Glassman Danielle, Kher Raadhika, Ananth Cande V, Girda Eugenia
Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
SAGE Open Med. 2025 Jun 10;13:20503121251342047. doi: 10.1177/20503121251342047. eCollection 2025.
To examine the real-life utilization of sentinel lymph node mapping for surgical staging of patients with endometrial cancer. We evaluated patterns of surgical staging in unmapped patients and studied how this practice affected adjuvant therapies and survival.
We conducted a retrospective chart review of patients with newly diagnosed endometrial cancer who underwent minimally invasive surgical staging, including sentinel lymph node mapping with cervical injection of indocyanine green from January 2019 to December 2021. Patient demographics, surgical findings, sentinel lymph node mapping, adjuvant therapy, and recurrence rates were collected. Sentinel lymph node detection rates were calculated, and reasons for omitting lymphadenectomy in unmapped patients were evaluated.
Among 121 patients, 80 (66%) had successful sentinel lymph node mapping and 41 (34%) failed mapping. Our yearly detection rate was 63%, 68%, and 70% for 2019, 2020, and 2021, respectively. In patients with successful sentinel lymph node mapping, 73.8% were low-grade and 26.2% were high-grade histology. For patients with failed mapping, 75.6% were low-grade and 24.4% were high-grade histology. For the failed mapping cohort, 23 patients (56.1%) had a complete lymphadenectomy performed, of which 3 (13.0%) had positive lymph nodes. Reasons for omitting lymphadenectomy were documented as: (1) intraoperative pathologic evaluation; (2) inability to tolerate Trendelenburg; (3) difficulty with anatomical dissection/visualization; and (4) evidence of locally advanced disease. There were 18 incompletely staged patients, including 8 (44.4%) with low-risk disease, 2 (11.1%) with locally advanced disease, and 1 (5.6%) with serous histology. The remaining 7 (38.9%) unstaged patients were offered and/or received adjuvant radiation based on final pathology. During a short-term follow-up period, no patients in the unmapped or incompletely staged cohorts had a recurrence of the disease.
The rate of sentinel lymph node detection is improving. Low-risk disease identified on intraoperative pathology was the most common reason for omitting lymphadenectomy in unmapped patients, and that practice did not seem to affect adjuvant therapy or recurrence of disease.
探讨前哨淋巴结定位在子宫内膜癌患者手术分期中的实际应用情况。我们评估了未进行定位患者的手术分期模式，并研究了这种做法如何影响辅助治疗和生存率。
我们对2019年1月至2021年12月期间接受微创外科分期的新诊断子宫内膜癌患者进行了回顾性病历审查，包括通过宫颈注射吲哚菁绿进行前哨淋巴结定位。收集患者的人口统计学资料、手术结果、前哨淋巴结定位、辅助治疗和复发率。计算前哨淋巴结检出率，并评估未进行定位患者省略淋巴结清扫术的原因。
121例患者中，80例（66%）前哨淋巴结定位成功，41例（34%）定位失败。2019年、2020年和2021年的年检出率分别为63%、68%和70%。在前哨淋巴结定位成功的患者中，73.8%为低级别组织学类型，26.2%为高级别组织学类型。在定位失败的患者中，75.6%为低级别组织学类型，24.4%为高级别组织学类型。对于定位失败的队列，23例患者（56.1%）进行了完整的淋巴结清扫术，其中3例（13.0%）有阳性淋巴结。省略淋巴结清扫术的原因记录为：（1）术中病理评估；（2）无法耐受头低脚高位；（3）解剖分离/可视化困难；（4）局部晚期疾病的证据。有18例分期不完全的患者，包括8例（44.4%）低风险疾病患者、2例（11.1%）局部晚期疾病患者和1例（5.6%）浆液性组织学类型患者。其余7例（38.9%）未分期患者根据最终病理接受了和/或接受了辅助放疗。在短期随访期间，未进行定位或分期不完全的队列中没有患者出现疾病复发。
前哨淋巴结检出率正在提高。术中病理确定的低风险疾病是未进行定位患者省略淋巴结清扫术的最常见原因，而且这种做法似乎并未影响辅助治疗或疾病复发。
