Aortic sentinel node detection in endometrial cancer: 6 year prospective study

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Nuclear Medicine Imaging

Background:

• Endometrial cancer staging often relies on lymph node assessment.
• Sentinel lymph node (SLN) biopsy is a minimally invasive staging technique.
• Identifying lymphatic drainage pathways is crucial for accurate SLN detection.

Purpose of the Study:

• To evaluate the efficacy of dual cervical and fundal indocyanine green injection for SLN detection in endometrial cancer.
• To assess the detection rates of SLNs in parametrial and infundibular pathways.
• To determine the diagnostic performance of this dual injection technique for nodal metastasis.

Main Methods:

• Prospective observational study of 332 patients undergoing laparoscopic endometrial cancer surgery.
• Dual injection of indocyanine green into the cervix and fundus for SLN identification.
• Ultrastaging of all detected SLNs and pelvic/para-aortic lymphadenectomy in 172 patients.

Main Results:

• Overall SLN detection rate of 94.0%, with high rates for pelvic (91.3%) and para-aortic (68.1%) nodes.
• Lymph node involvement detected in 16.9% of cases, including isolated aortic metastases in 25% of positive cases.
• Dual injection technique demonstrated high sensitivity (98.3%) and specificity (100%) for SLN detection.

Conclusions:

• Dual cervical and fundal indocyanine green injection is a feasible and effective technique for SLN detection in endometrial cancer.
• The technique achieves high detection rates, particularly for para-aortic SLNs, which are often involved in metastasis.
• This method aids in accurate staging and identifying isolated aortic metastases, crucial for treatment decisions in high-risk patients.