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Factors influencing the adoption of the sentinel lymph node technique for endometrial cancer staging: an international survey of gynecologic oncologists
  1. Jvan Casarin1,2,
  2. Francesco Multinu1,3,
  3. Nadeem Abu-Rustum4,5,
  4. David Cibula6,
  5. William A Cliby1,
  6. Fabio Ghezzi2,
  7. Mario Leitao4,5,
  8. Ikuo Konishi7,
  9. Joo-Hyun Nam8,
  10. Denis Querleu9,
  11. Pamela T Soliman10,
  12. Kathleen J Yost11,
  13. Amy L Weaver11,
  14. Andrea Mariani1 and
  15. Gretchen E Glaser1
  1. 1 Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
  3. 3 Department of Gynecology, European Institute of Oncology (IEO), Milan, Italy
  4. 4 Department of Surgery, Division of Gynecology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
  5. 5 Department of Obstetrics and Gynecology, Weill Cornell Medical Center, New York City, New York, USA
  6. 6 Departmentof Obstetrics and Gynecology, Gynecologic Oncology Center, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
  7. 7 National Hospital Organization Kyoto Medical Center, Kyoto, Japan
  8. 8 Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan Seoul, Seoul, Korea
  9. 9 Institut Begonié Cancer Center, Bordeaux, France
  10. 10 Department of Gynecologic Oncology and Reproductive Medicine, Anderson Cancer Center, Houston, Texas, USA
  11. 11 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Gretchen E Glaser, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA; glaser.gretchen{at}


Objective To explore the factors influencing adoption of the sentinel lymph node (SLN) technique for endometrial cancer staging among gynecologic oncologists.

Methods A self-administered, web-based survey was sent via email (April 20 through May 21, 2017) to all members of European Society of Gynecologic Oncologists, International Gynecologic Cancer Society, and Society of Gynecologic Oncologists. Surgical and pathologic practices related to SLN and reasons for not adopting this technique were investigated.

Results Overall, 489 attending physicians or consultants in gynecologic oncology from 69 countries responded: 201 (41.1%), 118 (24.1%), and 117 (23.9%) from Europe, the USA, and other countries, respectively (10.8% did not report a country). SLN was adopted by 246 (50.3%) respondents, with 93.1% injecting the cervix and 62.6 % using indocyanine green dye. The National Comprehensive Cancer Network SLN algorithm was followed by 160 (65.0%) respondents (USA 74.4%, Europe 55.4%, other countries 71.4%). However, 66.7% completed a backup lymphadenectomy in high-risk patients. When SLN biopsy revealed isolated tumor cells, 13.8% of respondents recommended adjuvant therapy. This percentage increased to 52% if micrometastases were detected. Among the 243 not adopting SLN, 50.2% cited lack of evidence and 45.3% stated that inadequate instrumentation fueled their decisions.

Conclusions SLN with a cervical injection is gaining widespread acceptance for staging of endometrial cancer among gynecologic oncologists worldwide. Standardization of the surgical approach with the National Comprehensive Care Network algorithm is applied by most users. Management of isolated tumor cells and the role of backup lymphadenectomy for ‘high-risk’ cases remain areas of investigation.

  • endometrial cancer
  • lymphadenectomy
  • minimally invasive surgery
  • sentinel lymph node
  • survey

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  • Presented at Presented at the 20th International Meeting of the European Society of Gynaecological Oncology, Vienna, Austria, 4–7 Nov 2017

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.