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

https://www.gynecologiconcology-online.net/article/S0090-8258(14)00146-2/pdf

Detection of sentinel lymph nodes in minimally invasive surgery using indocyanine green and near-infrared fluorescence imaging for uterine and cervical malignancies

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

https://www.gynecologiconcology-online.net/article/S0090-8258(11)00719-0/pdf

Sentinel lymph node biopsy in endometrial cancer: Meta-analysis of 26 studies

The lymph node status of a patient is a key determinate in staging, prognosis and adjuvant treatment of endometrial cancer. Despite this, the potential additional morbidity associated with lymphadenectomy makes its role controversial. This study systematically reviews the accuracy literature on sentinel node biopsy; ultra sound scanning, magnetic resonance imaging (MRI) and computer tomography (CT) for determining lymph node status in endometrial cancer. Relevant articles were identified form MEDLINE (1966–2006), EMBASE (1980–2006), MEDION, the Cochrane library, hand searching of reference lists from primary articles and reviews, conference abstracts and contact with experts in the field. The review included 18 relevant primary studies (693 women). Data was extracted for study characteristics and quality. Bivariate random-effect model meta-analysis was used to estimate diagnostic accuracy of the various index tests. MRI (pooled positive LR 26.7, 95% CI 10.6 – 67.6 and negative LR 0.29 95% CI 0.17 – 0.49) and successful sentinel node biopsy (pooled positive LR 18.9 95% CI 6.7 – 53.2 and negative LR 0.22, 95% CI 0.1 – 0.48) were the most accurate tests. CT was not as accurate a test (pooled positive LR 3.8, 95% CI 2.0 – 7.3 and negative LR of 0.62, 95% CI 0.45 – 0.86. There was only one study that reported the use of ultrasound scanning. MRI and sentinel node biopsy have shown similar diagnostic accuracy in confirming lymph node status among women with primary endometrial cancer than CT scanning, although the comparisons made are indirect and hence subject to bias. MRI should be used in preference, in light of the ASTEC trial, because of its non invasive nature.

/pdf/a-systematic-review-of-tests-for-lymph-node-status-in-41dk7jb4ze.pdf

A systematic review of tests for lymph node status in primary endometrial cancer.

Lelievre L, Camatte S, Le Frere-belda MA, Kerrou K, Froissart M, Taurelle R, Vilde F, Lecuru F. Sentinel lymph node biopsy in cervix and corpus uteri cancers. Int J Gynecol Cancer 2004;14:271—278. Lymphatic spread is a major prognostic factor in earlycervical and endometrial cancers, associated with a significant decrease of survival. Therefore, pelvicþpara-aortic lymphadenectomy is routinely part of the surgical management of those cancers. Nevertheless, the prevalence of metastatic disease to pelvic lymph nodes is less than 15% in FIGO stage IA2/IB1cervix cancers and 9—20% in FIGO stage I/II endometrial cancers. The sentinel lymph node (SLN) is the first node to receive the lymph coming from the tumor, hence it is the first to receive metastasizing cancer cells. The SLN biopsy has been proposed in uterine cancers. Its application in routine could avoid 80% of unnecessary radical lymphadenectomies. The morbidity is likely to be reduced, which appears particularly interesting for endometrial cancer patients who are often obese and aged. In addition, it allows an accurate exploration of all the drainage routes including the main basins: obturator and external iliac, as well as those considered aberrant and not systematically examined: internal iliac, common iliac, presacral, para-aortic, or inguinal areas. Then, the risk of recurrences due to missed positive nodes in spite of standard radical lymphadenectomy would be reduced. Furthermore, as recent studies have shown that lymph node micrometastases are associated to a risk of recurrence, it would be relevant to perform serial step sectioning and immunochemistry techniques on the sentinel nodes, likewise for breast and vulvar cancers. Finally, this procedure could be part of mini-invasive laparoscopic staging explorations prior to radiochemotherapy in cervix cancers. The aim of this study was to assess the feasibility of the sentinel node procedure in early cervical and endometrial cancers with the use of the combined method of detection, including 99mTc-radiocolloid and blue dye injections. Materials and methods We undertook a prospective trial including all the patients with early cervical or endometrial cancers scheduled to undergo surgical pelvicþ-para-aortic evaluation associated to hysterectomy. From January to December 2002, all the patients with cervix cancer, clinical FIGO stages IA2 and IB1, were enrolled; exception was made for patients with suspicion of metastatic nodes on pelvic magnetic resonance imaging. Two patients with stage IB2 and IIB cancers were also eligible to assess the lymphatic spread prior to radiochemotherapy. Patients with endometrial cancer (previously diagnosed by curretage) were enrolled; exception was made for those with extra-uterine extension, peritoneal carcinosis, suspicion of metastatic lymph node(s) or distant metastasis after clinical examination, pelvic ultrasonography or pelvic magnetic resonance imaging. Address correspondence and reprint requests to: Lelièvre Loı̈c, Service de Chirurgie Gynécologique et Oncologique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France. Email: lelievre.loic@ wanadoo.fr Int J Gynecol Cancer 2004, 14, 271—278

