title: Evaluation of the sentinel lymph node algorithm with blue dye labeling for early-stage endometrial cancer in a multicentric setting.
abstract: OBJECTIVE
  Sentinel lymph node (SLN) removal may be a midterm between no and full pelvic dissection in early endometrial cancer. Whereas the use of blue dye alone in SLN detection has a poor accuracy, its integration in an SLN algorithm may yield better results and overcome hurdles such as the requirement of nuclear medicine facility.
  
  
  METHODS
  Sixty-six patients with clinical stage I endometrial cancer were prospectively enrolled in a multicentre study between May 2003 and June 2009. Patent blue was injected intraoperatively into the cervix. We retrospectively assessed the accuracy of a previously described SLN algorithm consisting of the following sequence: (1) pelvic node area is inspected for removal of all mapped SLN and (2) excision of every suspicious non-SLN, (3) in the absence of mapping in a hemipelvis, a standard ipsilateral lymphadenectomy is then performed.
  
  
  RESULTS
  Sentinel nodes were identified in 41 patients (62.1%), mostly in interiliac and obturator areas. None was detected in the para-aortic area. Detection was bilateral in 23 cases (56.1%). Seven patients (10.6%) had positive nodes. The false-negative rate was 40% using SLN detection alone. When the algorithm was applied, the false-negative rate was 14.3%. The use of a SLN algorithm would have avoided 53% of lymphadenectomies
  
  
  CONCLUSIONS
  Our multicentric evaluation validates the use of a SLN algorithm based on blue-only sentinel node mapping in early-stage endometrial cancer. The application of such SLN algorithm should be evaluated in a prospective context and might lead to decrease unnecessary lymphadenectomies.
authors.affiliation: Department of General and Gynecologic Surgery, Rangueil Academic Hospital, Toulouse, France. fmv2001@qatar-med.cornell.edu
authors.forename: Fabien
authors.initials: F
authors.lastname: Vidal
authors.forename: Pierre
authors.initials: P
authors.lastname: Leguevaque
authors.forename: Stephanie
authors.initials: S
authors.lastname: Motton
authors.forename: Jerome
authors.initials: J
authors.lastname: Delotte
authors.forename: Gwenael
authors.initials: G
authors.lastname: Ferron
authors.forename: Denis
authors.initials: D
authors.lastname: Querleu
authors.forename: Arash
authors.initials: A
authors.lastname: Rafii
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000473:pathology* / Q000601:surgery; D000231:Adenocarcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D000465:Algorithms; D004396:Coloring Agents; D018284:Cystadenocarcinoma, Serous / Q000473:pathology* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy
chemical_list: D004396:Coloring Agents; D012394:Rosaniline Dyes; C008769:sulfan blue