Cervical and hysteroscopic injection for identification of sentinel lymph node in endometrial cancer

• Published in: Gynecologic oncology 2008-10, Vol.111 (1), p.62-67
• Main Authors: Perrone, Anna Myriam, Casadio, Paolo, Formelli, Guido, Levorato, Maurizio, Ghi, Tullio, Costa, Silvano, Meriggiola, Maria Cristina, Pelusi, Giuseppe
• Format: Article
• Language: English
• Subjects: Aged; Cervix Uteri; Endometrial cancer; Endometrial Neoplasms - diagnostic imaging; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Female; Hematology, Oncology and Palliative Medicine; Humans; Hysteroscopy - methods; Laparoscopy; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymph Nodes - surgery; Middle Aged; Neoplasm Staging; Obstetrics and Gynecology; Radionuclide Imaging; Radiopharmaceuticals - administration & dosage; Sentinel lymph node; Sentinel Lymph Node Biopsy - methods; Technetium Tc 99m Aggregated Albumin - administration & dosage
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2008.05.032

Abstract Objectives The aims of our study were to evaluate the possibility of identifying the sentinel lymph node (SLN) in patients with endometrial cancer (EC) and to directly compare two injection techniques, cervical and hysteroscopic injection. Methods Fifty-four patients with endometrial carcinoma, clinical stages I and II, were submitted to complete surgical staging through laparoscopy, as recommended by FIGO in 1988. For the mapping procedure the patients were divided into two groups of injection: the cervical injection group and hysteroscopic injection group. Technetium (Tc) 99m radiocolloid was used as tracer. Results Intraoperative detection rate of SLN was 70% in cervical group and 65% in the hysteroscopic group ( p = n.s.). In the cervical group, all patients had SLN in the pelvis only and the mean SLN removed was 18 (range 2–26). In the hysteroscopic group, all patients had SNLs in the pelvis and two patients had SLN both in the pelvis and above the bifurcation of the aorta. Mean pelvic SLN removed was 20 (range 8–42). Conclusions Our data shows that it is possible to identify the SLN in tumours of the endometrium. Both cervical and hysteroscopic techniques are feasible but the hysteroscopic procedure might represent the only method able to highlight the complete lymphatic drainage of the uterus as suggested by the presence of paraaortic positive SLN only in this group.