title: Impact of sentinel lymph node biopsy on the therapeutic management of early-stage endometrial cancer: Results of a retrospective multicenter study.
abstract: OBJECTIVE
  The aim of this study is to assess the impact of sentinel lymph node (SLN) mapping and ultrastaging on the therapeutic management of early-stage endometrial cancer.
  
  
  METHODS
  This retrospective multicenter study covered the period from January 2000 through December 2012 and included 304 women with presumed low- or intermediate-risk endometrial cancer. Node staging, histology results, and the effects of both on therapeutic management were assessed in two groups: those who underwent the SLN mapping and ultrastaging procedure and those treated in accordance with French guidelines.
  
  
  RESULTS
  The SLN procedure detected metastatic lymph nodes in three times more women than lymphadenectomy did (16.2% versus 5.1%, p=0.03). Specifically, it found 7 macrometastases (5.1%) and 15 micrometastases (11%); 11 of the latter (8.1%) were detected by serial sectioning and immunohistochemistry (IHC), that is, pathologic ultrastaging. The SLN biopsy false-negative rate was 0% (95% CI: 0-1.6%). This ultrastaging enabled us to modify the adjuvant therapy for half the patients. Women with micrometastases detected by the SLN procedure were treated with external beam radiotherapy (EBRT), while those whose SLN biopsies were negative received vaginal brachytherapy (VBT) or clinical follow-up. SLN biopsies had no impact on recurrence-free survival.
  
  
  CONCLUSIONS
  SLN mapping and ultrastaging improved staging and made it possible to adapt adjuvant therapy to risk of recurrence.
authors.affiliation: Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France. Electronic address: Emilie_raimond@hotmail.com.
authors.forename: Emilie
authors.initials: E
authors.lastname: Raimond
authors.affiliation: Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Pierre et Marie Curie University - Paris 6, Paris, France.
authors.forename: Marcos
authors.initials: M
authors.lastname: Ballester
authors.affiliation: Department of Surgical Oncology, Georges-François Leclerc Cancer Center, Bourgogne University, Dijon, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Hudry
authors.affiliation: Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Pierre et Marie Curie University - Paris 6, Paris, France.
authors.forename: Sofiane
authors.initials: S
authors.lastname: Bendifallah
authors.affiliation: Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Pierre et Marie Curie University - Paris 6, Paris, France.
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
authors.affiliation: Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Graesslin
authors.affiliation: Department of Surgical Oncology, Georges-François Leclerc Cancer Center, Bourgogne University, Dijon, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Coutant
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods; D002277:Carcinoma / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
keywords: Adjuvant therapy; Endometrial cancer; Sentinel lymph node biopsy