Summary Background Retrospective single-centre series have shown the feasibility of sentinel lymph-node (SLN) identification in endometrial cancer. We did a prospective, multicentre cohort study to assess the detection rate and diagnostic accuracy of the SLN procedure in predicting the pathological pelvic-node status in patients with early stage endometrial cancer. Methods Patients with International Federation of Gynecology and Obstetrics (FIGO) stage I–II endometrial cancer had pelvic SLN assessment via cervical dual injection (with technetium and patent blue), and systematic pelvic-node dissection. All lymph nodes were histopathologically examined and SLNs were serial sectioned and examined by immunochemistry. The primary endpoint was estimation of the negative predictive value (NPV) of sentinel-node biopsy per hemipelvis. This is an ongoing study for which recruitment has ended. The study is registered with ClinicalTrials.gov, number NCT00987051. Findings From July 5, 2007, to Aug 4, 2009, 133 patients were enrolled at nine centres in France. No complications occurred after injection of technetium colloid and no anaphylactic reactions were noted after patent blue injection. No surgical complications were reported during SLN biopsy, including procedures that involved conversion to open surgery. At least one SLN was detected in 111 of the 125 eligible patients. 19 of 111 (17%) had pelvic-lymph-node metastases. Five of 111 patients (5%) had an associated SLN in the para-aortic area. Considering the hemipelvis as the unit of analysis, NPV was 100% (95% CI 95–100) and sensitivity 100% (63–100). Considering the patient as the unit of analysis, three patients had false-negative results (two had metastatic nodes in the contralateral pelvic area and one in the para-aortic area), giving an NPV of 97% (95% CI 91–99) and sensitivity of 84% (62–95). All three of these patients had type 2 endometrial cancer. Immunohistochemistry and serial sectioning detected metastases undiagnosed by conventional histology in nine of 111 (8%) patients with detected SLNs, representing nine of the 19 patients (47%) with metastases. SLN biopsy upstaged 10% of patients with low-risk and 15% of those with intermediate-risk endometrial cancer. Interpretation SLN biopsy with cervical dual labelling could be a trade-off between systematic lymphadenectomy and no dissection at all in patients with endometrial cancer of low or intermediate risk. Moreover, our study suggests that SLN biopsy could provide important data to tailor adjuvant therapy. Funding Direction Interregionale de Recherche Clinique, Ile-de-France, Assistance Publique–Hopitaux de Paris.

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(11)70070-5.pdf

Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO)

Purpose Sentinel lymph node (SLN) biopsy may be used to target lymph node metastases in patients with early cervical cancer. Whether SLN biopsy only is acceptable in the staging and surgical management of early cervical cancer remains unknown. This prospective multicenter study (SENTICOL [Ganglion Sentinelle dans le Cancer du Col]) assessed the sensitivity and negative predictive value (NPV) of SLN biopsy. Patients and Methods Adults with cervical carcinoma who met the International Federation of Gynecology and Obstetrics criteria for stage IA1 with lymphovascular space invasion to stage IB1 underwent technetium 99 lymphoscintigraphy and Patent Blue injection followed by laparoscopic lymph node mapping, SLN removal, and lymph node dissection. Only surgeons trained in SLN biopsy in cervical carcinoma participated in the study. SLNs and nonsentinel lymph nodes underwent routine staining. Negative SLNs were subjected to ultrastaging. The reference method was pelvic and/or para-aortic lymphadenectomy with his...

https://ascopubs.org/doi/pdf/10.1200/JCO.2010.32.0432

Bilateral Negative Sentinel Nodes Accurately Predict Absence of Lymph Node Metastasis in Early Cervical Cancer: Results of the SENTICOL Study

Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis.

The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology.

/pdf/a-comprehensive-overview-of-radioguided-surgery-using-gamma-46u7urctug.pdf

A comprehensive overview of radioguided surgery using gamma detection probe technology

Subjective assessment versus ultrasound models to diagnose ovarian cancer: A systematic review and meta-analysis.

Objectives
To map sentinel lymph nodes (SLNs) detected by intracervical injection in patients with endometrial cancer and to determine the prevalence of node micrometastases.

Methods
Radionuclide and blue dye injections were used for SLN detection in 43 patients with clinical stage I endometrial cancer. Lymphoscintigraphy was done before surgery. Intraoperatively, the pelvic and para-aortic territories were examined for blue and/or radioactive nodes. Pelvic lymphadenectomy was performed with or without para-aortic lymphadenectomy. SLNs stained with hematoxylin-eosin-saffron were examined and, when negative, evaluated using step sectioning and immunohistochemistry.

