Original Article

OPEN: Sentinel Lymph Node Sampling in Robot-Assisted Staging of Endometrial Cancer

Authors: Erin Curcio, DO, Briana Miller, PA-C, Alexandra Giglio, DO, Arda Akoluk, MD, Brian Erler, MD, James Bosscher, MD, Mark Borowsky, MD, Verda Hicks, MD, Karim ElSahwi, MD

Abstract

Objective: Sentinel lymph node (SLN) sampling in endometrial cancer staging has become an acceptable standard. Indocyanine green dye injected into the cervix and detected by near-infrared light is technically simple and sensitive. We aimed to evaluate SLN sampling in robot-assisted surgical staging of endometrial cancer at a university-affiliated teaching hospital.

Methods: A retrospective chart review, from January 2016 to December 2017, of patients who underwent robot-assisted surgical staging with cervical injection of indocyanine green dye detected by near-infrared light. The map rate, sensitivity, false negatives, and negative predictive value were calculated.

Results: A total of 105 charts were reviewed; 79 patients met inclusion criteria. The mean age was 65 (range 38–93) and the mean body mass index was 33.3 (range 16–49). Most patients (72.2%) had stage I disease and grade 1 or 2 histology (77.1%). Eight (10.1%) patients had lymph node metastasis. Seventy-two (91.1%) patients had positive mapping to at least 1 SLN. Sixty-two (78.5%) patients had bilateral mapping. Forty-four patients had concurrent pelvic ± para-aortic lymph node dissection and were included in the sensitivity analysis. Five of 44 cases had LN metastasis. The sensitivity was 80%, and the negative predictive value of SLN sampling was 97.5%.

Conclusions: SLN mapping and sampling at a university-affiliated teaching hospital have comparable map rate, sensitivity, and negative predictive value as demonstrated in multiple trials. The technique has the potential to standardize endometrial cancer staging across different practice settings.
Posted in: Gynecologic Cancer6

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Images

Fig. 1. Sentinel lymph node dissection cohort. LND, lymph node dissection; SLN, sentinel lymph node.

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Table 1. Patient characteristics (N = 79)

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Table 2. Lymph node dissection (N = 79)

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Table 3. SLN location

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Fig. 2. Lymph node metastases. LN, lymph node; LND, lymph node dissection; SLN, sentinel lymph node.

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Table 4. Sensitivity and NPV

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Table 5. Studies with cervical injection of dye

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