Unexpected locations of sentinel lymph nodes in endometrial cancer

•SLN are detected in the presacral, hypogastric vein, and parametrial areas.•These areas are not harvested in a routine lymphadenectomy.•SLN is the most likely, and frequently only, lymph node to contain metastasis. To evaluate the anatomical location of sentinel lymph nodes (SLN) following intra-op...

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Bibliographic Details
Published in:Gynecologic oncology 2017-10, Vol.147 (1), p.18-23
Main Authors: How, Jeffrey, Boldeanu, Irina, Lau, Susie, Salvador, Shannon, How, Emily, Gotlieb, Raphael, Abitbol, Jeremie, Halder, Ajay, Amajoud, Zainab, Probst, Stephan, Brin, Sonya, Gotlieb, Walter
Format: Article
Language:English
Subjects:
Adult
Aged
Endometrial Neoplasms - diagnosis
Endometrial Neoplasms - pathology
Female
Humans
Lymph Node Excision - statistics & numerical data
Middle Aged
Prospective Studies
Sentinel Lymph Node - pathology
Sentinel Lymph Node Biopsy - methods
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Summary:•SLN are detected in the presacral, hypogastric vein, and parametrial areas.•These areas are not harvested in a routine lymphadenectomy.•SLN is the most likely, and frequently only, lymph node to contain metastasis. To evaluate the anatomical location of sentinel lymph nodes (SLN) following intra-operative cervical injection in endometrial cancer. All consecutive patients with endometrial cancer undergoing sentinel lymph node mapping were included in this prospective study following intra-operative cervical injection of tracers. Areas of SLN detection distribution were mapped. Among 436 patients undergoing SLN mapping, there were 1095 SLNs removed, and 7.9% of these SLNs found in 13.1% of patients, were detected in areas not routinely harvested during a standard lymph node dissection. These included the internal iliac vein, parametrial, and pre-sacral areas. The SLN was the only positive node in 46.1% (15/36) of cases with successful mapping and completion lymphadenectomy, including 3 cases where the sentinel node in the atypical location was the only node with metastatic disease. SLN mapping using intra-operative cervical injection is capable to map out areas not typically included in a standard lymphadenectomy. The sentinel node is the most relevant lymph node to analyze and may enable to discover metastatic disease in unusual areas.
ISSN:0090-8258
1095-6859
DOI:10.1016/j.ygyno.2017.07.125