title: Tracer injection sites and combinations for sentinel lymph node detection in patients with endometrial cancer.
abstract: OBJECTIVE
  The aim of the present study was to clarify the most effective combination of injected tracer types and injection sites in order to detect sentinel lymph nodes (SLNs) in early endometrial cancer.
  
  
  METHODS
  The study included 100 consecutive patients with endometrial cancer treated at Tohoku University Hospital between June 2001 and December 2012. The procedure for SLN identification entailed either radioisotope (RI) injection into the endometrium during hysteroscopy (55 cases) or direct RI injection into the uterine cervix (45 cases). A combination of blue dye injected into the uterine cervix or uterine body intraoperatively in addition to preoperative RI injection occurred in 69 of 100 cases. All detected SLNs were recorded according to the individual tracer and the resultant staging from this method was compared to the final pathology of lymph node metastases including para-aortic nodes.
  
  
  RESULTS
  SLN detection rate was highest (96%) by cervical RI injection; however, no SLNs were detected in para-aortic area. Para-aortic SLNs were detected only by hysteroscopic RI injection (56%). All cases with pelvic lymph node metastases were detected by pelvic SLN biopsy. Isolated positive para-aortic lymph nodes were detected in 3 patients. Bilateral SLN detection rate was high (96%; 26 of 27 cases) by cervical RI injection combined with dye.
  
  
  CONCLUSIONS
  RI injection into the uterine cervix is highly sensitive in detection of SLN metastasis in early stage endometrial cancer. It is a useful and safe modality when combined with blue dye injection into the uterine body.
authors.affiliation: Department of Obstetrics and Gynecology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Sendai 980-8574, Japan. Electronic address: niikura@med.tohoku.ac.jp.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Niikura
authors.forename: Michiko
authors.initials: M
authors.lastname: Kaiho-Sakuma
authors.forename: Hideki
authors.initials: H
authors.lastname: Tokunaga
authors.forename: Masafumi
authors.initials: M
authors.lastname: Toyoshima
authors.forename: Hiroki
authors.initials: H
authors.lastname: Utsunomiya
authors.forename: Satoru
authors.initials: S
authors.lastname: Nagase
authors.forename: Tadao
authors.initials: T
authors.lastname: Takano
authors.forename: Mika
authors.initials: M
authors.lastname: Watanabe
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ito
authors.forename: Nobuo
authors.initials: N
authors.lastname: Yaegashi
mesh_terms: D000328:Adult; D000368:Aged; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D015609:Organotechnetium Compounds / Q000008:administration & dosage*; D010833:Phytic Acid / Q000008:administration & dosage*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C026177:technetium phytate; D010833:Phytic Acid
keywords: (99m)Tc-phytate; Endometrial cancer; Frozen section; Micrometastasis; Sentinel lymph node (SLN)