FIGO stage IIIC endometrial cancer identification among patients with complex atypical hyperplasia, grade 1 and 2 endometrioid endometrial cancer: laparoscopic indocyanine green sentinel lymph node mapping versus frozen section of the uterus, why get around the problem?
OBJECTIVE
To compare two surgical strategies used to identify lymph node metastases in patients with preoperative diagnosis of complex atypical hyperplasia (CAH), grade 1 and 2 endometrial cancer (EC).


METHODS
Data on patients with preoperative diagnosis of CAH, grade 1 and 2 EC undergoing laparoscopic indocyanine green (ICG) sentinel lymph node (SLN) mapping followed by frozen section of the uterus were collected. When risk factors were identified at frozen section, patients were subjected to a systematic lymphadenectomy. False negative (FN) rates, negative predictive values (NPV), positive predictive values (PPV) and correlation with stage IIIC EC were calculated for the systematic lymphadenectomy based on frozen section of the uterus and for the SLN mapping.


RESULTS
Six (9.5%) out of 63 patients had lymph nodal metastases. Based on frozen section of the uterus, 22 (34.9%) and 15 (22.2%) patients underwent a pelvic and a pelvic and paraaortic lymphadenectomy, respectively. Five patients with stage IIIC disease were identified with a FN rate of 16.7% and a NPV and PPV of 97.6 and 27.3%, respectively. Overall and bilateral detection rates of ICG SLN mapping were 100 and 97.6%, respectively; no FN were recorded. The identification of patients with stage IIIC disease with ICG SLN mapping showed a NPV and PPV of 100%. Correlation between indication to lymphadenectomy and stage IIIC disease was poor (κ = 0.244) when based on frozen section of the uterus and excellent (κ = 1) when based on SLN mapping.


CONCLUSIONS
ICG SLN mapping reduces the number of unnecessary systematic lymphadenectomies and the risk of underdiagnosing patients with metastatic lymph nodes.
Department of Obstetrics and Gynecology, University Hospital of Berne, University of Berne, Effingerstrasse 102, 3010, Bern, Switzerland. andrea.papadia@insel.ch.
Andrea
http://orcid.org/0000-0002-4909-9588
A
Papadia
Department of Obstetrics and Gynecology, University Hospital of Berne, University of Berne, Effingerstrasse 102, 3010, Bern, Switzerland.|Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy.
Maria Luisa
ML
Gasparri
Department of Obstetrics and Gynecology, University Hospital of Berne, University of Berne, Effingerstrasse 102, 3010, Bern, Switzerland.
Franziska
F
Siegenthaler
Department of Obstetrics and Gynecology, University Hospital of Berne, University of Berne, Effingerstrasse 102, 3010, Bern, Switzerland.
Sara
S
Imboden
Department of Obstetrics and Gynecology, University Hospital of Berne, University of Berne, Effingerstrasse 102, 3010, Bern, Switzerland.
Stefan
S
Mohr
Department of Obstetrics and Gynecology, University Hospital of Berne, University of Berne, Effingerstrasse 102, 3010, Bern, Switzerland.
Michael D
MD
Mueller
D000328:Adult; D000368:Aged; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage / Q000737:chemistry; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D014599:Uterus / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery
D007208:Indocyanine Green
Endometrial cancer; Frozen section; Indocyanine green; Laparoscopy; Sentinel lymph node mapping; Surgical staging