Columbia University College of Physicians and Surgeons, New York, New York, USA.
New York Presbyterian Hospital, New York, New York, USA.
BJOG. 2022 Aug;129(9):1591-1599. doi: 10.1111/1471-0528.17085. Epub 2022 Jan 25.
To examine the patterns and outcomes of sentinel lymph node (SLN) assessment in women with endometrial cancer.
Retrospective cohort study.
United States inpatient and outpatient hospital services.
Women with endometrial cancer who underwent a laparoscopic or robotic-assisted hysterectomy.
The Perspective Database from 2012 to 2018 was used. Performance of lymph node dissection was classified as SLN mapping, lymph node dissection or no nodal evaluation. Adjusted regression models were developed to examine the association between SLN mapping and morbidity and cost.
Utilisation rates, morbidity and cost of both lymph node dissection and SLN mapping.
Among 45 381 patients, SLN mapping was performed for 7768 patients (17.1%), lymph node dissection was performed for 23 214 patients (51.2%) and no lymphatic evaluation was performed for 14 399 patients (31.7%). SLN mapping increased from 1.8% in 2012 to 35.3% in 2018, whereas the rate of lymph node dissection decreased from 63.5% to 39.1% (p < 0.001). Among women who underwent nodal evaluation, residence in the west, White race and use of robotic-assisted hysterectomy were associated with SLN mapping (p < 0.05 for all). The complication rate was 5.9% for SLN mapping, compared with 7.3% in those that underwent lymph node dissection (aRR 0.85, 95% CI 0.77-0.95). The median hospital costs for women who underwent SLN mapping ($10 479) and lymph node dissection ($10 747) were higher than for those who did not undergo nodal assessment ($9149) (p < 0.001).
The performance of SLN mapping is increasing for endometrial cancer. Compared with lymph node dissection, SLN mapping is associated with lower morbidity. SLN mapping significantly increases the costs compared with hysterectomy alone.
SLN mapping is increasing rapidly for endometrial cancer and is associated with decreased perioperative morbidity.
研究子宫内膜癌患者前哨淋巴结（SLN）评估的模式和结果。
回顾性队列研究。
美国住院和门诊医院服务。
接受腹腔镜或机器人辅助子宫切除术的子宫内膜癌患者。
使用 2012 年至 2018 年的透视数据库。对淋巴结清扫术的表现进行分类，包括 SLN 绘图、淋巴结清扫或无淋巴结评估。开发调整后的回归模型来研究 SLN 绘图与发病率和成本之间的关联。
淋巴结清扫术和 SLN 绘图的利用率、发病率和成本。
在 45381 名患者中，7768 名患者（17.1%）进行了 SLN 绘图，23214 名患者（51.2%）进行了淋巴结清扫，14399 名患者（31.7%）未进行淋巴结评估。SLN 绘图从 2012 年的 1.8%增加到 2018 年的 35.3%，而淋巴结清扫的比例从 63.5%下降到 39.1%（p<0.001）。在接受淋巴结评估的女性中，居住在西部、白种人和使用机器人辅助子宫切除术与 SLN 绘图相关（所有 p<0.05）。SLN 绘图的并发症发生率为 5.9%，而淋巴结清扫术为 7.3%（aRR 0.85，95%CI 0.77-0.95）。进行 SLN 绘图（10479 美元）和淋巴结清扫术（10747 美元）的女性的中位住院费用高于未进行淋巴结评估的女性（9149 美元）（p<0.001）。
子宫内膜癌中 SLN 绘图的应用正在迅速增加。与淋巴结清扫相比，SLN 绘图与较低的围手术期发病率相关。与单纯子宫切除术相比，SLN 绘图显著增加了成本。
SLN 绘图在子宫内膜癌中迅速增加，与围手术期发病率降低相关。
