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Reply to Gücer, F.; Dünnebacke, J. Comment on "Hawez et al. Endometrial Intraepithelial Neoplasia, Concurrent Endometrial Cancer and Risk for Pelvic Sentinel Node Metastases. <i>Cancers</i> 2024, <i>16</i>, 4215".

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Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy
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A selective anatomically based lymph node sampling can replace a side specific pelvic lymphadenectomy in endometrial

Michele Bollino1, Barbara Geppert1, Celine Lönnerfors1

  • 1Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital Lund, Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden.

European Journal of Cancer (Oxford, England : 1990)
|April 24, 2024
PubMed
Summary

Sentinel lymph node (SLN) mapping in endometrial cancer (EC) shows most metastases are in typical pelvic locations. Selective lymph node removal at obturator and interiliac areas may replace full pelvic lymphadenectomy if mapping fails.

Keywords:
Anatomically based samplingEndometrial cancerSide specific pelvic lymphadenectomyTypical positions of sentinel lymph nodes

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Area of Science:

  • Gynecologic Oncology
  • Surgical Oncology
  • Pathology

Background:

  • Sentinel lymph node (SLN) biopsy is crucial for staging endometrial cancer (EC).
  • Accurate identification of metastatic SLNs guides treatment decisions and avoids unnecessary morbidity.
  • Understanding typical metastatic patterns is key for refining surgical approaches.

Purpose of the Study:

  • To evaluate the anatomical locations of metastatic pelvic SLNs in EC patients.
  • To determine the proportion of SLNs located within and outside typical anatomical positions along the upper paracervical lymphatic pathway (UPP).

Main Methods:

  • Pelvic SLN detection using cervically injected indocyanine green (ICG) in 162 women with EC.
  • Adherence to a strict anatomically based algorithm for SLN identification and definition.
  • Intraoperative depiction of SLN positions, ultrastaging, and immunohistochemistry for metastasis detection.

Main Results:

  • A median of two metastatic SLNs were found per patient along the UPP.
  • 25.3% of women had isolated metastases in the obturator fossa, accounting for 49.1% of all SLN metastases.
  • 17.3% of women had SLN metastases outside typical positions, but 95.7% had at least one metastatic SLN in a typical location.

Conclusions:

  • Selective removal of SLNs in typical obturator and interiliac positions, along with parauterine lymphovascular tissue (PULT), can potentially replace full pelvic lymphadenectomy.
  • The obturator fossa is the most common site for metastatic SLNs in EC.
  • SLN mapping, even if unsuccessful in identifying all positive nodes, can guide targeted lymphadenectomy.