title: Utilization of sentinel lymph node biopsy for uterine cancer.
abstract: To limit the potential short and long-term morbidity of lymphadenectomy, sentinel lymph node biopsy has been proposed for endometrial cancer. The principle of sentinel lymph node biopsy relies on removal of a small number of lymph nodes that are the first drainage basins from a tumor and thus the most likely to harbor tumor cells. While the procedure may reduce morbidity, efficacy data are limited and little is known about how commonly the procedure is performed.
  
  
  
  We examined the patterns and predictors of use of sentinel lymph node biopsy and outcomes of the procedure in women with endometrial cancer who underwent hysterectomy.
  
  
  
  We used the Perspective database to identify women with uterine cancer who underwent hysterectomy from 2011 through 2015. Billing and charge codes were used to classify women as having undergone lymphadenectomy, sentinel lymph node biopsy, or no nodal assessment. Multivariable models were used to examine clinical, demographic, and hospital characteristics with use of sentinel lymph node biopsy. Length of stay and cost were compared among the different methods of nodal assessment.
  
  
  
  Among 28,362 patients, 9327 (32.9%) did not undergo nodal assessment, 17,669 (62.3%) underwent lymphadenectomy, and 1366 (4.8%) underwent sentinel lymph node biopsy. Sentinel lymph node biopsy was performed in 1.3% (95% confidence interval, 1.0-1.6%) of abdominal hysterectomies, 3.4% (95% confidence interval, 2.7-4.1%) of laparoscopic hysterectomies, and 7.5% (95% confidence interval, 7.0-8.0%) of robotic-assisted hysterectomies. In a multivariable model, more recent year of surgery was associated with performance of sentinel lymph node biopsy. Compared to abdominal hysterectomy, those undergoing laparoscopic (adjusted risk ratio, 2.45; 95% confidence interval, 1.89-3.18) and robotic-assisted (adjusted risk ratio, 2.69; 95% confidence interval, 2.19-3.30) hysterectomy were more likely to undergo sentinel lymph node biopsy. Among women who underwent minimally invasive hysterectomy, length of stay and cost were lower for sentinel lymph node biopsy compared to lymphadenectomy.
  
  
  
  The use of sentinel lymph node biopsy for endometrial cancer increased from 2011 through 2015. The increased use was most notable in women who underwent a robotic-assisted hysterectomy.
authors.affiliation: Herbert Irving Comprehensive Cancer Center of the College of Physicians and Surgeons, Columbia University, New York, NY; College of Physicians and Surgeons, Columbia University, New York, NY; New York Presbyterian Hospital, New York, NY. Electronic address: jw2459@columbia.edu.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, NY; New York Presbyterian Hospital, New York, NY.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cham
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Ling
authors.initials: L
authors.lastname: Chen
authors.affiliation: Herbert Irving Comprehensive Cancer Center of the College of Physicians and Surgeons, Columbia University, New York, NY; College of Physicians and Surgeons, Columbia University, New York, NY; New York Presbyterian Hospital, New York, NY.
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.affiliation: Herbert Irving Comprehensive Cancer Center of the College of Physicians and Surgeons, Columbia University, New York, NY; College of Physicians and Surgeons, Columbia University, New York, NY; New York Presbyterian Hospital, New York, NY.
authors.forename: June Y
authors.initials: JY
authors.lastname: Hou
authors.affiliation: Herbert Irving Comprehensive Cancer Center of the College of Physicians and Surgeons, Columbia University, New York, NY; College of Physicians and Surgeons, Columbia University, New York, NY; Joseph L. Mailman School of Public Health, Columbia University, New York, NY; New York Presbyterian Hospital, New York, NY.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Tergas
authors.affiliation: Yale University, New Haven, CT.
authors.forename: Vrunda
authors.initials: V
authors.lastname: Desai
authors.affiliation: Weill Cornell Medical College, New York, NY; New York Presbyterian Hospital, New York, NY.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, NY; Joseph L. Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.affiliation: Herbert Irving Comprehensive Cancer Center of the College of Physicians and Surgeons, Columbia University, New York, NY; College of Physicians and Surgeons, Columbia University, New York, NY; Joseph L. Mailman School of Public Health, Columbia University, New York, NY; New York Presbyterian Hospital, New York, NY.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.affiliation: Herbert Irving Comprehensive Cancer Center of the College of Physicians and Surgeons, Columbia University, New York, NY; College of Physicians and Surgeons, Columbia University, New York, NY; Joseph L. Mailman School of Public Health, Columbia University, New York, NY; New York Presbyterian Hospital, New York, NY; Yale University, New Haven, CT.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008875:Middle Aged; D065287:Robotic Surgical Procedures; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: endometrial cancer; lymphadenectomy; sentinel lymph node; uterine cancer