial Invasion Isolate Tumor Cell Sentinel Lymph Node Mapping 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Creasman WT, Morrow CP, Bundy BN, et al. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group study. Cancer. 1987;60(8 Suppl):2035–41. Epub 1987/10/15.PubMedCrossRefGoogle Scholar
  2. 2.
    Benedetti Panici P, Basile S, Maneschi F, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100(23):1707–16. Epub 2008/11/27.PubMedCrossRefGoogle Scholar
  3. 3.
    Kitchener H, Swart AM, Qian Q, et al. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373(9658):125–36. Epub 2008/12/17.PubMedCrossRefGoogle Scholar
  4. 4.
    May K, Bryant A, Dickinson HO, et al. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev. 2010;1, CD007585. Epub 2010/01/22.PubMedGoogle Scholar
  5. 5.
    Seamon LG, Fowler JM, Cohn DE. Lymphadenectomy for endometrial cancer: the controversy. Gynecol Oncol. 2010;117(1):6–8. Epub 2010/01/30.PubMedCrossRefGoogle Scholar
  6. 6.
    Creasman WT, Mutch DE, Herzog TJ. ASTEC lymphadenectomy and radiation therapy studies: are conclusions valid? Gynecol Oncol. 2010;116(3):293–4. Epub 2009/11/10.PubMedCrossRefGoogle Scholar
  7. 7.
    Press J, Gotlieb W. Controversies in the treatment of early stage endometrial carcinoma. Obstet Gynecol Int. 2012;2012:8.CrossRefGoogle Scholar
  8. 8.
    Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392–9. Epub 1992/04/01.PubMedCrossRefGoogle Scholar
  9. 9.
    Schwartz GF, Giuliano AE, Veronesi U. Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19–22, 2001, Philadelphia, Pennsylvania. Cancer. 2002;94(10):2542–51. Epub 2002/08/14.PubMedCrossRefGoogle Scholar
  10. 10.
    Van der Zee AG, Oonk MH, De Hullu JA, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2008;26(6):884–9. Epub 2008/02/19.CrossRefGoogle Scholar
  11. 11.
    Lecuru F, Mathevet P, Querleu D, 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 Off J Am Soc Clin Oncol. 2011;29(13):1686–91. Epub 2011/03/30.CrossRefGoogle Scholar
  12. 12.
    Ben-Shachar I, Pavelka J, Cohn DE, et al. Surgical staging for patients presenting with grade 1 endometrial carcinoma. Obstet Gynecol. 2005;105(3):487–93. Epub 2005/03/02.PubMedCrossRefGoogle Scholar
  13. 13.
    Frumovitz M, Slomovitz BM, Singh DK, et al. Frozen section analyses as predictors of lymphatic spread in patients with early-stage uterine cancer. J Am Coll Surg. 2004;199(3):388–93. Epub 2004/08/25.PubMedCrossRefGoogle Scholar
  14. 14.
    Burke TW, Levenback C, Tornos C, et al. Intraabdominal lymphatic mapping to direct selective pelvic and paraaortic lymphadenectomy in women with high-risk endometrial cancer: results of a pilot study. Gynecol Oncol. 1996;62(2):169–73. Epub 1996/08/01.PubMedCrossRefGoogle Scholar
  15. 15.
    Ballester M, Rouzier R, Coutant C, et al. Limits of lymphoscintigraphy for sentinel node biopsy in women with endometrial cancer. Gynecol Oncol. 2009;112(2):348–52. Epub 2008/12/17.PubMedCrossRefGoogle Scholar
  16. 16.
    Solima E, Martinelli F, Ditto A, et al. Diagnostic accuracy of sentinel node in endometrial cancer by using hysteroscopic injection of radiolabeled tracer. Gynecol Oncol. 2012;126(3):419–23. Epub 2012/06/05.PubMedCrossRefGoogle Scholar
  17. 17.
