title: Relevance of sentinel lymph node procedure for patients with high-risk endometrial cancer.
abstract: OBJECTIVE
  While the accuracy of the Sentinel Lymph Node (SLN) procedure has been validated in patients with early-stage endometrial cancer (EC) at low and intermediate risk of recurrence, its relevance for high-risk EC remains unknown. The aim of this study was to evaluate the contribution of SLN biopsy in staging patients with presumed high-risk EC.
  
  
  METHODS
  This retrospective multicenter study, conducted from January 2001 to December 2012, included 180 patients with early-stage EC undergoing SLN biopsy. Detection rate and false negative rate were assessed according to risk groups of recurrence.
  
  
  RESULTS
  SLNs were detected in 159/180 patients (88%) and were bilateral in 63% of cases. Of the 180 patients, 41 (22%) had a positive lymph node. Ultrastaging detected metastases undiagnosed by conventional histology in 17/41 patients (41%). The false negative rate was 6% (9/159); 2.3% in the low/intermediate risk group and 20% in the high-risk group (p = 0.0008). Lymphovascular space invasion (LVSI) was present in 48 patients (27%). Preoperative findings classified 146 patients as ESMO low/intermediate risk (81%) and 34 as high risk (19%). Ten of the 34 patients (29%) in the presumed high-risk group were downstaged on final histology and 5/18 patients (28%) initially diagnosed with type 2 were finally classified as having type 1 EC. Classification was more likely discordant for patients with preoperative type 2 EC (p = 0.03) and in the initial high-risk group (p = 0.02).
  
  
  CONCLUSIONS
  SLN biopsy associated with LVSI status can select which high-risk patients with EC would benefit from comprehensive staging.
authors.affiliation: Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie Paris 6, France. Electronic address: iptissem.naoura@tnn.aphp.fr.
authors.forename: Iptissem
authors.initials: I
authors.lastname: Naoura
authors.affiliation: Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie Paris 6, France.
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Canlorbe
authors.affiliation: Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie Paris 6, France; Inserm UMRS-707, Université Pierre et Marie Curie Paris 6, France.
authors.forename: Sofiane
authors.initials: S
authors.lastname: Bendifallah
authors.affiliation: Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie Paris 6, France.
authors.forename: Marcos
authors.initials: M
authors.lastname: Ballester
authors.affiliation: Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie Paris 6, France; Inserm UMRS-938, Université Pierre et Marie Curie Paris 6, France.
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
keywords: Detection rate; ESMO group risk; Endometrial cancer; False negative rate; High-risk group; Sentinel lymph node biopsy