title: A study on uterine lymphatic anatomy for standardization of pelvic sentinel lymph node detection in endometrial cancer.
abstract: To describe the anatomy of uterine lymphatic drainage following cervical or fundal tracer injection to enable standardization of a pelvic sentinel lymph node (SLN) concept in endometrial cancer (EC).
  
  
  
  A prospective consecutive study of women with EC was conducted. A fluorescent dye (Indocyanine green) was injected into the cervix (n=60) or the uterine fundus (n=30). A systematic trans- and retroperitoneal mapping of uterine lymphatic drainage was performed. Positions of the pelvic SLNs, defined by afferent lymph vessels, and lymph node metastases were compared.
  
  
  
  Two consistent lymphatic pathways with pelvic SLNs were identified irrespective of injection site; an upper paracervical pathway (UPP) with draining medial external and/or obturator lymph nodes and a lower paracervical pathway (LPP) with draining internal iliac and/or presacral lymph nodes. Bilateral display of at least one pelvic pathway following cervical and fundal injection occurred in 98% and 80% respectively (p=0.005). Bilateral display of both pelvic pathways occurred in 30% and 20% respectively (p=0.6) as the LPP was less often displayed. Nearly one third of the 19% node positive patients had metastases along the LPP. No false negative SLNs were identified.
  
  
  
  Based on uterine lymphatic anatomy a bilateral detection of at least one SLN in both the UPP and LPP should be aimed for. Absence of display of the LPP may warrant a full presacral lymphadenectomy. Although pelvic pathways and positions of SLNs are independent of the tracer injection site, cervical injection is preferable due to a higher technical success rate.
authors.affiliation: Department of Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Barbara
authors.initials: B
authors.lastname: Geppert
authors.affiliation: Department of Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Céline
authors.initials: C
authors.lastname: Lönnerfors
authors.affiliation: Department of Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Michele
authors.initials: M
authors.lastname: Bollino
authors.affiliation: Department of Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Anastasija
authors.initials: A
authors.lastname: Arechvo
authors.affiliation: Department of Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden. Electronic address: Jan.Persson@med.lu.se.
authors.forename: Jan
authors.initials: J
authors.lastname: Persson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002584:Cervix Uteri / Q000098:blood supply*; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage / Q000032:analysis; D042601:Lymphatic Vessels / Q000033:anatomy & histology* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D014599:Uterus / Q000098:blood supply*
chemical_list: D007208:Indocyanine Green
keywords: Anatomy; Endometrial cancer; Indocyanine green; Lymphadenectomy; Lymphatic metastases; Lymphatic system; Sentinel lymph node biopsy