Iptissem Naoura1, Geoffroy Canlorbe2, Sofiane Bendifallah3, Marcos Ballester2, Emile Daraï4. 1. Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie Paris 6, France. Electronic address: iptissem.naoura@tnn.aphp.fr. 2. Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie Paris 6, France. 3. Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie Paris 6, France; Inserm UMRS-707, Université Pierre et Marie Curie Paris 6, France. 4. Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie Paris 6, France; Inserm UMRS-938, Université Pierre et Marie Curie Paris 6, France.
Abstract
OBJECTIVE: While the accuracy of the Sentinel Lymph Node (SLN) procedure has been validated in patients with early-stage endometrial cancer (EC) at low and intermediate risk of recurrence, its relevance for high-risk EC remains unknown. The aim of this study was to evaluate the contribution of SLN biopsy in staging patients with presumed high-risk EC. METHODS: This retrospective multicenter study, conducted from January 2001 to December 2012, included 180 patients with early-stage EC undergoing SLN biopsy. Detection rate and false negative rate were assessed according to risk groups of recurrence. RESULTS: SLNs were detected in 159/180 patients (88%) and were bilateral in 63% of cases. Of the 180 patients, 41 (22%) had a positive lymph node. Ultrastaging detected metastases undiagnosed by conventional histology in 17/41 patients (41%). The false negative rate was 6% (9/159); 2.3% in the low/intermediate risk group and 20% in the high-risk group (p = 0.0008). Lymphovascular space invasion (LVSI) was present in 48 patients (27%). Preoperative findings classified 146 patients as ESMO low/intermediate risk (81%) and 34 as high risk (19%). Ten of the 34 patients (29%) in the presumed high-risk group were downstaged on final histology and 5/18 patients (28%) initially diagnosed with type 2 were finally classified as having type 1 EC. Classification was more likely discordant for patients with preoperative type 2 EC (p = 0.03) and in the initial high-risk group (p = 0.02). CONCLUSIONS: SLN biopsy associated with LVSI status can select which high-risk patients with EC would benefit from comprehensive staging.
OBJECTIVE: While the accuracy of the Sentinel Lymph Node (SLN) procedure has been validated in patients with early-stage endometrial cancer (EC) at low and intermediate risk of recurrence, its relevance for high-risk EC remains unknown. The aim of this study was to evaluate the contribution of SLN biopsy in staging patients with presumed high-risk EC. METHODS: This retrospective multicenter study, conducted from January 2001 to December 2012, included 180 patients with early-stage EC undergoing SLN biopsy. Detection rate and false negative rate were assessed according to risk groups of recurrence. RESULTS: SLNs were detected in 159/180 patients (88%) and were bilateral in 63% of cases. Of the 180 patients, 41 (22%) had a positive lymph node. Ultrastaging detected metastases undiagnosed by conventional histology in 17/41 patients (41%). The false negative rate was 6% (9/159); 2.3% in the low/intermediate risk group and 20% in the high-risk group (p = 0.0008). Lymphovascular space invasion (LVSI) was present in 48 patients (27%). Preoperative findings classified 146 patients as ESMO low/intermediate risk (81%) and 34 as high risk (19%). Ten of the 34 patients (29%) in the presumed high-risk group were downstaged on final histology and 5/18 patients (28%) initially diagnosed with type 2 were finally classified as having type 1 EC. Classification was more likely discordant for patients with preoperative type 2 EC (p = 0.03) and in the initial high-risk group (p = 0.02). CONCLUSIONS: SLN biopsy associated with LVSI status can select which high-risk patients with EC would benefit from comprehensive staging.
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