Sentinel lymph node in endometrial cancer: a review.

Area of Science:

• Gynecologic Oncology
• Surgical Pathology

Background:

• Lymph node status is a critical prognostic indicator in endometrial cancer (EC).
• Sentinel lymph node (SLN) biopsy has been explored for over 15 years in EC but is not yet standard practice.
• Complex lymphatic drainage and limited large-scale studies hinder SLN biopsy adoption in EC.

Purpose of the Study:

• To review the current data on sentinel lymph node biopsy in endometrial cancer.
• To evaluate the detection rates, metastatic involvement, and false-negative rates of SLN biopsy in EC.
• To discuss the clinical significance of low-volume metastases detected by SLN biopsy.

Main Methods:

• Systematic review of main clinical trials reporting SLN biopsy in endometrial cancer.
• Analysis of detection rates, metastatic SLN involvement, and false-negative rates.
• Evaluation of the proportion of low-volume disease (micrometastases, isolated tumor cells) in positive SLNs.

Main Results:

• An overall SLN detection rate of 81.7% was reported across main clinical trials.
• Metastatic involvement in SLNs was found in 10.9% of patients, with a false-negative rate of 12.3%.
• Thirty-five percent of SLN metastases represented low-volume disease (micrometastases or isolated tumor cells).

Conclusions:

• SLN biopsy can upstage patients with previously underestimated risk, potentially allowing omission of adjuvant therapy.
• The clinical significance of low-volume SLN disease in EC requires further investigation.
• Additional studies are necessary to determine the survival benefits of SLN biopsy in specific EC patient subsets.