Sentinel lymph-node biopsy in endometrial cancer with two different tracers – first results of the prospective observational SNB-CE study
DOI:
https://doi.org/10.6016/ZdravVestn.3094Keywords:
neoplasms, surgical oncology, indocyanine green, technetiumAbstract
Background: Endometrial cancer is the most common gynaecologic malignancy in the developed countries. The removal of retroperitoneal lymph nodes is the standard procedure to determine the stage of the disease. Sentry node biopsy (SNB) has been established as a method of choice for surgical staging of preoperatively presumably initial endometrial cancer. In 2014 we started a prospective two-part observational study at the Department of Gynaecological Oncology and Breast Oncology of the University Medical Centre Maribor. Our primary goal was to analyze the rate of SNB detection, while the secondary one was to determine the sensitivity of the SNB method. Our aim was to perform a pilot comparison of the retroperitoneal lymph node evaluation.
Methods: The first part of the SNB-CE study included 45 patients with initial endometrial cancer between 2014 and 2016. In all the patients, preoperative imaging was used to determine the local status of the disease and to confirm the absence of metastases. Initially, radioactive technetium (Tc99) and by the end of 2016 indocyanine green (ICG) were used to label the lymph node. We determined the level of lymph node detection, bilateral lymph node detection, and the sensitivity of the SNB to assess lymph node coverage.
Results: The rate of detection and removal of the sentinel lymph nodes using Tc99 was 63.6% (CI 95% 55.6 – 87.1%). The nodes were found bilaterally in 52.3%. ICG detection and removal rates were 68.8% (CI 95% 61.2 – 95.0%). Sentinel lymph nodes were found bilaterally in all patients with lymph nodes present in the removed tissue (100%). The detection rate of sentinel lymph nodes using both markers was 87.5% (CI 95% 40.0 – 97.2%), all of them bilateral. The sensitivity of the SNB method to assess the status of retroperitoneal lymph nodes was 66.7%, a false negative lymph node occurred in one patient (2.4%).
Conclusion: There has been great progress in the last decade regarding the use of SNB in endometrial cancer. SNB is already incorporated into protocols of international guidelines. It has been demonstrated that the method has appropriate sensitivity with the ability to appropriately evaluate the stage of disease without systematic lymphadenectomy. Further research will show the feasibility of better tracers, better sites of tracer application as well as the long-term impact on the overall survival rate of patients treated using this method alone.
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