https://ijgc.bmj.com/content/ijgc/14/2/271.full.pdf

Sentinel lymph node biopsy in cervix and corpus uteri cancers

We report a case of granulomatous peritonitis which occurred following laparoscopic exeresis of a dermoid cyst of the ovary performed together with medically induced abortion. The peritoneal cavity was contaminated when the cyst ruptured during the procedure emptying sebum and hairs in the peritoneum. Abondant washing with aspiration of all the visible particles was done with a 5 mm canula. The diagnosis of granulomatous peritonitis was suggested with the development of persistant fever, degradation of the patient's general health, moderate abdominal pain and a nodular image at echography located on the operated ovary. The nodule was found to be an inflammatory granuloma on a foreign body. Two second-look laparotomies, one transrectal and the other via the xypho-pubian route, were required 1 month after the initial operation for complete cure. The diagnosis was confirmed on the pathology report.

[Granulomatous peritonitis after laparoscopic surgery of an ovarian dermoid cyst. Diagnosis, management, prevention, a case report].

La technique du ganglion sentinelle (GS) a ete proposee dans les cancers de l’uterus afin d’optimiser le diagnostic des metastases et des micrometastases lymphatiques dans les stades precoces. Ont ete incluses des patientes ayant un cancer uterin a un stade precoce : 8 cancers invasifs du col et 15 cancers de l’endometre. Toutes ont eu une lymphoscintigraphie preoperatoire et 19 patientes ont eu une cœlioscopie. La detection peroperatoire des GS a ete realisee apres injection cervicale de colorant bleu et a l’aide d’une sonde de detection gamma a main. Les ganglions non sentinelles ont ete retires et adresses separement en anatomopathologie. La lymphoscintigraphie a ete positive pour 6 cancers du col (75 %) et 13 cancers de l’endometre (86,6 %), montrant chez 5 patientes des GS extra‐iliaques. Au moins un GS a ete identifie en peroperatoire pour 6 cancers du col et pour 14 cancers de l’endometre. Le taux de detection a ete plus eleve avec la methode isotopique. La plupart des GS etaient ilio‐obturateurs. Quatre patientes ayant un cancer de l’endometre avaient une extension lymphatique pelvienne, interessant seulement le(s) GS dans chaque cas. Aucun cas de GS faux negatif n’a ete note. La biopsie du ganglion sentinelle semble realisable pour les cancers du col et de l’endometre. Cette technique pourrait eviter des curages etendus inutiles et permettrait une meilleure evaluation lymphatique. ▴

Technique du ganglion sentinelle appliquée aux cancers de l’utérus : étude préliminaire

Laparoscopic pelvic lymphadenectomy in an anatomical model: results of an experimental comparative trial

Impact of pneumoperitoneum on visceral metastasis rate and survival. Results in two ovarian cancer models in rats

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