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Poster/ePoster Sessions
03. Endometrial cancer
#158 Clinical pitfalls in setting up A ‘endometrial cancer sentinel lymph node mapping’ surgical protocol
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  1. Lorenzo Ceppi1,
  2. Tommaso Bignardi1,
  3. Maria Lieta Interdonato1,
  4. Carmela Quatrale1,
  5. Manuela Bramerio2,
  6. Liliana Marchetta1,3,
  7. Valeria Matera1,3,
  8. Martina Bombelli1,3,
  9. Martina Bertoni1,3,
  10. Gianluca Donatiello1,3,
  11. Maria Chiara Palucci1,3 and
  12. Mario Giuseppe Meroni1
  1. 1Department of Gynecology and Obstetrics, Grande Ospedale Metropolitano Niguarda, Milan, Italy
  2. 2Department of Pathology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
  3. 3Department of Medicine and Surgery, Obstetrics and Gynecology, Milano-Bicocca University, Monza, Italy

Abstract

Introduction/Background Sentinel lymph node (SLN) mapping with indocyanine green (ICG) with Mini-Invasive surgery (MIS) is becoming the standard technique in the treatment of early-stage endometrial cancer (ESEC). The setting up of a standardized surgical and pathology protocol to acquire proficiency is crucial to optimize the SLN detection rate. We sought to describe the first 18 months’ results of such implementation in a large metropolitan hospital in Milan.

Methodology All patients diagnosed with ESEC, treated with MIS as primary surgery, and undergoing ICG injection to detect SLN, between 09/2021–03/2022, were included. Ultra staging technique for nodal analysis has been adopted. We assessed variables affecting successful and unsuccessful mapping.

Results Of 46 included patients 80.4% had successful SLN mapping, with 54.3% bilateral and 26.1% monolateral detection. The overall rate of positive SLN was 6.5%, with 2 macro metastasis and 1 isolated tumor cells. Sites of SLN mapping were external iliac (64.4%), obturator fossa (20.3%), common iliac (10.2%). Considering three semesters time-frame, successful mapping progressively increased with (9/12)75.0%, (13/17)76.5%, (15/17)88.2% in the 1st, 2nd and 3rd semester, respectively. SLN empty nodes rates were 16%, 6%, 5% respectively. To gain such proficiency, we progressively adopted a composite standardized protocol including: injection-to-mapping time extension (8.3%, 20.0%, 29.4% respectively), cervical reinjection (0, 1, 1 case respectively), SLN frozen section in not obvious nodal tissue (0, 1, 4 cases respectively). Comparing successful and unsuccessful mapping cases, patients’ and tumor features did not significantly differ between the groups in the three time-frames.

Conclusion Patients and tumor features did not affect the successful migration rate in ESEC SLN mapping in this initial period. On the other hand, a satisfactory rate of successful migration was reached after acquiring an adequate technical skill armamentarium, with a learning curve of about 30 cases.

Disclosures no disclosures reported

https://doi.org/10.1136/ijgc-2023-ESGO.281

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