title: Accuracy of robotic sentinel lymph node detection (RSLND) for patients with endometrial cancer (EC).
abstract: OBJECTIVE
  Lymphadenectomy as a part of the staging for EC patients is controversial. Sentinel lymph node detection has been introduced to determine which patients would benefit from adjuvant therapy and to limit morbidities associated with a full pelvic nodal dissection. The purpose of this study is to evaluate diagnostic accuracy and detection rate of robotic sentinel lymph node detection (RSLND) as a part of the surgical staging for EC.
  
  
  METHODS
  A retrospective database of all patients who underwent intraoperative lymphatic mapping using cervical injection methylene blue followed by RSLND as a part of their procedure was reviewed. Sentinel lymph node (SLN) was initially examined by routine Hematoxylin and Eosin (H&E) and ultrastaging by immunohistochemistry (IHC).
  
  
  RESULTS
  Between 4/2011 and 6/2013, 120 patients with endometrial cancer underwent RSLND. The median age was 62years (25-87); median BMI was 32 (18-76). Out of 120 patients, only one patient underwent RSLND with fertility preservation; and 119 patients underwent robotic hysterectomy and surgical staging with RSLND. None of the cases was converted to an open procedure. At least 1 SLN was detected in 86% (103/120) of the patients. Bilateral SLNs were detected in 52% (62/120). Positive nodes were identified in 8% (10/120) of the patients. Of those with SLN (+), 50% (5/10) were by ultrastaging (IHC) alone. No patients had positive regional nodes without SLN (+).
  
  
  CONCLUSIONS
  RSLND using methylene blue cervical injection can identify SLN in most patients with EC. IHC ultrastaging improves the detection of node positive disease when compared to traditional pathological evaluation.
authors.affiliation: Department of Obstetrics and Gynecology and Women's Health, Morristown and Overlook Medical Center, Atlantic Health System, Morristown, NJ 07960, USA.
authors.forename: Pranjal H
authors.initials: PH
authors.lastname: Desai
authors.affiliation: Department of Cellular and Molecular Biology, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hughes
authors.affiliation: Department of Obstetrics and Gynecology and Women's Health, Morristown and Overlook Medical Center, Atlantic Health System, Morristown, NJ 07960, USA; Women's Cancer Center, Carol G. Simon Cancer Center, Atlantic Health System, Morristown, NJ 07960, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Tobias
authors.affiliation: Department of Obstetrics and Gynecology and Women's Health, Morristown and Overlook Medical Center, Atlantic Health System, Morristown, NJ 07960, USA; Women's Cancer Center, Carol G. Simon Cancer Center, Atlantic Health System, Morristown, NJ 07960, USA.
authors.forename: Nana
authors.initials: N
authors.lastname: Tchabo
authors.affiliation: Department of Obstetrics and Gynecology and Women's Health, Morristown and Overlook Medical Center, Atlantic Health System, Morristown, NJ 07960, USA; Women's Cancer Center, Carol G. Simon Cancer Center, Atlantic Health System, Morristown, NJ 07960, USA.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Heller
authors.affiliation: Department of Clinical Pathology, Morristown Medical Center, Morristown, NJ 07960, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Dise
authors.affiliation: Department of Obstetrics and Gynecology and Women's Health, Morristown and Overlook Medical Center, Atlantic Health System, Morristown, NJ 07960, USA; Women's Cancer Center, Carol G. Simon Cancer Center, Atlantic Health System, Morristown, NJ 07960, USA; Division of Gynecologic Oncology, Sylvester Cancer Center, University of Miami, Miller School of Medicine, Miami, FL 33154, USA. Electronic address: bslomo@mac.com.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Slomovitz
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary / Q000601:surgery; D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D002296:Carcinosarcoma / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D004396:Coloring Agents; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008198:Lymph Nodes / Q000473:pathology*; D008751:Methylene Blue; D008875:Middle Aged; D010052:Ovariectomy; D010388:Pelvis; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D058994:Salpingectomy; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue
keywords: Robotic; Sentinel lymph node detection; Ultrastaging