title: Sentinel lymph node mapping with staging lymphadenectomy for patients with endometrial cancer increases the detection of metastasis.
abstract: OBJECTIVE
  To compare the performance of sentinel lymph node (SLN) mapping with staging lymphadenectomy versus staging lymphadenectomy alone for the detection of metastasis and the use of adjuvant therapies in patients with endometrial cancer.
  
  
  METHODS
  All patients with apparent early-stage endometrial cancer (n=780) who underwent robotic-assisted hysterectomy with pelvic±aortic lymphadenectomy from July-2006 to June-2013 were compared [pelvic±aortic lymphadenectomy (n=661) versus SLN-mapped cases with pelvic±aortic lymphadenectomy (n=119)]. Isosulfan-blue and indocyanine-green with near-infrared imaging were used for SLN mapping. Clinico-pathological data, FIGO stage, GOG risk category, and adjuvant therapies were compared.
  
  
  RESULTS
  Non-mapped and mapped cases were comparable with respect to BMI, histology, depth-of-invasion, and lympho-vascular space invasion. The mapped group had more pelvic lymph node (LN) harvested compared to non-mapped group (26.4±10.5 vs. 18.8±8.5, p<0.001). Aortic LN yields were identical for both groups (9.0±5.6 vs. 9.0±6.0). The mapped group had more LN metastasis detected (30.3% vs. 14.7%, p<0.001), more stage IIIC (30.2% vs. 14.5%, p<0.001), more GOG high-risk cases (32.8% vs. 21.8%, p=0.013), and received more chemotherapy+radiation (28.6% vs. 16.3%, p<0.003). The SLN was the only metastasis in 18 (50%) mapped cases with positive nodes. The SLN false negative rate was 1/36 (2.8%). Micrometastases or isolated tumor cells were identified in 22/35 (62.9%) SLN metastases. Multivariate analysis demonstrated that SLN mapping imparted a significant effect on the detection of metastatic disease [adjusted OR=3.29, p<0.001].
  
  
  CONCLUSIONS
  The performance of SLN mapping with staging lymphadenectomy increased the detection of lymph node metastasis and was associated with more use of adjuvant therapies.
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and Global Robotics Institute, Orlando, FL 32804, USA. Electronic address: robhollowaymd@gmail.com.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Holloway
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and Global Robotics Institute, Orlando, FL 32804, USA.
authors.forename: Sarika
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and Global Robotics Institute, Orlando, FL 32804, USA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Stavitzski
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and Global Robotics Institute, Orlando, FL 32804, USA.
authors.forename: Xiang
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and Global Robotics Institute, Orlando, FL 32804, USA.
authors.forename: Erica L
authors.initials: EL
authors.lastname: Takimoto
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and Global Robotics Institute, Orlando, FL 32804, USA.
authors.forename: Ajit
authors.initials: A
authors.lastname: Gubbi
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and Global Robotics Institute, Orlando, FL 32804, USA.
authors.forename: Glenn E
authors.initials: GE
authors.lastname: Bigsby
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and Global Robotics Institute, Orlando, FL 32804, USA.
authors.forename: Lorna A
authors.initials: LA
authors.lastname: Brudie
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and Global Robotics Institute, Orlando, FL 32804, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Kendrick
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and Global Robotics Institute, Orlando, FL 32804, USA. Electronic address: sarfraz.ahmad@flhosp.org.
authors.forename: Sarfraz
authors.initials: S
authors.lastname: Ahmad
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
keywords: Adjuvant treatments; Endometrial cancer; Lymph node metastasis; Robotic surgery; Sentinel lymph node mapping