Laparoscopic detection of sentinel lymph nodes in patients with endometrial cancer: Preliminary results

  • Gonzalez Gea L
  • Zapico Goñi A
  • Fuentes Castro P
 et al. 
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Abstract

Sentinel node detection in endometrial cancer. The aim of this study was to set feasibility of laparoscopic intraoperative sentinel node detection in low and intermediate-risk endometrial carcinoma. From September 2010 to May 2011, 12 consecutive patients with endometrial cancer were scheduled for laparoscopic staging according to FIGO including sentinel node (SLN) biopsy pelvic and/or paraaortic lymphadenectomy, hysterectomy and bilateral salpingo-oophorectomy. First step of the procedure consisted of injection of Isosulfan or methylene blue dye into the cervix and into the subserosal miometrium at the fundus. Mean age was 64,3 + 3,2 (48-83) years. Mean body mass index was 26,75 + 1,4 (20,81-32,02). Dye uptake into pelvic lymphatics occurred in 11 of the 12 patients (91, 7%). The average of SLN retrieved was 1.9 per patient (range 1 to 5). Among the 11 patients with at least one SLN detected, pelvic location of the SLN was bilateral in 6 cases (45,5%) and unilateral in 5 cases (54,5%). The most frequent location of SLNs included interiliac nodes (44%) followed by obturator nodes (30%). Only one patient (9,1%) has a sentinel node micrometastasis at definitive histology. No blue lymph nodes were identified in paraaortic area in the 2 patients when paraaortic lymphadenectomy was performed. No anaphylactic reactions occurred after blue dye injection and there were no surgical complications related to SLN biopsy. Four patients (33%) with grade 1 tumour at preoperative histology had grade 2 at final exam. Radiological stage by MRI was correct in 10 cases (83,3%) and underestimated in 2 patients with stage Ia in MRI with postoperative Ib staging. Blue dye Sentinel lymph node mapping is a feasible and safety procedure in low-intermediate risk endometrial cancer and may be a reasonable option between systematic lymphadenectomy and no dissection at all.

Author-supplied keywords

  • anaphylaxis
  • biopsy
  • body mass
  • dissection
  • dye
  • endometrium cancer
  • endometrium carcinoma
  • histology
  • human
  • hysterectomy
  • injection
  • lymph node
  • lymph node dissection
  • lymph vessel
  • methylene blue
  • micrometastasis
  • neoplasm
  • nuclear magnetic resonance imaging
  • obturator
  • patient
  • pelvis
  • postoperative complication
  • procedures
  • risk
  • safety
  • salpingooophorectomy
  • sentinel lymph node
  • staging

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Authors

  • L Gonzalez Gea

  • A Zapico Goñi

  • P Fuentes Castro

  • S Heron Iglesias

  • M Guzman Muñoz

  • N Martinez Parrondo

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