    Kang S, Yoo HJ, Hwang JH, et al. Sentinel lymph node biopsy in endometrial cancer: meta-analysis of 26 studies. Gynecol Oncol. 2011;123(3):522–7. Epub 2011/09/29.PubMedCrossRefGoogle Scholar
  18. 18.
    Khoury-Collado F, Glaser GE, Zivanovic O, et al. Improving sentinel lymph node detection rates in endometrial cancer: how many cases are needed? Gynecol Oncol. 2009;115(3):453–5. Epub 2009/09/22.PubMedCrossRefGoogle Scholar
  19. 19.
    Rossi EC, Ivanova A, Boggess JF. Robotically assisted fluorescence-guided lymph node mapping with ICG for gynecologic malignancies: a feasibility study. Gynecol Oncol. 2012;124(1):78–82. Epub 2011/10/15.PubMedCrossRefGoogle Scholar
  20. 20.
    Holloway RW, Bravo RA, Rakowski JA, et al. Detection of sentinel lymph nodes in patients with endometrial cancer undergoing robotic-assisted staging: a comparison of colorimetric and fluorescence imaging. Gynecol Oncol. 2012;126(1):25–9. Epub 2012/04/13.PubMedCrossRefGoogle Scholar
  21. 21.
    Frumovitz M, Bodurka DC, Broaddus RR, et al. Lymphatic mapping and sentinel node biopsy in women with high-risk endometrial cancer. Gynecol Oncol. 2007;104(1):100–3. Epub 2006/09/12.PubMedCrossRefGoogle Scholar
  22. 22.
    Lopes LA, Nicolau SM, Baracat FF, et al. Sentinel lymph node in endometrial cancer. Int j Gynecol Cancer Off J Int Gynecol Cancer Soc. 2007;17(5):1113–7. Epub 2007/03/28.CrossRefGoogle Scholar
  23. 23.
    Holub Z, Jabor A, Lukac J, et al. Laparoscopic detection of sentinel lymph nodes using blue dye in women with cervical and endometrial cancer. Med Sci Monit Int Med J Exp Clin Res. 2004;10(10):CR587–91. Epub 2004/09/28.Google Scholar
  24. 24.
    Li B, Li XG, Wu LY, et al. A pilot study of sentinel lymph nodes identification in patients with endometrial cancer. Bull Cancer. 2007;94(1):E1–4. Epub 2007/01/24.PubMedGoogle Scholar
  25. 25.
    Altgassen C, Muller N, Hornemann A, et al. Immunohistochemical workup of sentinel nodes in endometrial cancer improves diagnostic accuracy. Gynecol Oncol. 2009;114(2):284–7. Epub 2009/05/19.PubMedCrossRefGoogle Scholar
  26. 26.
    Echt ML, Finan MA, Hoffman MS, et al. Detection of sentinel lymph nodes with lymphazurin in cervical, uterine, and vulvar malignancies. South Med J. 1999;92(2):204–8. Epub 1999/03/11.PubMedCrossRefGoogle Scholar
  27. 27.
    Holub Z, Jabor A, Kliment L. Comparison of two procedures for sentinel lymph node detection in patients with endometrial cancer: a pilot study. Eur J Gynaecol Oncol. 2002;23(1):53–7. Epub 2002/03/06.PubMedGoogle Scholar
  28. 28.
    Gien LT, Kwon JS, Carey MS. Sentinel node mapping with isosulfan blue dye in endometrial cancer. J Obstet Gynaecol Can JOGC (Journal d’obstetrique et gynecologie du Canada: JOGC). 2005;27(12):1107–12. Epub 2006/03/10.Google Scholar
  29. 29.
    Robova H, Charvat M, Strnad P, et al. Lymphatic mapping in endometrial cancer: comparison of hysteroscopic and subserosal injection and the distribution of sentinel lymph nodes. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2009;19(3):391–4. Epub 2009/05/02.CrossRefGoogle Scholar
  30. 30.
