Introduction/Background To look at the negative predictive value (NPV) of selective sentinel node biopsy (SLNB) and to assess the impact of negative SLNB on long-term total survival (OS) and disease-free survival (DFS) in cases with discordance in preoperative staging.
Methodology Retrospective longitudinal observational study.
80 patients with endometrial adenocarcinoma (EC) in early stages with intermediate, intermediate-high and high risk (ESGO/ESTRUS/ESP guidelines) were revised, from March 2010 to January 2023. SLNB was performed in 10 discordant cases with low risk in preoperative study. Pelvic and para-aortic lymphadenectomy (LND) was performed in 50 cases and SLNB and LND in 20 cases. NPV of the SLNB was analyzed when SLNB and LND were performed at the same time. The impact of negative SLNB on survival was analyzed by comparing the group with negative SLNB (21 cases) and the group of systematic LND, positive or non-localized SLNB (59 cases) (Keplein Mayer and Cox regression).
Results The final staging revealed a discordance of 17.1% in pathology, of 27.5% in the estimate of myometrial invasion (MRI) and of 24.1% in lymph node involvement (MRI & CT). A mean of 24 (SD 9.2) pelvic nodes and 22.8 (SD 10.3) para-aortic nodes were removed. Lymph node invasion was observed in 27 cases. In 6 cases the para-aortic nodes were positive with negative pelvic nodes (12.2%).
In this LND group, in 11 cases SLNB was negative, in 8 cases positive and in 1 case not located (6.3%). When the SLNB was negative, lymphatic involvement was observed in 1 case (9.1%) corresponding to para-aortic nodes (90.9% NPV).
Conclusion In our series, the negative SLNB avoided staging reinterventions in the initial stages with intermediate, intermediate-high- and high-risk EC in early stages.
Disclosures No recurrence or death events were observed in cases of negative SLNB when was compared with systematic LND.
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