The benefit of sentinel lymph node evaluation in pre-operative grade 1 endometrial cancer

Debate is ongoing whether patients with pre-operative grade 1 endometrial cancer should undergo surgery by gynecologists without lymph node assessment. The objective of this study is to evaluate the value of having the surgery performed by a gynecologic oncologist with sentinel lymph node assessment.

Single-center retrospective cohort study on patients who underwent robotic surgery for endometrial cancer between 2011-2020. All consecutive cases with grade 1 endometrioid cancer on pre-operative biopsy were included. Sentinel lymph nodes assessment was systematically performed. We defined clinical impact as the proportion of cases where pelvic lymph node status knowledge led to a change in adjuvant therapy.

The study cohort included 383 patients. The median age and body mass index were 62 (range; 30-92) years and 32.5 (range; 16.9-85.6) kg/m², respectively. The discordance between pre-operative and post-operative histology or grade occurred in 47.8%. The bilateral sentinel lymph nodes detection rate was 76%. The overall median number of sampled lymph nodes was 4 (0-36), and if a sentinel lymph node was identified, it was 2 (1-2). The rate of positive lymph nodes was 6.3%. Routine sentinel lymph nodes assessment led to treatment escalation in 4.2% of patients and external radiation sparing in 8.4% of patients. The overall clinical benefit was estimated at 12.5%.

Surgical staging with sentinel lymph nodes for pre-operative grade 1 endometrioid endometrial carcinoma, when done by a gynecologic oncologist, offers substantial clinical benefit by informing adjuvant treatment decisions based on lymph node status, avoiding overtreatment, with its inherent side effects, and undertreatment, which may affect oncological outcomes.