    Torne A, Pahisa J, Vidal-Sicart S, et al. Transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR): a new method for sentinel lymph node detection in endometrial cancer. Gynecol Oncol. 2013;128(1):88–94. Epub 2012/10/23.PubMedCrossRefGoogle Scholar
  31. 31.
    Niikura H, Okamura C, Utsunomiya H, et al. Sentinel lymph node detection in patients with endometrial cancer. Gynecol Oncol. 2004;92(2):669–74. Epub 2004/02/10.PubMedCrossRefGoogle Scholar
  32. 32.
    Maccauro M, Lucignani G, Aliberti G, et al. Sentinel lymph node detection following the hysteroscopic peritumoural injection of 99mTc-labelled albumin nanocolloid in endometrial cancer. Eur J Nucl Med Mol Imaging. 2005;32(5):569–74. Epub 2004/12/31.PubMedCrossRefGoogle Scholar
  33. 33.
    Delaloye JF, Pampallona S, Chardonnens E, et al. Intraoperative lymphatic mapping and sentinel node biopsy using hysteroscopy in patients with endometrial cancer. Gynecol Oncol. 2007;106(1):89–93. Epub 2007/04/20.PubMedCrossRefGoogle Scholar
  34. 34.
    Fersis N, Gruber I, Relakis K, 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(3):339–42. Epub 2004/06/03.PubMedGoogle Scholar
  35. 35.
    Raspagliesi F, Ditto A, Kusamura S, et al. Hysteroscopic injection of tracers in sentinel node detection of endometrial cancer: a feasibility study. Am J Obstet Gynecol. 2004;191(2):435–9. Epub 2004/09/03.PubMedCrossRefGoogle Scholar
  36. 36.
    Perrone AM, Casadio P, Formelli G, et al. Cervical and hysteroscopic injection for identification of sentinel lymph node in endometrial cancer. Gynecol Oncol. 2008;111(1):62–7. Epub 2008/07/16.PubMedCrossRefGoogle Scholar
  37. 37.
    Feranec R, Moukova L, Stanicek J, et al. Detekce sentinelove uzliny u pacientek s karcinomem endometria s vyuzitim hysteroskopie [Sentinel lymph node identification using hysteroscopy in patients with endometrial cancer]. Klinicka onkologie: casopis Ceske a Slovenske onkologicke spolecnosti. 2010;23(2):92–8. Epub 2010/05/15.Google Scholar
  38. 38.
    Rossi EC, Jackson A, Ivanova A, et al. Detection of sentinel nodes for endometrial cancer with robotic assisted fluorescence imaging: cervical versus hysteroscopic injection. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2013;23(9):1704–11. Epub 2013/11/02.CrossRefGoogle Scholar
  39. 39.
    Baker VL, Adamson GD. Threshold intrauterine perfusion pressures for intraperitoneal spill during hydrotubation and correlation with tubal adhesive disease. Fertil Steril. 1995;64(6):1066–9. Epub 1995/12/01.PubMedGoogle Scholar
  40. 40.
    Khoury-Collado F, Murray MP, Hensley ML, et al. Sentinel lymph node mapping for endometrial cancer improves the detection of metastatic disease to regional lymph nodes. Gynecol Oncol. 2011;122(2):251–4. Epub 2011/05/17.PubMedCrossRefGoogle Scholar
  41. 41.
    Ballester M, Dubernard G, Lecuru F, 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. Epub 2011/04/15.PubMedCrossRefGoogle Scholar
  42. 42.
    Bats AS, Clement D, Larousserie F, et al. Does sentinel node biopsy improve the management of endometrial cancer? Data from 43 patients. J Surg Oncol. 2008;97(2):141–5. Epub 2007/12/01.PubMedCrossRefGoogle Scholar
  43. 43.
    Delpech Y, Cortez A, Coutant C, et al. The sentinel node concept in endometrial cancer: histopathologic validation by serial section and immunohistochemistry. Ann Oncol Off J Eur Soc Med Oncol/ESMO. 2007;18(11):1799–803. Epub 2007/08/22.CrossRefGoogle Scholar
  44. 44.
