title: Robotic blue-dye sentinel lymph node detection for endometrial cancer - Factors predicting successful mapping.
abstract: OBJECTIVE
  Sentinel lymph node (SLN) mapping has emerged as a viable option for the treatment of patients with endometrial cancer. We report our initial experience with SLN mapping algorithm, and examine the factors predicting successful SLN mapping.
  
  
  METHODS
  We analyzed all data recorded in our institute on robotic blue-dye SLN detection mapping from the time it was first introduced to our department in January 2012-December 2014. Data included patient demographics, SLN allocation, operating room times, and pathology results.
  
  
  RESULTS
  During the study period, 74 patients had robotic assisted surgery for endometrial cancer with attempted SLN mapping. SLN was found overall in 46 patients (62.1%). At first, SLN was detected in only 50% of cases, but after performing 30 cases, detection rates rose to 84.6% (OR = 3.34, CI 1.28-8.71; p = 0.003). Univariate analysis showed a higher detection rate with methylene blue than patent blue dye, 74.3% vs. 52.3% (OR = 2.744, 95% CI 1.026-7.344; p = 0.042). In multivariate analysis, high body mass index (BMI) was associated with failed mapping (OR = 0.899; 95% CI 0.808-1.00), as was the presence of lymph-vascular space invasion (LVSI) (OR = 0.126; 95% CI 0.24-0.658) and few cases per surgeon (OR = 1.083, 95% CI 1.032-1.118). Factors related to uterine pathology itself, including tumor histology, grade, method of diagnosis, the presence of an endometrial polyp, and lower uterine segment involvement were not found to be associated with successful mapping.
  
  
  CONCLUSIONS
  Surgeon experience, BMI and LVSI may affect the success rate of SLN mapping for endometrial cancer. These factors should be investigated further in future studies.
authors.affiliation: Gynecologic Oncology Division, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: eitanr@clalit.org.il.
authors.forename: R
authors.initials: R
authors.lastname: Eitan
authors.affiliation: Gynecologic Oncology Division, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: gads@clalit.org.il.
authors.forename: G
authors.initials: G
authors.lastname: Sabah
authors.affiliation: Gynecologic Oncology Division, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: Haimkr@clalit.org.il.
authors.forename: H
authors.initials: H
authors.lastname: Krissi
authors.affiliation: Gynecologic Oncology Division, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: odedrab@clalit.org.il.
authors.forename: O
authors.initials: O
authors.lastname: Raban
authors.affiliation: Gynecologic Oncology Division, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: avibh@clalit.org.il.
authors.forename: A
authors.initials: A
authors.lastname: Ben-Haroush
authors.affiliation: Gynecologic Oncology Division, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: rcgold@netvision.net.il.
authors.forename: C
authors.initials: C
authors.lastname: Goldschmit
authors.affiliation: Gynecologic Oncology Division, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: drlevavi@clalit.org.il.
authors.forename: H
authors.initials: H
authors.lastname: Levavi
authors.affiliation: Gynecologic Oncology Division, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: dr.peled@gmail.com.
authors.forename: Y
authors.initials: Y
authors.lastname: Peled
mesh_terms: D004396:Coloring Agents; D016889:Endometrial Neoplasms / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008751:Methylene Blue; D008875:Middle Aged; D015203:Reproducibility of Results; D012371:Robotics / Q000379:methods*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue
keywords: Lymph nodes; Surgery; Uterine cancer