Results
Feasibility was 100%. No adverse effects occurred. SLNs were identified in 30 patients (69.8%), usually in an interiliac location (28/30 patients, 93.3%). SLNs were found only in the common iliac chain in 1 (3%) patient and in both the common iliac chain and promontory area in another (3%). No patients had para-aortic SLNs or SLNs confined to the promontory. Node metastases were identified in eight patients and were confined to SLNs in six. In 2 (2/30, 6%) patients, SLNs contained micrometastases. No false-negatives occurred.

Conclusions
Intracervical injection of radionuclide and blue dye chiefly revealed pelvic SLNs. The prevalence of micrometastases was within the expected range. Comparisons with peritumoral injection are needed. J. Surg. Oncol. 2008;97:141–145. © 2007 Wiley-Liss, Inc.

Does sentinel node biopsy improve the management of endometrial cancer? Data from 43 patients.

Sentinel lymph node biopsy improves staging in early cervical cancer

Resume Objectif Le but de ce travail etait d’evaluer le taux de detection, la topographie et le taux de faux negatifs du ganglion sentinelle (GS) dans les cancers de l’endometre. Materiel et methode Vingt-six patientes ont ete incluses. Une lymphoscintigraphie etait pratiquee avant l’intervention. La detection peroperatoire des GS etait realisee apres injection cervicale de bleu et a l’aide d’une sonde de detection gamma endoscopique. Les ganglions sentinelles et non-sentinelles etaient adresses separement en anatomopathologie. Les GS etaient examines apres coloration a l’hematoxyline-eosine-safran, et par immunohistochimie en cas de negativite. Resultats Vingt-six patientes ont eu une lymphoscintigraphie positive. La detection peroperatoire a ete possible chez 21 patientes (80,8 %) : le taux de detection avec la methode isotopique, 19 cas (73,1 %), etait superieur a celui du bleu, 15 cas (57,7 %). Nous n’avons pas observe de GS lombo-aortiques isoles et tous les GS etaient ilio-obturateurs. Sept patientes avaient une extension lymphatique, impliquant seulement le GS pour 4 d’entre elles. Une micrometastase a ete retrouvee sur un GS, alors que le reste du curage pelvien contenait des cellules tumorales isolees. Aucun GS faux negatif n’a ete note. Conclusion La biopsie du GS apparait faisable dans les cancers de l’endometre. Un GS micrometastatique a ete mis en evidence. Cependant, aucun GS lombo-aortique isole n’a ete retrouve.

La biopsie du ganglion sentinelle dans les cancers de l’endomètre est-elle faisable ?

OBJECTIVES
To evaluate detection rate, topography and false negatives of sentinel lymph node in endometrial cancer.


MATERIAL AND METHODS
Twenty-six patients were included. Lymphoscintigraphy was performed the day before surgery. Preoperative detection of the sentinel lymph node was performed with cervical blue dye injection and a gamma probe. Separate pathology examinations were performed for sentinel and non-sentinel lymph nodes. Sentinel lymph nodes were examined with hematoxylin-eosin-safran stain, and immunohistochemistry if negative.


RESULTS
Twenty-six patients had a positive lymphoscintigraphy. Preoperative detection was successful in 21 patients (80.8%): the detection rate with isotopic method, 19 cases (73.1%), was superior to the dye detection, 15 cases (57.7%). No isolated lombo-aortic sentinel lymph nodes were observed, and all sentinel lymph nodes were in the ilio-obturator region. Seven patients presented lymphatic spread, and 4 of them had at least one sentinel node. There was one micrometastasis in sentinel node, associated with isolated tumoral cells in pelvic lymphadenectomy. There was no false negative of sentinel node.


CONCLUSION
The biopsy of sentinel lymph node is a feasible procedure in endometrial cancer. There was one micrometastatic sentinel node. However there was no isolated lomboaortic sentinel lymph node in this study.

https://ijgc.bmj.com/content/ijgc/16/Suppl_3/770.4.full.pdf

0608: Is Sentinel Node Biopsy Feasible in Endometrial Cancer? Results in 26 Patients

Background
Peroperative identification of malignancy is crucial to management planning for ovarian cysts. The aim of this study was to evaluate the performance of laparoscopy in identifying malignant ovarian cysts.

Performance of laparoscopy in identifying malignant ovarian cysts.

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