    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. Epub 2008/01/23.PubMedCrossRefGoogle Scholar
  45. 45.
    Barlin JN, Khoury-Collado F, Kim CH, 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(3):531–5. Epub 2012/03/01.PubMedCrossRefGoogle Scholar
  46. 46.
    How J, Lau S, Press J, et al. Accuracy of sentinel lymph node detection following intra-operative cervical injection for endometrial cancer: a prospective study. Gynecol Oncol. 2012;127(2):332–7. Epub 2012/08/23.PubMedCrossRefGoogle Scholar
  47. 47.
    Gargiulo T, Giusti M, Bottero A, et al. Sentinel Lymph Node (SLN) laparoscopic assessment early stage in endometrial cancer. Minerva Ginecol. 2003;55(3):259–62. Epub 2003/10/29.PubMedGoogle Scholar
  48. 48.
    Pelosi E, Arena V, Baudino B, et al. Pre-operative lymphatic mapping and intra-operative sentinel lymph node detection in early stage endometrial cancer. Nucl Med Commun. 2003;24(9):971–5. Epub 2003/09/10.PubMedCrossRefGoogle Scholar
  49. 49.
    Barranger E, Cortez A, Grahek D, et al. Laparoscopic sentinel node procedure using a combination of patent blue and radiocolloid in women with endometrial cancer. Ann Surg Oncol. 2004;11(3):344–9. Epub 2004/03/03.PubMedCrossRefGoogle Scholar
  50. 50.
    Lelievre L, Camatte S, Le Frere-belda MA, et al. Sentinel lymph node biopsy in cervix and corpus uteri cancers. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2004;14(2):271–8. Epub 2004/04/17.CrossRefGoogle Scholar
  51. 51.
    Mais V, Peiretti M, Gargiulo T, et al. Intraoperative sentinel lymph node detection by vital dye through laparoscopy or laparotomy in early endometrial cancer. J Surg Oncol. 2010;101(5):408–12. Epub 2010/02/02.PubMedGoogle Scholar
  52. 52.
    Gonçalves E, Figueiredo O, Fernanda C. Sentinel lymph node in endometrial cancer: an overview. Gynecol Oncol. 2009;113(2):163–9. Epub 2009/02/20.CrossRefGoogle Scholar
  53. 53.
    Abu-Rustum NR, Khoury-Collado F, Pandit-Taskar N, et al. Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma? Gynecol Oncol. 2009;113(2):163–9. Epub 2009/02/24.PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Mariani A, Dowdy SC, Cliby WA, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008;109(1):11–8. Epub 2008/02/29.PubMedCentralPubMedCrossRefGoogle Scholar
  55. 55.
    Schwartz GF, Giuliano AE, Veronesi U. Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast April 19 to 22, 2001, Philadelphia, Pennsylvania. Hum Pathol. 2002;33(6):579–89. Epub 2002/08/02.PubMedCrossRefGoogle Scholar
  56. 56.
    Bézu C, Coutant C, Ballester M, et al. Ultrastaging of lymph node in uterine cancers. J Exp Clin Cancer Res. 2010;29(5):8.Google Scholar
  57. 57.
    Ballester M, Dubernard G, Bats AS, et al. Comparison of diagnostic accuracy of frozen section with imprint cytology for intraoperative examination of sentinel lymph node in early-stage endometrial cancer: results of Senti-Endo study. Ann Surg Oncol. 2012;19(11):3515–21. Epub 2012/05/12.PubMedCrossRefGoogle Scholar
  58. 58.
    Kim CH, Soslow RA, Park KJ, et al. Pathologic ultrastaging improves micrometastasis detection in sentinel lymph nodes during endometrial cancer staging. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2013;23(5):964–70. Epub 2013/05/23.CrossRefGoogle Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyMcGill UniversityMontrealCanada
  2. 2.Division of Surgical and Gynecologic OncologyJewish General Hospital, McGill UniversityMontrealCanada

Personalised recommendations