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Sehnal B, Waldauf P, Matej R, Hruda M, Robova H, Drozenova J, Pichlik T, Zapletal J, Rob L, Halaska MJ. Comparison of tracer application methods for sentinel lymph node detection in open surgery patients with endometrial cancer: a retrospective cohort study. BMC Cancer 2025; 25:638. [PMID: 40200256 PMCID: PMC11980138 DOI: 10.1186/s12885-025-14037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 03/28/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of different tracers´ application techniques for sentinel lymph node (SLN) detection in women with endometrial cancer undergoing laparotomy. Additionally, potential risk factors for SLN detection failure were assessed. METHODS We retrospectively analyzed data from 248 endometrial cancer patients who underwent abdominal surgery with SLN mapping between January 2020 and March 2024. Statistical analyses were conducted using the Wilcoxon rank sum test for continuous variables and either Pearson's chi-square test or Fisher's exact test for categorical variables, with a significance level set at p < 0.05. RESULTS Group I + S consisted of 147 women with intracervical and subserosal tracers´application and group I + I included 101 women with intracervical and intrafundal application. Successful detection of SLN on both sides was achieved in 39.9% (99/248) of all patients, in 38.1% (56/147) in the I + S group and in 42.6% (43/101) in the I + I group, respectively. SLNs were identified in 32.7% (81/248) of all patients on only one side of the pelvis, in 31.3% (46/147) in the I + S and in 34.7% (35/101) in the I + I group, respectively. No SLNs were detected in 27.4% (68/248) of all subjects, comprising 30.6% (45/147) from the I + S and 22.8% (23/101) from the I + I group. Although the success rate of SLN detection was higher in the I + I group and on the right side of the pelvis regardless of the detection method, these differences were not statistically significant. An age exceeding 66.3 years was recognized as a critical risk factor for successful detection, other followed factors did not demonstrate a statistically significant impact on overall detection success. Additional significant risk factors were identified: depth of tumor myometrial invasion on the right side, history of pelvic surgery, and total tumor volume on the left side. CONCLUSIONS The study did not reveal significant differences in SLN mapping success between the groups receiving intracervical + intrafundal and intracervical + subserosal tracers´applications among endometrial cancer patients treated via open surgery. Overall, older age emerged as the most critical risk factor for SLN detection failure, while other assessed factors did not show a statistically significant impact on overall detection success. TRIAL REGISTRATION Institution University Hospital Královské Vinohrady, Prague, Czech Republic. REGISTRATION NUMBER EK-VP-21-0-2023. Date of registration 7-JUN-2023. This study was retrospectively registered in compliance with the Declaration of Helsinki.
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Affiliation(s)
- Borek Sehnal
- Department of Obstetrics and Gynaecology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, Prague 10, 100 34, Czech Republic.
- Department of Obstetrics and Gynecology, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Srobarova 1150/50, Prague 10, 100 34, Czech Republic.
| | - Petr Waldauf
- Department of Anaesthesia and Intensive Care Medicine, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
| | - Radoslav Matej
- Department of Pathology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
| | - Martin Hruda
- Department of Obstetrics and Gynaecology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
| | - Helena Robova
- Department of Obstetrics and Gynaecology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
| | - Jana Drozenova
- Department of Pathology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
| | - Tomas Pichlik
- Department of Obstetrics and Gynaecology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
| | - Jan Zapletal
- Department of Obstetrics and Gynaecology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
| | - Lukas Rob
- Department of Obstetrics and Gynaecology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
| | - Michael J Halaska
- Department of Obstetrics and Gynaecology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
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Huang L, Cheng W, He C, Li X, Huang L, Zhang J, Song L, Zhou Y, Wang C, Gan X, Qiu J. Is fluorometric sentinel lymph node biopsy in endometrial cancer necessary? Front Med (Lausanne) 2024; 11:1434311. [PMID: 39114827 PMCID: PMC11304349 DOI: 10.3389/fmed.2024.1434311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024] Open
Abstract
Objective In this study, we collected perioperative and postoperative follow-up data from patients with endometrial cancer (EC) at different stages to evaluate the role of sentinel lymph node biopsy (SLNB) in endometrial cancer surgery. Methods A total of 186 endometrial cancer patients undergoing radical hysterectomy from January 2018 to April 2022 were retrospectively analyzed. Patients were classified into four groups. Group A comprised patients diagnosed with stage IA grade 1 and 2 endometrioid EC who underwent SLNB. Group B comprised patients with stage IA grade 1 and 2 endometrioid EC who did not undergo SLNB. Group C comprised patients with higher-grade endometrioid EC, wherein systematic lymph node dissection was performed based on SLNB results. Group D comprised patients with higher-grade endometrioid EC who did not undergo SLNB and instead underwent direct systematic lymph node dissection. Clinical, pathological data, and follow-up information for all patients were collected. Results In Group A and B, SLNB was performed on 36 out of 67 patients with IA stage 1 and 2 endometrial cancer, yielding a SLN positivity rate of 5.6%. There were no significant differences observed between the two groups regarding perioperative outcomes and postoperative follow-up. Conversely, among 119 patients with higher-grade endometrial cancer, 52 underwent SLNB, with 20 patients exhibiting SLN positivity, resulting in a SLN positivity rate of 38.4%. However, the decision to undergo SLNB did not yield significant differences in perioperative outcomes and postoperative follow-up among these patients. Conclusion For stage IA grade 1 and 2 endometrioid EC, the incidence of lymph node positivity is low, omitting SLNB in this subpopulation is a feasible option. In other stages of endometrioid EC, there is no significant difference in perioperative and postoperative follow-up data between patients undergoing routine systematic lymphadenectomy and those undergoing systematic lymphadenectomy based on SLNB results. Therefore, if SLNB is not available, the standard procedure of PLND remains an option to obtain information about lymph node status, despite the surgical complications associated with this procedure.
