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Original research
Sentinel lymph node assessment in patients with atypical endometrial hyperplasia: a systematic review and meta-analysis
  1. Santiago Vieira-Serna1,2,
  2. Jonathan Peralta3,
  3. David Viveros-Carreño1,3,4,
  4. Juliana Rodriguez3,5,6,
  5. John Edwin Feliciano-Alfonso3 and
  6. Rene Pareja3,7
  1. 1 Department of Gynecologic Oncology, Clínica Universitaria Colombia, Bogotá, Colombia
  2. 2 Department of Obstetrics and Gynecology, Hospital Universitario San Ignacio, Bogotá, Colombia
  3. 3 Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
  4. 4 Deparment of Gynecologic Oncology, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo - CTIC, Bogotá, Colombia
  5. 5 Department of Gynecology and Obstetrics, Section of Gynecologic Oncology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
  6. 6 Department of Obstetrics and Gynecology, Universidad Nacional de Colombia, Bogotá, Colombia
  7. 7 Department of Gynecologic Oncology, Clinica ASTORGA, Medellín, Colombia
  1. Correspondence to Dr Santiago Vieira-Serna, Department of Gynecologic Oncology, Clínica Universitaria Colombia, Bogotá, Colombia; sant_vieira{at}hotmail.com

Abstract

Objective This systematic review and meta-analysis aimed to assess the rate of sentinel lymph node (SLN) metastases in patients with a pre-operative diagnosis of atypical hyperplasia/endometrial intra-epithelial neoplasia and endometrial cancer in hysterectomy specimens.

Methods A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the protocol was registered in PROSPERO (CRD42023416769). MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus databases were searched from inception until April 2023. The inclusion criteria were patients with a pre-operative diagnosis of atypical hyperplasia/endometrial intra-epithelial neoplasia undergoing hysterectomy who did or did not undergo SLN assessment.

Results Four studies met the inclusion criteria. All studies were non-randomized studies with a total of 10 217 patients, 1044 in the SLN group and 9173 in the non-nodal assessment group. The unilateral and bilateral detection rate was 89% (I2=27.6%, 2 studies, 342 participants, 304 events) and 79% (I2=89.2%, 2 studies, 342 participants, 271 events), respectively. The rate of involved SLNs was 1.6% (I2=0%, 3 studies, 424 participants, 7 involved SLN) and 3.5% (I2=0%, 3 studies, 197 participants, 7 involved SLN) in patients with a pre-operative diagnosis of atypical hyperplasia/endometrial intra-epithelial neoplasia as the denominator and in those with endometrial cancer in the hysterectomy specimen, respectively. The cancer rate in the hysterectomy specimen was 45% (I2=72.8%, 3 studies, 503 participants, 224 events) and the most frequent endometrial cancer International Federation of Gynecology and Obstetrics 2009 stage was IA in 199 (89.2%) patients. The complication rate was similar between the groups.

Conclusion The rate of SLN metastases in patients with pre-operative atypical hyperplasia/endometrial intra-epithelial neoplasia is less than 2%, suggesting that routine SLN evaluation may not be necessary in this population.

  • Sentinel Lymph Node
  • Endometrial Hyperplasia
  • Endometrial Neoplasms

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. In accordance with the Journal’s guidelines, we will provide our data for independent analysis by a team selected by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

https://doi.org/10.1136/ijgc-2023-004936

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. In accordance with the Journal’s guidelines, we will provide our data for independent analysis by a team selected by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

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    Footnotes

    • Twitter @julianalrc, @RParejaGineOnco

    • Contributors SV-S contributed to conceptualizing the project, independently screening and assessing all studies, preparing the manuscript and is responsible for the overall content as the guarantor. JP contributed to conceptualizing the project, independently screening, assessing all studies, and contributed to the editing of the manuscript. DV-C contributed to conceptualizing the project, provided the search strategy, statistical assistance and contributed to the editing of the manuscript. JR contributed to conceptualizing the project and statistical assistance. JEF-A contributed to conceptualizing the project, reviewing the data, and analyses. RP contributed to conceptualizing the project, consulted for clinical expertise, reviewed the data and analyses, and edited the manuscript.

    • 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.

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