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Comparison of sentinel lymph node distribution and lymphatic drainage pathway between high- and low-risk endometrial cancers

  • Gynecologic Oncology
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to compare the distribution and drainage pathway of sentinel lymph nodes between high- and low-risk endometrial cancers.

Methods

In total, 429 patients with endometrial cancer who underwent sentinel lymph node biopsy in Peking University People’s Hospital from July 2015 to April 2022 were retrospectively enrolled. There were 148 patients in the high-risk group and 281 patients in the low-risk group.

Results

The unilateral and bilateral detection rates of sentinel lymph nodes were 86.5% and 55.9%, respectively. The highest detection rate was achieved in the subgroup with a combined use of indocyanine green (ICG) and carbon nanoparticles (CNP) (94.4% for unilateral detection and 66.7% for bilateral detection). The upper paracervical pathway (UPP) was detected in 93.3% of cases in the high-risk group and 96.0% of cases in the low-risk group (p = 0.261). The lower paracervical pathway (LPP) was detected in 10.0% of cases in the high-risk group and 17.9% of cases in the low-risk group (p = 0.048). Remarkably increased detection rates of SLN in the common iliac (7.5%) and para-aortic or precaval areas (2.9%) were observed in the high-risk group. In contrast, a markedly decreased detection rate of SLN in the internal iliac area (1.9%) was observed in the high-risk group.

Conclusion

The highest detection rate of SLN was observed in the subgroup with a combined use of ICG and CNP. The detection of UPP is important for both high-risk and low-risk cases, while LPP detection plays a more important role in the low-risk group. Lymphadenectomy in the common iliac and para-aortic or precaval areas is essential for patients with high-risk EC. Removal of internal iliac lymph nodes is essential for patients with low-risk EC, in case of ineffective SLN mapping.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, upon reasonable request.

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Acknowledgements

Figure 1 was drawn by Miao He, Department of Obstetrics & Gynecology, Peking University People’s Hospital.

Funding

This study was funded by the National Key Technology Research and Developmental Program of China (Program Nos. 2022YFC2704402 and 2022YFC2704405) and the Peking University People’s Hospital Research and Development Funds RDL2020-07.

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Author notes

  1. Jiayu Chen and Sichen Liang are co-first authors for this article.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China

    Jiayu Chen, Sichen Liang, Miao He, Zhiqi Wang, Hao Deng, Guo Zhang, Xin Yang, Xudong Liang, Xiuli Sun, Rong Zhou, Xiaowei Li, Yi Li & Jianliu Wang

  2. Department of Obstetrics and Gynecology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China

    Jiayu Chen

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  1. Jiayu Chen
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Contributions

JC, SL, and JW: contributed to conception and design of the study. ZW, HD, GZ, XY, XL, XS, RZ, XL, YL: contributed to the performance of surgery. JC and MH: organized the database. SL: performed the statistical analysis. JC: wrote the first draft of the manuscript. SL: wrote sections of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.

Corresponding author

Correspondence to Jianliu Wang.

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The authors declare that there is no conflict of interests.

Ethical approval

Our study obtained ethics approval from the Ethics Committee of Peking University People's Hospital.

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Informed consent was obtained from all individual participants included in the study.

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Chen, J., Liang, S., He, M. et al. Comparison of sentinel lymph node distribution and lymphatic drainage pathway between high- and low-risk endometrial cancers. Arch Gynecol Obstet 308, 1641–1647 (2023). https://doi.org/10.1007/s00404-023-07111-8

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