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Predictive factors of sentinel lymph node failed mapping in endometrial carcinoma patients: a systematic review and meta-analysis
  1. Antonio Raffone1,2,
  2. Francesco Fanfani3,4,
  3. Diego Raimondo1,
  4. Giulia Rovero2,
  5. Federica Renzulli2,
  6. Antonio Travaglino5,6,
  7. Umberto De Laurentiis2,
  8. Angela Santoro5,
  9. Gian Franco Zannoni5,
  10. Paolo Casadio1,
  11. Giovanni Scambia3,4,
  12. Renato Seracchioli1,2 and
  13. Antonio Mollo7
  1. 1Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
  2. 2Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
  3. 3Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
  4. 4Department of Women and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
  5. 5Gynecopathology and Breast Pathology Unit, Department of Woman’s Health Science, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Lazio, Italy
  6. 6Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Campania, Italy
  7. 7Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Baronissi, Campania, Italy
  1. Correspondence to Dr Diego Raimondo, Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy; die.raimondo{at}gmail.com; Dr Giulia Rovero, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; giulia.rovero{at}studio.unibo.it

Abstract

Objective In endometrial carcinoma patients, sentinel lymph node bilateral mapping fails in 20–25% of cases, with several factors affecting the likelihood of detection. However, pooled data about predictive factors of failure are lacking. The aim of this systematic review and meta-analysis was to assess the predictive factors of sentinel lymph node failed mapping in endometrial cancer patients undergoing sentinel lymph node biopsy.

Methods A systematic review and a meta-analysis was performed searching all studies assessing predictive factors of sentinel lymph node failed mapping in apparent uterine-confined endometrial cancer patients undergoing sentinel lymph node biopsy through the cervical injection of indocyanine green. The associations between sentinel lymph node failed mapping and predictive factors of failure were assessed, calculating the odds ratio (OR) with 95% confidence intervals.

Results Six studies with a total of 1345 patients were included. Compared with patients with sentinel lymph node bilateral successful mapping, patients with sentinel lymph node failed mapping showed: OR 1.39 (p=0.41) for body mass index >30 kg/m2; OR 1.72 (p=0.24) for menopausal status; OR 1.19 (p=0.74) for adenomyosis; OR 0.86 (p=0.55) for prior pelvic surgery; OR 2.38 (p=0.26) for prior cervical surgery; OR 0.96 (p=0.89) for prior Cesarean section; OR 1.39 (p=0.70) for lysis of adhesions during surgery before sentinel lymph node biopsy; OR 1.77 (p=0.02) for indocyanine green dose <3 mL; OR 1.28 (p=0.31) for deep myometrial invasion; OR 1.21 (p=0.42) for International Federation of Gynecology and Obstetrics (FIGO) grade 3; OR 1.89 (p=0.01) for FIGO stages III-IV; OR 1.62 (p=0.07) for non-endometrioid histotype; OR 1.29 (p=0.25) for lymph-vascular space invasion; OR 4.11 (p<0.0001) for enlarged lymph nodes; and OR 1.71 (p=0.022) for lymph node involvement.

Conclusion Indocyanine green dose <3 mL, FIGO stage III-IV, enlarged lymph nodes, and lymph node involvement are predictive factors of sentinel lymph node failed mapping in endometrial cancer patients.

  • Endometrium
  • Surgical Oncology
  • Lymphatic Metastasis
  • Uterine Cancer
  • Gynecologic Surgical Procedures

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @frafanfani

  • RS and AM contributed equally.

  • Contributors AR, FF and GR independently assessed eligibility of the studies, inclusion criteria, risk of bias, data extraction, and data analysis. FF, DR and GR independently assessed the electronic search. All authors contributed to the elaboration of methods for risk of bias assessment, data extraction, and analysis. AR, FF, DR, GR, PC, GS, AM and RS conceived the study. All authors worked on the study design and manuscript preparation. GZ, PC, GS, AM and RS supervised the whole study. RS and AM share last authorship. AR is the guarantor.

  • 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.