Page 55 - Test PDF v5

« Back to Contents
LiFE re
Literature for ENYGO
Sentinel node mapping in gynaecological malignancies
Editor Anton Ilin
Descriptive summary
Endometrial cancer:
Sentinel lymph node mapping (SLNM) in patients with endometrial
cancer is now actual and widely discussed, which was the result
of great team work (ESMO-ESGO-ESTRO Consensus Conference on
Endometrial Cancer). Unfortunately, the role of SLNM in endometrial
cancer is still not well established [1].
Laparoscopy has in some cases certain advantages over
laparotomy – less tissue traumatisation, early activation of patient, decide where to inject the dye. 3) Considering that the exclusive
decreased period of hospitalization and, as a consequence, de-
creased cost of treatment. Ghezzi F et al. published a case of SLND
using a 5.8-mm 0° optical camera with a near-infrared high-intensity
light source and 3-mm instruments. SLN was detected bilaterally.
The operative time was 60 min, and the estimated blood loss was
50 ml [2]. Mini-laparoscopy is a less invasive approach, but the
feasibility of using it instead of traditional laparoscopy requires
further study.
Large series suggest that SLNM is feasible and even has benefits
such as detection of micrometastases compared with conventional
histology but the value of these findings is unclear.
Eriksson et al. reviewed the experience of two institutions with
different nodal assessment approaches in patients with endome-
trial carcinoma and minimal myometrial invasion. In the first group
(642 patients – 57 %) SLNM algorithm was used per institutional
protocol. In other group (493 patients – 43 %) pelvic and para-aortic
lymphadenectomy was performed for patients with grade 3 cancers
and/or primary tumour diameter>2cm. Pelvic nodes (PLNs) were re-
moved in 93 % and 58 % of patients, respectively; para-aortic nodes
(PALNs) were removed in 14.5 % and 50 % of patients, respectively.
Metastases to PLNs were detected in 5.1 % and 2.6 % of patients,
respectively, and to PALNs in 0.8 % and 1.0 %, respectively [3].
3-year DFS was similar in both groups (95 %). Based on the results,
the authors conclude that SLND approach is feasible and could be
recommended for endometrial cancer staging. An the same time it
is necessary to standardize the methodology of the procedure and
patient enrolment criteria to validate SLND in definite groups of pa-
tients as well as to determine the significance of ultramicrostaging.
Kataoka et al. published results of the prospective evaluation of 57
Japanese endometrial cancer patients undergoing sentinel node
mapping using the scintigraphic method (hysteroscopic sub-endo-
Continued on the next page 
International Journal of Gynecological Cancer, Volume 26, Supplement #1 Page 55
SURGICAL MANAGEMENT
metrial injection of 99mTc). In 32 cases it was combined with the
dye method. Sensitivity and negative predictive values were 100 %,
100 %, respectively [4]. A total of 56.3 % of positive lymph nodes
were present in the pelvis while 43.8 % in PALNs, which is different
from other reports. The combined method seems to be more effec-
tive compared to isolated procedures, but the significance of this
advantage is debated because of the minor difference in results and
technical complexity of the method. Buda et al. marked some critical
drawbacks for hysteroscopic tracer injection: 1) The necessity for a
more demanding technique with a longer learning curve compared to
the cervical injection; requires the support of nuclear medicine when
99mTc is injected with the patient still awake during the procedure.
2) In the case of a focal endometrial lesion, it could be difficult to
aortic migration can occur more frequently in the case of a fundal
high grade tumour with a deep myometrial infiltration, it is really a
commitment to standardize such a demanding technique for such a
limited number of cases [5].
Cervical cancer:
Wuntakal et al. reviewed the experience of West Kent Gynaecolog-
ical Oncology Centre in SLND for 132 patients with cervical cancer
stage IA1-IIA. The most common SLN locations were the external
iliac (38.6 %), obturator (25.3 %) and internal iliac (23.6 %) regions,
that compared to results of previous studies. No SLN was found
in the upper para-aortic region. Factors associated with unilateral
detection of sentinel nodes were also assessed, finding older age as
a solitary indipendent factor [6]. The authors supposed it could be a
result of sclerosis in the lymphatic vessels or reduced perfusion in
the pelvis that led to reduced accumulation of 99mTc and blue dye.
For SLNM with indocyanine green it seems to be a promising marker,
not only because of a detection rate but also partly due to the safety
and convenience of administration. Sara et al. published results of a
retrospective study in which indocyanine green used for laparoscopic
SLND for patients with cervical cancer. Overall detection rates were
83 % and 95.5 %, and bilateral detection rates were 61 and 95.5 %
for 99mTc and patent blue dye group (36 patients) and indocyanine
green group (22 patients), respectively.