Relevance of sentinel lymph node procedure for patients with high-risk endometrial cancer

Iptissem Naoura; Geoffroy Canlorbe; Sofiane Bendifallah; Marcos Ballester; Emile Daraï

doi:10.1016/j.ygyno.2014.10.027

Relevance of sentinel lymph node procedure for patients with high-risk endometrial cancer

Gynecol Oncol. 2015 Jan;136(1):60-4. doi: 10.1016/j.ygyno.2014.10.027. Epub 2014 Oct 31.

Authors

Iptissem Naoura¹, Geoffroy Canlorbe², Sofiane Bendifallah³, Marcos Ballester², Emile Daraï⁴

Affiliations

¹ Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie Paris 6, France. Electronic address: iptissem.naoura@tnn.aphp.fr.
² Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie Paris 6, France.
³ Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie Paris 6, France; Inserm UMRS-707, Université Pierre et Marie Curie Paris 6, France.
⁴ Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie Paris 6, France; Inserm UMRS-938, Université Pierre et Marie Curie Paris 6, France.

PMID: 25449312
DOI: 10.1016/j.ygyno.2014.10.027

Abstract

Objective: While the accuracy of the Sentinel Lymph Node (SLN) procedure has been validated in patients with early-stage endometrial cancer (EC) at low and intermediate risk of recurrence, its relevance for high-risk EC remains unknown. The aim of this study was to evaluate the contribution of SLN biopsy in staging patients with presumed high-risk EC.

Methods: This retrospective multicenter study, conducted from January 2001 to December 2012, included 180 patients with early-stage EC undergoing SLN biopsy. Detection rate and false negative rate were assessed according to risk groups of recurrence.

Results: SLNs were detected in 159/180 patients (88%) and were bilateral in 63% of cases. Of the 180 patients, 41 (22%) had a positive lymph node. Ultrastaging detected metastases undiagnosed by conventional histology in 17/41 patients (41%). The false negative rate was 6% (9/159); 2.3% in the low/intermediate risk group and 20% in the high-risk group (p = 0.0008). Lymphovascular space invasion (LVSI) was present in 48 patients (27%). Preoperative findings classified 146 patients as ESMO low/intermediate risk (81%) and 34 as high risk (19%). Ten of the 34 patients (29%) in the presumed high-risk group were downstaged on final histology and 5/18 patients (28%) initially diagnosed with type 2 were finally classified as having type 1 EC. Classification was more likely discordant for patients with preoperative type 2 EC (p = 0.03) and in the initial high-risk group (p = 0.02).

Conclusions: SLN biopsy associated with LVSI status can select which high-risk patients with EC would benefit from comprehensive staging.

Keywords: Detection rate; ESMO group risk; Endometrial cancer; False negative rate; High-risk group; Sentinel lymph node biopsy.

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Aged, 80 and over
Algorithms
Endometrial Neoplasms / pathology*
Female
Humans
Lymph Nodes / pathology*
Lymphatic Metastasis
Middle Aged
Neoplasm Staging
Retrospective Studies
Risk Factors
Sentinel Lymph Node Biopsy / methods*