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Comparison of outcomes between the one-step and two-step sentinel lymph node mapping techniques in endometrial cancer

Authors
 Yoo-Na Kim  ;  Kyung Jin Eoh  ;  Jung-Yun Lee  ;  Eun Ji Nam  ;  SungHoon Kim  ;  Young-Tae Kim  ;  Sang Wun Kim 
Citation
 INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol.30(3) : 318-324, 2020-03 
Journal Title
 INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER 
ISSN
 1048-891X 
Issue Date
2020-03
MeSH
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols / therapeutic use ; Chemotherapy, Adjuvant ; Endometrial Neoplasms / drug therapy ; Endometrial Neoplasms / pathology* ; Endometrial Neoplasms / radiotherapy ; Endometrial Neoplasms / surgery ; Female ; Humans ; Image-Guided Biopsy / methods ; Indocyanine Green ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes / pathology ; Lymph Nodes / surgery ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Recurrence, Local / pathology ; Neoplasm Staging ; Optical Imaging / methods ; Perioperative Care / methods ; Radiotherapy, Adjuvant ; Robotic Surgical Procedures ; Sentinel Lymph Node / pathology* ; Sentinel Lymph Node / surgery ; Sentinel Lymph Node Biopsy / methods*
Keywords
endometrial neoplasms ; lymphatic metastasis ; neoplasm recurrence, local ; sentinel lymph node
Abstract
Introduction: Fluorescence image-guided sentinel lymph node (SLN) biopsy using a two-step mapping technique incorporates sequential injection of indocyanine green into the bilateral uterine cornus, followed by cervical injection. Outcomes were compared with the conventional cervical (one-step) method . Methods: Patients with FIGO stage I-III endometrial cancer who underwent laparoscopic or robotic staging, including SLN biopsy, from May 2014 to December 2018, were retrospectively reviewed. Patient characteristics, pre-operative imaging, SLN detection pattern, pathologic result, adjuvant, and recurrence locations were analyzed. Results: A total of 199 patients received one-step (n=123) and two-step (n=76) SLN biopsy. Para-aortic SLN were more frequently identified in the two-step group. Lower and upper para-aortic SLN were identified in 67.1% and 38.2%, respectively, in the two-step group and in 18.7% and 5.7% in the one-step group (p<0.001). The number of para-aortic SLN harvested was superior in the two-step group (p<0.001). Metastatic para-aortic SLN were found in 7.9% of the two-step group and 2.4% of the one-step group (p=0.070). In detecting nodal metastasis, the sensitivities of the one- and two-step methods were 91.7% and 100.0%, negative predictive values were 99.0% and 100.0%, false-negative rates were 8.3% and 0%, and accuracy rates were 99.1% and 100.0%, respectively. The one-step method identified only three out of eight para-aortic lymph node metastases and missed five para-aortic lymph node metastases. There was no missed para-aortic lymph node metastasis in the two-step group. Recurrence was observed in two patients (2.6%; vaginal vault and adrenal gland) in the two-step group and seven patients (5.7%) including three nodal recurrences in the one-step group (p=0.307). Discussion: Two-step SLN mapping improved the para-aortic SLN detection rate, a known pitfall of conventional cervical injection. Proper evaluation of aortic nodal status will assist in the tailoring of adjuvant and prevent undertreatment of patients with isolated para-aortic metastasis.
Full Text
https://ijgc.bmj.com/content/30/3/318.long
DOI
10.1136/ijgc-2019-000962
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sang Wun(김상운) ORCID logo https://orcid.org/0000-0002-8342-8701
Kim, Sung Hoon(김성훈) ORCID logo https://orcid.org/0000-0002-1645-7473
Kim, Young Tae(김영태) ORCID logo https://orcid.org/0000-0002-7347-1052
Kim, Yoo‐Na(김유나)
Nam, Eun Ji(남은지) ORCID logo https://orcid.org/0000-0003-0189-3560
Eoh, Kyung Jin(어경진) ORCID logo https://orcid.org/0000-0002-1684-2267
Lee, Jung-Yun(이정윤) ORCID logo https://orcid.org/0000-0001-7948-1350
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/179088
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