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Anatomical distribution of sentinel lymph nodes in patients with endometrial cancer: a multicenter study
  1. Stefano Restaino1,
  2. Alessandro Buda2,3,
  3. Andrea Puppo4,
  4. Vito Andrea Capozzi5,
  5. Giulio Sozzi6,
  6. Jvan Casarin7,
  7. Vitalba Gallitelli8,
  8. Ferdinando Murgia9,
  9. Giuseppe Vizzielli1,10,
  10. Alessandro Baroni8,
  11. Giacomo Corrado8,
  12. Tina Pasciuto11,
  13. Debora Ferrari2,
  14. Antonia Novelli12,
  15. Roberto Berretta5,
  16. Francesco Legge9,
  17. Enrico Vizza13,
  18. Vito Chiantera6,
  19. Fabio Ghezzi7,
  20. Fabio Landoni2,
  21. Giovanni Scambia7,14 and
  22. Francesco Fanfani7,14
  1. 1 Department of Obstetrics, Gynecology, and Pediatrics, Obstetrics and Gynecology Unit, Udine University Hospital, DAME, Udine, Italy
  2. 2 Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
  3. 3 Ospedale Michele e Pietro Ferrero, Verduno, Italy
  4. 4 Clinic of Obstetrics and Gynecology, Santa Croce e Carle Hospital, Cuneo, Italy
  5. 5 Department of Medicine and Surgery, University of Parma, Parma, Italy
  6. 6 Department of Gynecologic Oncology, Università di Palermo, Palermo, Italy
  7. 7 Department of Obstetrics and Gynecology, University of Insubria, Women’s and Children’s Del Ponte Hospital, Varese, Italy
  8. 8 Università Cattolica del Sacro Cuore, Roma, Italy
  9. 9 Obstetrics and Gynecology Unit, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, Bari, Italy
  10. 10 Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, Udine, Italy
  11. 11 Research Core Facilty Data Collection G-STeP, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Largo Agostino Gemelli 8, Rome, Italy
  12. 12 Department of Gynaecology and Obstetrics, Regina Montis Regalis Hospital, Mondovì, Italy
  13. 13 Department of Experimental Clinical Oncology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
  14. 14 UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
  1. Correspondence to Dr Francesco Fanfani, Gynecologic Oncology, Catholic University of the Sacred Heart, 00168 Rome, Italy; francesco.fanfani74{at}


Objective Sentinel lymph node (SLN) mapping represents the standard approach in uterine confined endometrial cancer patients. The aim of this study was to evaluate the anatomical distribution of SLNs and the most frequent locations of nodal metastasis.

Methods This was an observational retrospective multicenter study involving eight high volume gynecologic cancer centers in Italy. We reviewed 1576 patients with a histologically confirmed diagnosis of endometrial cancer from September 2015 to June 2020. All patients underwent total hysterectomy with salpingo-ophorectomy and SLN mapping.

Results A total of 3105 SLNs were mapped and removed, 2809 (90.5%) of these were bilateral and 296 (9.5%) unilateral. The overall detection rate was 93.4% (77.9% bilateral and 15.5% unilateral). The majority of SLNs (80%) and positive SLNs (77.8%) were found at the external iliac and obturator level in both endometrioid and non-endometrioid endometrial cancer. Negative SLNs were more frequent in patients with endometrioid compared with non-endometrioid cancer (91.9% vs 86.1%, p<0.0001). Older patients, a higher body mass index, and non-endometrioid histology were more likely to have 'no mapping' (p<0.0001). Univariate and multivariate analysis showed that higher body mass index and age at surgery were independent predictive factors of empty node packet and fat tissue (p=0.029 and p<0.01, respectively).

Conclusion The most frequent sites of SLNs and metastases were located in the pelvic area below the iliac vessel bifurcation. Our findings showed that older age, a higher body mass index, and non-endometrioid histology had a negative impact on mapping.

  • sentinel lymph node
  • endometrial neoplasms
  • laparoscopes

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors Conception: SR and FF. Design and development: SR, VG, and AB. Data collection: VG, AB, VAC, GS, JC, FM, GC, DF, and AN. Data analysis: TP, GV, SR, and FF. Preparation of tables: VG and AB. Initial draft of manuscript: SR. Manuscript writing, review, and approval: all authors. SR and FF are the guarantors of the study.

  • 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.