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Patients' and gynecologists' views on sentinel lymph node mapping in low- and intermediate-risk endometrial cancer: a Dutch vignette study
  1. Johanna W M Aarts1,
  2. Lara C Burg1,
  3. Jenneke C Kasius2,
  4. Hans Groenewoud3,
  5. Arjan A Kraayenbrink4,
  6. Peep Stalmeier3 and
  7. Petra L M Zusterzeel1
  1. 1Obstetrics and Gynecology, Radboudumc, Nijmegen, The Netherlands
  2. 2Department of Gynaecology, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
  3. 3Health Evidence, Radboudumc University Medical Center, Nijmegen, The Netherlands
  4. 4Obstetrics & Gynaecology, Rijnstate Hospital, Arnhem, The Netherlands
  1. Correspondence to Dr Johanna W M Aarts, Obstetrics and Gynecology, Radboudumc, Nijmegen, Netherlands; j.w.m.aarts{at}


Objective Sentinel lymph node (SLN) mapping in endometrial cancer is gaining ground. However, patient views on this new technique are unknown. The aim of this study was to determine factors important to patients and gynecologists when considering SLN mapping in low- and intermediate-risk endometrial cancer.

Methods We performed a vignette study. Patients who underwent a total hysterectomy for low- or intermediate-risk endometrial cancer between 2012 and 2015 were invited. Dutch gynecologists specializing in gynecologic oncology were also invited. We based the selection for attributes in the vignettes on literature and interviews: risk of complications of SLN mapping; chance of finding a metastasis; survival gain; risk of complications after radiotherapy; operation time; and hospital of surgery (travel time). We developed a questionnaire with 18 hypothetical scenarios. Each attribute level varied and for each scenario, participants were asked how strongly they would prefer SLN on a scale from 1 to 7. The strength of preference for each scenario was analyzed using linear mixed effects models.

Results A total of 38% of patients (41/108) and 33% of gynecologists (42/126) participated in the study. Overall, they had a preference for SLN. The mean preference for patients was 4.29 (95% CI 3.72 to 4.85) and 4.39 (95% CI 3.99 to 4.78) for gynecologists. Patients’ preferences increased from 3.4 in the case of no survival gain to 4.9 in the case of 3-year survival gain (P<0.05) and it decreased when travel time increased to >60 min (−0.4, P=0.024), or with an increased risk of complications after adjuvant radiotherapy (−0.6, P=0.002). For gynecologists all attributes except travel time were important.

Conclusions Overall, patients and gynecologists were in favor of SLN mapping in low- and intermediate-risk endometrial cancer. Most important to patients were survival gain, travel time, and complication risk after adjuvant radiotherapy. These preferences should be taken into account when counseling about SLN mapping.

  • quality of life (PRO)/palliative care
  • SLN and lympadenectomy
  • sentinel lymph node
  • surgical procedures, operative
  • endometrial neoplasms

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  • JWMA and LCB contributed equally.

  • Contributors JA, LB, PZ, JK, PS, and HG contributed to the conception and writing up of this manuscript. JA, LB, PS, and HG contributed to the analysis plan and analysis of the data. All authors contributed to interpretation of the data. JA, LB, and AK were involved in the planning and carrying out of data collection. All authors contributed to writing up this manuscript and gave their final approval to the current version.

  • 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.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained for the study from the Radboudumc Committee for Ethics in Research (“CMO”) in the region Arnhem and Nijmegen on March 21 2018 (number 2018–4040).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data consist of deidentified participant data. Participants only provided consent for using the data in this study. Data can be obtained from the corresponding author.