Sentinel Lymph Node Biopsy in the Treatment of Endometrial Cancer: Why We Fail? Results of a Prospective Multicenter Study on the Factors Associated with Failure of Node Mapping with Indocyanine Green

Gynecol Obstet Invest. 2019;84(4):383-389. doi: 10.1159/000496699. Epub 2019 Jan 18.

Abstract

Background: The sentinel lymph node (SLN) mapping for endometrial cancer staging is gaining wide diffusion, but there is no definitive evidence on the factors associated with the failure of mapping.

Objectives: To analyze the factors associated with the possible failure of bilateral SLN mapping with indocyanine green (ICG).

Methods: A prospective observational study without control on 110 patients with endometrial cancer apparently confined to the uterus, underwent laparoscopic surgical staging with SLN mapping with ICG.

Results: Possible risk factors associated with bilateral mapping failure were analyzed, and a multivariate analysis was performed. The bilateral detection rate for SLNs mapping was 72.7%, whereas at least one SLN was detected in 79.1% of patients. No SLNs were identified in 6.3%. None of the patients or features related to tumor were associated with a risk of failure of the method. The only factor analyzed that was significantly associated with the success of bilateral mapping was the surgeon (p = 0.003).

Conclusions: Neither obesity nor the presence of lymph node metastases was associated with mapping failure. However, there remains a need for further studies to understand all the mechanisms linked to the unsuccessful method results and to reduce the use of systematic lymphadenectomy in the case of mapping failure.

Keywords: Endometrial cancer; Mapping; Risk failure; Sentinel lymph node.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Coloring Agents*
  • Endometrial Neoplasms / pathology
  • Endometrial Neoplasms / surgery*
  • Female
  • Humans
  • Indocyanine Green*
  • Laparoscopy / adverse effects*
  • Laparoscopy / methods
  • Lymph Node Excision
  • Lymphatic Metastasis / diagnostic imaging
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging / adverse effects*
  • Neoplasm Staging / methods
  • Prospective Studies
  • Risk Factors
  • Sentinel Lymph Node / diagnostic imaging
  • Sentinel Lymph Node Biopsy / adverse effects*
  • Sentinel Lymph Node Biopsy / methods
  • Treatment Failure
  • Uterus / diagnostic imaging
  • Uterus / pathology

Substances

  • Coloring Agents
  • Indocyanine Green