Sentinel node biopsy in Low- and Intermediate endometrial cancer Management

The treatment of endometrial cancer (EC) is primarily surgery (removal of uterus and adnexa). There is an ongoing controversy in the management of EC relates to lymphadenectomy. Randomized trials and a meta-analysis have shown that pelvic lymphadenectomy has no effect on overall or recurrence-free survival, but can lead to longer operation time and morbidity [Kitchener et al. 2009, Benedetti et al. 2008, May et al. Cochrane Rev 2010] However, the trials on lymphadenectomy in early stage endometrial cancer did not take into account the contribution of sentinel lymph node (SLN) biopsy in reducing the risk of surgical complications and improving staging.

Recent studies showed that SLN biopsy with ultra-staging upstaged 10% of patients with presumed low-risk and 15% of patients with presumed intermediate risk [Ballister et al. 2008, 2011;Abu Rustum 2014]. As involvement of lymph nodes has been proven to be one of the most important prognostic factors in other malignant tumors, SLN biopsy might be a good compromise between systemic lymph node dissection and no node dissection in women with low- or intermediate-risk EC.

When the lymph node status is unknown, indications for adjuvant therapies are on pathological features of surgical specimen of the primary tumor, exposing some patients to overtreatment and undertreatment. Introducing SNP in the treatment of EC will lead to only giving adjuvant treatment when women are truly at risk.

SLN biopsy in EC can be performed with cervical injection prior to surgery using indocyanine green with high detection rates 92-96% and negative predictive values 98-99%.

The proportion of patients with a positive sentinel lymph node( at least one macro- or micrometastasis) which alter the adjuvant therapy

Histological evaluation of the sentinel lymph node with ultrastaging and immunohystochemistry after surgery.

sentinel lymph node before the operation (hysterectomie and adnexa)