Introduction/Background Sentinel lymph node (SLN) mapping has been incorporated in international guidelines as an alternative to systematic lymphadenectomy for endometrial cancer surgical staging. However, the universal adoption of SLN technique is questioned and the aim of this study was to assess SLN mapping efficiency for staging early endometrioid endometrial cancer.
Methodology A retrospective observational study was performed between October 2020 and March 2022. Inclusion criteria for SLN-ICG mapping were the following: endometrioid endometrial cancer FIGO stage IA Grade 1–2 and stage IB Grade 1. Patients with body mass index (BMI) over 40 and/or patients with cervical pathologies were excluded. For the SLN-ICG mapping, 2 ml of indocyanine green (ICG) solution were injected at 3rd and 2 ml at 9th o’clock of the cervix. In case of mono-bilateral sentinel node detection failure, pelvic lymphadenectomy (PLND) was performed. Pathologic ultrastaging with immunochemistry was used.
Results Thirty-two (32) consecutive patients were included. The mean age was 59.72 ± 8.99 years and the mean BMI was 29.05 ±4.33 kg/m2. The mean operative time was 154.8 ± 27.79 minutes. Fifteen (n=15, 46.9%) out of the 32 patients underwent laparoscopic total hysterectomy/bilateral salpingo-oophorectomy(LAP TLH/BSO) and SLN-ICG mapping. The mean operative time was 140.6 ± 21.12 minutes. Of the remaining 17 patients, 9 (28.1%) were subjected to LAP TLH/BSO/SLN-ICG and PLND and 8 patients (25%) underwent LAP TLH/PLND without SLN mapping. The mean operative time was 173.8 ± 23.86 minutes and 145.0 ± 30.00 minutes, respectively. The overall and bilateral SLN detection rates were 96% (23/24) and 75% (18/24), respectively. Micrometastases were found only in 1/24 (4%) of SLN patients.
Conclusion The SLN-ICG endometrial mapping presents high diagnostic accuracy for lymph node staging in endometrial cancer, thus reducing operative time and post-operative complications and allowing ultrastaging pathologic assessment and increasing identification of micrometastases.
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