FIGO stage IIIC endometrial cancer identification among patients with complex atypical hyperplasia, grade 1 and 2 endometrioid endometrial cancer: laparoscopic indocyanine green sentinel lymph node mapping versus frozen section of the uterus, why get around the problem?
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To compare two surgical strategies used to identify lymph node metastases in patients with preoperative diagnosis of complex atypical hyperplasia (CAH), grade 1 and 2 endometrial cancer (EC).
Data on patients with preoperative diagnosis of CAH, grade 1 and 2 EC undergoing laparoscopic indocyanine green (ICG) sentinel lymph node (SLN) mapping followed by frozen section of the uterus were collected. When risk factors were identified at frozen section, patients were subjected to a systematic lymphadenectomy. False negative (FN) rates, negative predictive values (NPV), positive predictive values (PPV) and correlation with stage IIIC EC were calculated for the systematic lymphadenectomy based on frozen section of the uterus and for the SLN mapping.
Six (9.5%) out of 63 patients had lymph nodal metastases. Based on frozen section of the uterus, 22 (34.9%) and 15 (22.2%) patients underwent a pelvic and a pelvic and paraaortic lymphadenectomy, respectively. Five patients with stage IIIC disease were identified with a FN rate of 16.7% and a NPV and PPV of 97.6 and 27.3%, respectively. Overall and bilateral detection rates of ICG SLN mapping were 100 and 97.6%, respectively; no FN were recorded. The identification of patients with stage IIIC disease with ICG SLN mapping showed a NPV and PPV of 100%. Correlation between indication to lymphadenectomy and stage IIIC disease was poor (κ = 0.244) when based on frozen section of the uterus and excellent (κ = 1) when based on SLN mapping.
ICG SLN mapping reduces the number of unnecessary systematic lymphadenectomies and the risk of underdiagnosing patients with metastatic lymph nodes.
KeywordsEndometrial cancer Sentinel lymph node mapping Indocyanine green Laparoscopy Frozen section Surgical staging
Compliance with ethical standards
Conflict of interest
All of the authors declare no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- Buda A, Di Martino G, Vecchione F, Bussi B, Dell’Anna T, Palazzi S et al (2015) Optimizing strategies for sentinel lymph node mapping in early-stage cervical and endometrial cancer: comparison of real-time fluorescence with indocyanine green and methylene blue. Int J Gynecol Cancer 25:1513–1518CrossRefPubMedGoogle Scholar
- Buda A, Bussi B, Di Martino G, Di Lorenzo P, Palazzi S, Grassi T et al (2016a) Sentinel lymph node mapping with near-infrared fluorescent imaging using indocyanine green: a new tool for laparoscopic platform in patients with endometrial and cervical cancer. J Minim Invasive Gynecol 23:265–269CrossRefPubMedGoogle Scholar
- Buda A, Papadia A, Zapardiel I, Vizza E, Ghezzi F, De Ponti E et al (2016b) From conventional radiotracer Tc-99(m) with blue dye to indocyanine green fluorescence: a comparison of methods towards optimization of sentinel lymph node mapping in early stage cervical cancer for a laparoscopic approach. Ann Surg Oncol 23:2959–2965CrossRefPubMedGoogle Scholar
- Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer. Gynecol Oncol Group Study Cancer 60:2035–2041Google Scholar
- Imboden S, Papadia A, Nauwerk M, McKinnon B, Kollmann Z, Mohr S et al (2015) A comparison of radiocolloid and indocyanine green fluorescence imaging, sentinel lymph node mapping in patients with cervical cancer undergoing laparoscopic surgery. Ann Surg Oncol 22:4198–4203CrossRefPubMedPubMedCentralGoogle Scholar
- NCCN clinical practice guidelines in oncology (2015) Uterine neoplasms. Version 2.2015. http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf
- Sala P, Morotti M, Menada MV, Cannavino E, Maffeo I, Abete L et al (2014) Intraoperative frozen section risk assessment accurately tailors the surgical staging in patients affected by early-stage endometrial cancer: the application of 2 different risk algorithms. Int J Gynecol Cancer 24:1021–1026CrossRefPubMedGoogle Scholar
- Sinno AK, Peijnenburg E, Fader AN, Temkin SM, Stone R, Levinson K et al (2016) Reducing overtreatment: a comparison of lymph node assessment strategies for endometrial cancer. Gynecol Oncol (Epub ahead of print), PMID:27568279Google Scholar