[Lymph node management in endometrial cancer].

Area of Science:

• Gynecologic Oncology
• Surgical Innovation
• Cancer Diagnostics

Background:

• Endometrial cancer (EC) is a significant global health concern, ranking as the leading gynecological cancer in France.
• Accurate lymph node staging is crucial for determining adjuvant treatment in EC, but traditional methods carry risks.
• Sentinel lymph node biopsy (SLN) has emerged as a less invasive alternative to full lymphadenectomy.

Purpose of the Study:

• To evaluate the efficacy and safety of the evolving SLN technique in endometrial cancer staging.
• To assess the impact of Indocyanine Green (ICG) fluorescence detection on SLN identification and patient outcomes.
• To explore the potential of SLN to reduce the need for secondary staging procedures and improve adjuvant therapy adaptation.

Main Methods:

• Review of recent advancements in SLN techniques for EC, including robotics and fluorescence imaging.
• Analysis of data on Indocyanine Green (ICG) detection rates, bilateral migration, and detection of sentinel lymph nodes (SLN).
• Consideration of the implications of SLN findings on the necessity of secondary staging procedures like paraaortic lymphadenectomy.

Main Results:

• Indocyanine Green (ICG) detection of SLN demonstrates high bilateral migration rates (88-100%) and excellent pelvic SLN detection (97%).
• The SLN technique, particularly with ICG, is associated with a significant decrease in procedural morbidity.
• The study suggests that widespread adoption of SLN for early-stage EC may reduce the need for secondary staging.

Conclusions:

• The SLN procedure, enhanced by ICG fluorescence, offers a more accurate and less morbid approach to lymph node staging in endometrial cancer.
• Implementing SLN for all early-stage EC cases could streamline treatment pathways and improve patient management.
• Further integration of SLN techniques promises to refine adjuvant therapy decisions and minimize surgical complications.