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Focused Plenary 02: Surgery
AS04. Endometrial/Uterine corpus cancers
SO015LBA/#1261  Identifying a safe algorithm for sentinel lymph node mapping in high-risk endometrial cancer; the sentirec endo study
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  1. Sarah Bjørnholt1,
  2. Ole Mogensen1,
  3. Sara Sponholtz2,
  4. Kirsten Bouchelouche3,
  5. Erik Parner4,
  6. Malene Hildebrandt5,
  7. Gudrun Neumann6,
  8. Algirdas Markauskas6,
  9. Signe Bjørn7,
  10. Ligita Frøding7,
  11. Annika Jakobsen8,
  12. Katja Dahl1 and
  13. Pernille Jensen1
  1. 1Aarhus University Hospital, Department of Gynecology and Obstetrics, Aarhus, Denmark
  2. 2Faculty of Health Science, University of Southern Denmark, Department of Clinical Research, Odense, Denmark
  3. 3Aarhus University Hospital, Department of Clinical Medicine – Nuclear Medicine and Pet, Aarhus, Denmark
  4. 4Aarhus University, Department of Public Health and Biostatistics, Aarhus, Denmark
  5. 5Odense University Hospital3. department of Clinical Medicine – Nuclear Medicine and Pet, Odense, Denmark
  6. 6Odense University Hospital, Department of Gynecology and Obstetrics, Odense, Denmark
  7. 7Copenhagen University Hospital, Rigshospitalet, Department of Gynecology and Obstetrics, Copenhagen, Denmark
  8. 8Copenhagen University Hospital, Rigshospitaet, Department of Nuclear Medicine, Copenhagen, Denmark

Abstract

Introduction Sentinel lymph node (SLN) mapping is suggested to be a safe staging method for women with high-risk endometrial cancer (EC). However, approximately 20–45% of women have failed mapping, leaving a need for consensus on the choice of the surgical algorithm in case of non-mapping. We aimed to assess the safety of SLN-mapping algorithms in women with high-risk EC.

Methods We undertook a national prospective diagnostic accuracy study of SLN-mapping in women with high-risk EC from March 2017- January 2023. A power calculation was based on the negative predictive value (NPV). Women underwent SLN-mapping, pelvic (PLD) and paraaortic (PALND) lymph node dissection besides removal of any FDG/PET-positive lymph nodes.

Results We included 216 women; 170 women underwent SLN mapping, PLD and PALND and were included in the analyses. 42/170 (24.7%) had nodal metastasis. The algorithm SLN+PLD in case of failed mapping demonstrated a sensitivity of 88% (95% CI 74–96) and an NPV of 96% (95% CI 91–99). The sensitivity increased to 93% (95% CI 81–99) and the NPV to 98% (95% CI 93–100) if PLD was combined with removal of any PET-positive lymph nodes regardless of mapping. PLD+PALND in non-mapping cases achieved a sensitivity of 95% (95% CI 84–99), NPV 98% (95% CI 95–100).

Conclusion/Implications SLN-mapping is a safe staging procedure in women with high-risk EC if strictly adhering to a surgical algorithm, including removal of any PET-positive lymph nodes independent of location and PLD in failed mapping cases. PLD+PALND obtain similar accuracy in case of failed mapping if FDG/PET-CT is not available.

https://doi.org/10.1136/ijgc-2023-IGCS.29

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