Objective: To determine the feasibility of sentinel node mapping in endometrial cancer using hysteroscopic injection of isosulfan blue dye.
Methods: Sixteen patients with endometrial cancer were enrolled in this pilot study. Hysteroscopy was performed at laparotomy to locate the tumour. Isosulfan blue dye was injected into the endomyometrium around the tumour by hysteroscopy, into the serosa overlying the tumour, or both. Blue lymph nodes were removed as sentinel nodes. Pelvic lymphadenectomy, total abdominal hysterectomy, and bilateral salpingo-oophorectomy were then performed.
Results: Dye uptake into lymphatics occurred in 13 of the 16 cases (81%). Blue lymph nodes were identified in five cases with serosal injection alone (56%) and in two cases with combined serosal and hysteroscopic injection (50%). No blue lymph nodes were identified with hysteroscopic injection alone. The overall sentinel node identification rate was 44%, and the negative predictive value was 86%.
Conclusion: Although the concept of sentinel node mapping in endometrial cancer is appealing, the technique of hysteroscopic injection of isosulfan blue dye alone had minimal success in this study. Alternative methods should be explored.