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Gynecol Oncol. 2017 May;145(2):248-255. doi: 10.1016/j.ygyno.2017.03.012. Epub 2017 Mar 28.

Sentinel lymph node mapping reduces practice pattern variations in surgical staging for endometrial adenocarcinoma: A before and after study.

Author information

1
Harvard Medical School, Boston, MA, USA.
2
Harvard Medical School, Boston, MA, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Dana-Farber Cancer Institute, Boston, MA, USA. Electronic address: kelias@bwh.harvard.edu.
3
Harvard Medical School, Boston, MA, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
4
Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA.
5
Harvard Medical School, Boston, MA, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Dana-Farber Cancer Institute, Boston, MA, USA.

Abstract

OBJECTIVE:

To examine the effects of universal sentinel lymph node mapping on the use of nodal staging in endometrial adenocarcinoma.

METHODS:

Two approaches to laparoscopic staging for endometrial adenocarcinoma were compared using a before and after study design. The before cohort underwent selective lymphadenectomy from January 1, 2014-October 1, 2015 while the after cohort underwent universal sentinel lymph node (SLN) mapping from October 2, 2015-September 29, 2016.

RESULTS:

The before cohort comprised 215 patients and the after cohort 166 patients. In women undergoing SLN mapping, a sentinel node was identified at least unilaterally in 146/153 cases (95.4%), and bilaterally in 114/153 (74.5%) of cases. Pelvic nodes were removed in 35.8% of the before cohort versus 92.2% of the after cohort (p<0.0001) with more nodal evaluation among both low risk (9.6% vs. 91%, p<0.0001) and high risk cases (66% vs. 94%, p<0.0001). While the proportion of low risk cases diagnosed with nodal involvement did not significantly change (0.9% to 3.1%, p=0.32), there was a trend toward more diagnoses of nodal involvement in high risk cases (5% to 13.2%, p=0.06). Mean number of pelvic lymph nodes removed (15 vs. 4, p<0.0001), mean operative time (181min vs. 137min, p<0.0001), estimated blood loss (80ml vs. 56ml, p=0.004), and rate of post-operative complications (13% vs. 5.2%, p=0.04) all decreased after the adoption of SLN dissection.

CONCLUSIONS:

Universal sentinel lymph node dissection for laparoscopic endometrial cancer staging reduces heterogeneity in surgeon staging practice, increases nodal detection, and lowers post-operative complications.

KEYWORDS:

Endometrial cancer; Near infrared imaging; Practice pattern variation; Sentinel lymph node dissection

PMID:
28363672
DOI:
10.1016/j.ygyno.2017.03.012
[Indexed for MEDLINE]

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