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Affiliation(s)
- Liqiong Huang
- Department of Obstetrics and Gynecology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Cheng
- Department of Obstetrics and Gynecology, Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Chenghui He
- Department of Obstetrics and Gynecology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xin Li
- Department of Obstetrics and Gynecology, Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Lu Huang
- Department of Obstetrics and Gynecology, Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jiajia Zhang
- Department of Obstetrics and Gynecology, Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Liwen Song
- Department of Obstetrics and Gynecology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yifan Zhou
- Department of Obstetrics and Gynecology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chenchen Wang
- Shanghai United Family Pudong Hospital, Shanghai, China
| | - Xiaoqin Gan
- Department of Obstetrics and Gynecology, Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jin Qiu
- Department of Obstetrics and Gynecology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Ignatov A, Mészáros J, Ivros S, Gennari P, Ignatov T. Oncologic Outcome of Robotic-Assisted and Laparoscopic Sentinel Node Biopsy in Endometrial Cancer. Cancers (Basel) 2023; 15:5894. [PMID: 38136438 PMCID: PMC10741694 DOI: 10.3390/cancers15245894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Recently, sentinel lymph node biopsy (SLNB) has been introduced in the surgical staging of endometrial cancer as an alternative to systematic lymph node dissection (LND). However, the survival impact of SLNB is not yet well characterised. METHODS We performed a retrospective study of 419 patients with endometrial cancer treated with SLNB alone or with pelvic and para-aortic LND. For SLNB mapping, indocyanine green was used. RESULTS Median follow-up was 66 months. After exclusions, 337 patients were eligible for analysis. Of them, 150 underwent SLNB and 187 LND. During the follow-up time, 27 (24.7%) of the 150 who underwent SLNB and 54 (28.9%) of the 187 who underwent LND were diagnosed with recurrent disease (p = 0.459). The estimated 5-year disease-free survival (DFS) rate was 76.7% and 72.2% for patients in the SLNB and LND group, respectively (p = 0.419). The 5-year overall survival (OS) rates were 80.7% and 77.0% in the SLNB and LND group, respectively (p = 0.895). Survival rates were similar in both groups independent of lymph node status. Multivariable analysis confirmed that the staging approach was not associated with oncological outcome. For patients without lymph node metastases, patient outcome was worsened by advanced tumour stage and non-endometrioid tumour histology. In the group of patients with confirmed lymph node metastases, advanced tumour stage and inadequate adjuvant treatment significantly reduced DFS and OS. CONCLUSION Our data suggested that SLNB did not compromise the oncological outcome of patients with endometrial cancer compared to LND.
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Affiliation(s)
- Atanas Ignatov
- Department of Gynecology and Obstetrics, Otto-von-Guericke University, 39108 Magdeburg, Germany; (J.M.); (S.I.); (P.G.); (T.I.)
| | - József Mészáros
- Department of Gynecology and Obstetrics, Otto-von-Guericke University, 39108 Magdeburg, Germany; (J.M.); (S.I.); (P.G.); (T.I.)
| | - Stylianos Ivros
- Department of Gynecology and Obstetrics, Otto-von-Guericke University, 39108 Magdeburg, Germany; (J.M.); (S.I.); (P.G.); (T.I.)
- Gynecologic Oncology Unit, Metropolitan Hospital, 18547 Athens, Greece
| | - Paolo Gennari
- Department of Gynecology and Obstetrics, Otto-von-Guericke University, 39108 Magdeburg, Germany; (J.M.); (S.I.); (P.G.); (T.I.)
| | - Tanja Ignatov
- Department of Gynecology and Obstetrics, Otto-von-Guericke University, 39108 Magdeburg, Germany; (J.M.); (S.I.); (P.G.); (T.I.)
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