Accuracy of Sentinel Node in Detecting Lymph Node Metastasis in Primary Endometrial Carcinoma


Background: Endometrial carcinoma is the most common gynecological cancer and its treatment is stillcontroversial, especially in its early stages. There are conflicting data about the efficacy of retroperitoneallymphadenectomy during abdominal hysterectomy and bilateral salpingoophrectomy treatment.Lymphadenectomy carries a risk of severe complications, especially in women with co-morbidities. Selectivelymphadenectomy has been widely employed for staging evaluation of endometrial carcinoma because it is simpleand seems to provide reliable data regarding nodal metastasis. This study was designed to evaluate accuracy ofsentinel node sampling in detecting lymph node metastasis in primary endometrial carcinoma during staginglaparotomy. Materials and
Methods: Ninety-three women with endometrial carcinoma at high-risk for nodalmetastasis were studied. During laparotomy, methylene blue dye was injected into sub-serosal myometrium, thenretroperitoneal spaces were opened and blue lymph nodes within pelvic and para-aortic regions were removed asseparate specimens for histopathological examination (sentinel lymph nodes = SLNs). Hysterectomy and selectivelymphadenectomy then performed for all women included in this study.
Results: Deposition of methylene dyeinto at least one lymph node was observed in 73.1% (68/93) of studied cases. 18.3% (17/93) of studied womenhad positive lymph node metastasis and 94.1% (16/17) of them had positive metastasis in SLNs. In this study,SNLs had 94.4% sensitivity and 100% specificity in prediction of lymph node metastasis. Mean number of lymphnodes removed from each case decreased when SLNs biopsy were taken.
Conclusions: SLNs are the key lymphnodes in endometrial tumor metastasis and their involvement could be an indicator for whether or not completesystematic lymphadenectomy is needed during staging laparotomy.