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Lymphatic Mapping in Endometrial Cancer: Comparison of Hysteroscopic and Subserosal Injection and the Distribution of Sentinel Lymph Nodes
  1. Helena Robova, MD, PhD*,
  2. Martin Charvat, MD*,
  3. Pavel Strnad, MD, PhD*,
  4. Martin Hrehorcak, MD*,
  5. Katerina Taborska, MD,
  6. Petr Skapa, MD and
  7. Lukas Rob, MD, PhD*
  1. * Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology,
  2. Departments of Endocrinology and Nuclear Medicine,
  3. Pathological Anatomy and Molecular Medicine, 2nd Medical Faculty, Charles University Prague, Prague, Czech Republic.
  1. Address correspondence and reprint requests to Lukas Rob, MD, PhD, Department of Obstetrics and Gynaecology, Faculty Hospital Motol, Vuvalu 84, 150 00 Prague 5. E-mail: lukas.rob{at}


Introduction: Endometrial cancer incidence increases over the age of 65 and lymphadenectomy in these women is a morbid procedure. Sentinel lymph node (SLN) should avoid extensive lymphadenectomy in node negative patients. The aim of this prospective study is to determine the feasibility and usefulness of lymphatic mapping and SLN identification in the management of endometrial cancer.

Methods: From January 2004 to December 2007 101 women with endometrial cancer participated in the study. We injected 99Tc hysteroscopically, peritumorally 2 hours before laparotomy in 24 women. We applied 99Tc and blue dye subserously after laparotomy and before adhesiolysis in 67 women. Ten patients with metastatic disease in ovary, omentum, peritoneum, and bulky nodes were excluded from analysis.

Results: We detected SLN in 12 women (50%) in hysteroscopic group and in 49 women (73.1%) in subserous group. We identified 133 SLNs in 61 women. We found 20 SLNs (15.0%) in supraobturator region, 78 (58.6%) in external iliac area, 11 (8.3%) in paraaortal area, 13 (9.8%) on common iliac artery, 8 (6.0%) in medial part of lateral parametrium, and 3 (2.3%) in presacral area.

Conclusions: Sentinel lymph node identification is a new strategy that can be used to examine nodal status with a high successful rate in breast, cervical, and vulvar cancer. Results in endometrial cancer are not as successful, however. In the future, it will be necessary to find optimal timing, the best route of application, and the "right" size of the 99mTc particles. Subserous application seems to be superior to hysteroscopic application.

  • Endometrial cancer
  • Sentinel lymph node
  • Hysteroscopy
  • Subserosal injection

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