title: Sentinel lymph node mapping reduces practice pattern variations in surgical staging for endometrial adenocarcinoma: A before and after study.
abstract: To examine the effects of universal sentinel lymph node mapping on the use of nodal staging in endometrial adenocarcinoma.
  
  
  
  Two approaches to laparoscopic staging for endometrial adenocarcinoma were compared using a before and after study design. The before cohort underwent selective lymphadenectomy from January 1, 2014-October 1, 2015 while the after cohort underwent universal sentinel lymph node (SLN) mapping from October 2, 2015-September 29, 2016.
  
  
  
  The before cohort comprised 215 patients and the after cohort 166 patients. In women undergoing SLN mapping, a sentinel node was identified at least unilaterally in 146/153 cases (95.4%), and bilaterally in 114/153 (74.5%) of cases. Pelvic nodes were removed in 35.8% of the before cohort versus 92.2% of the after cohort (p<0.0001) with more nodal evaluation among both low risk (9.6% vs. 91%, p<0.0001) and high risk cases (66% vs. 94%, p<0.0001). While the proportion of low risk cases diagnosed with nodal involvement did not significantly change (0.9% to 3.1%, p=0.32), there was a trend toward more diagnoses of nodal involvement in high risk cases (5% to 13.2%, p=0.06). Mean number of pelvic lymph nodes removed (15 vs. 4, p<0.0001), mean operative time (181min vs. 137min, p<0.0001), estimated blood loss (80ml vs. 56ml, p=0.004), and rate of post-operative complications (13% vs. 5.2%, p=0.04) all decreased after the adoption of SLN dissection.
  
  
  
  Universal sentinel lymph node dissection for laparoscopic endometrial cancer staging reduces heterogeneity in surgeon staging practice, increases nodal detection, and lowers post-operative complications.
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Harvard Medical School, Boston, MA, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Dana-Farber Cancer Institute, Boston, MA, USA. Electronic address: kelias@bwh.harvard.edu.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Elias
authors.affiliation: Harvard Medical School, Boston, MA, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Brooke E
authors.initials: BE
authors.lastname: Howitt
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Larissa J
authors.initials: LJ
authors.lastname: Lee
authors.affiliation: Harvard Medical School, Boston, MA, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Feltmate
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
keywords: Endometrial cancer; Near infrared imaging; Practice pattern variation; Sentinel lymph node dissection