Lymphatic mapping in endometrial cancer: comparison of hysteroscopic and subserosal injection and the distribution of sentinel lymph nodes.
BACKGROUND
Endometrial cancer incidence increases over the age of 65 and lymphadenectomy in these women is a morbid procedure. Sentinel lymph node (SLN) should avoid extensive lymphadenectomy in node negative patients. The aim of this prospective study is to determine the feasibility and usefulness of lymphatic mapping and SLN identification in the management of endometrial cancer.


METHODS
From January 2004 to December 2007 101 women with endometrial cancer participated in the study. We injected Tc hysteroscopically, peritumorally 2 hours before laparotomy in 24 women. We applied Tc and blue dye subserously after laparotomy and before adhesiolysis in 67 women. Ten patients with metastatic disease in ovary, omentum, peritoneum, and bulky nodes were excluded from analysis.


RESULTS
We detected SLN in 12 women (50%) in hysteroscopic group and in 49 women (73.1%) in subserous group. We identified 133 SLNs in 61 women. We found 20 SLNs (15.0%) in supraobturator region, 78 (58.6%) in external iliac area, 11 (8.3%) in paraaortal area, 13 (9.8%) on common iliac artery, 8 (6.0%) in medial part of lateral parametrium, and 3 (2.3%) in presacral area.


CONCLUSIONS
Sentinel lymph node identification is a new strategy that can be used to examine nodal status with a high successful rate in breast, cervical, and vulvar cancer. Results in endometrial cancer are not as successful, however. In the future, it will be necessary to find optimal timing, the best route of application, and the "right" size of the Tc particles. Subserous application seems to be superior to hysteroscopic application.
Robova
Helena
H
Department of Obstetrics and Gynaecology, Charles University Prague, Czech Republic.
Charvat
Martin
M
Strnad
Pavel
P
Hrehorcak
Martin
M
Taborska
Katerina
K
Skapa
Petr
P
Rob
Lukas
L
D000328:Adult; D000368:Aged; D018196:Carcinoma, Adenosquamous / Q000000981:diagnostic imaging / Q000473:pathology; D018269:Carcinoma, Endometrioid / Q000000981:diagnostic imaging / Q000473:pathology; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D015552:Injections, Intralesional; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011446:Prospective Studies; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin
D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid