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

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.