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Sentinel lymph node (SLN) biopsy has emerged as an alternative staging approach in women with assumed early-stage endometrial carcinoma. Through image-guided surgery and pathologic ultrastaging, the SLN approach is introducing “precision medicine” to the surgical management of gynecologic cancers, providing a comprehensive evaluation of high-yield lymph nodes. This approach improves the surgeons’ ability to detect small-volume metastatic disease while reducing intraoperative and postoperative morbidity associated with lymphadenectomy. Although the majority of clinicians in Europe and the USA have recognized the value of SLN biopsy in endometrial carcinoma and introduced this as part of clinical practice, there is ongoing debate regarding its role in very low-risk patients as well as in patients at high risk of nodal metastasis. The significance of low-volume metastasis is not fully understood, and there is no consensus in regard to how the presence of isolated tumor cells should guide adjuvant therapy. Standardized protocols for histopathologic evaluation of SLNs are lacking.
Study | Study Population | Nodal Assessment | n | Metastatic Nodes | p-Value | DFS | p-Value | OS | p-Value |
---|---|---|---|---|---|---|---|---|---|
Eriksson [17] |
Endometroid Myoinvasion < 50% |
SLN LND |
642 493 |
5.1% pelvic 2.6% pelvic |
0.03 | 94.9% 96.8% (3-year) |
nr | 97.4% 95.4% (3-year) |
0.07 |
Schlappe [18] |
Endometrioid Myoinvasion > 50% |
SLN LND |
82 94 |
33.3% pelvic 14.8% pelvic |
0.005 | 78.7% 77.7% (3-year) |
nr | 91.8% 77.6% (3-year) |
nr |
Schlappe [19] |
Serous & Clear Cell | SLN LND |
118 96 |
22% pelvic 20% pelvic |
0.83 | 69% 80% (3-year) |
0.32 | 88% 77% (3-year) |
0.06 |
Schiavone [20] |
Carcinosarcoma | SLN LND |
48 88 |
17.5% nr |
na | 23 mo 23.2 mo |
0.7 | nr | na |
Basaran [21] |
Serous Carcinoma | SLN LND |
79 166 |
26.5% 29.5% |
0.63 | 58.8% 64.9% (2-year) |
0.48 | 89.1% 83.9% (2-year) |
0.85 |