Manuel Maria Ianieri1,2, Andrea Puppo3, Antonia Novelli3,4, Federica Campolo5, Tommaso Staniscia6, Giuseppe Di Martino6, Elisa Piovano3, Francesco Bruni7, Giovanni Roviglione7, Daniele Mautone7, Marcello Ceccaroni7. 1. Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore" Hospital, Verona, Italy, manuel_dorian@yahoo.it. 2. Department of Medical and Oral Sciences and Biotechnologies, "G.D'Annunzio" University, Chieti, Italy, manuel_dorian@yahoo.it. 3. Department of Obstetrics and Gynecology, "Regina Montis Regalis Hospital, Mondovì, Italy. 4. Department of Women and Child Health, Catholic University of the Sacred Heart, Rome, Italy. 5. Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy. 6. School of Hygiene and Preventive Medicine, Department of Medicine and Ageing, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy. 7. Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore" Hospital, Verona, Italy.
Abstract
BACKGROUND: The sentinel lymph node (SLN) mapping for endometrial cancer staging is gaining wide diffusion, but there is no definitive evidence on the factors associated with the failure of mapping. OBJECTIVES: To analyze the factors associated with the possible failure of bilateral SLN mapping with indocyanine green (ICG). METHODS: A prospective observational study without control on 110 patients with endometrial cancer apparently confined to the uterus, underwent laparoscopic surgical staging with SLN mapping with ICG. RESULTS: Possible risk factors associated with bilateral mapping failure were analyzed, and a multivariate analysis was performed. The bilateral detection rate for SLNs mapping was 72.7%, whereas at least one SLN was detected in 79.1% of patients. No SLNs were identified in 6.3%. None of the patients or features related to tumor were associated with a risk of failure of the method. The only factor analyzed that was significantly associated with the success of bilateral mapping was the surgeon (p = 0.003). CONCLUSIONS: Neither obesity nor the presence of lymph node metastases was associated with mapping failure. However, there remains a need for further studies to understand all the mechanisms linked to the unsuccessful method results and to reduce the use of systematic lymphadenectomy in the case of mapping failure.
BACKGROUND: The sentinel lymph node (SLN) mapping for endometrial cancer staging is gaining wide diffusion, but there is no definitive evidence on the factors associated with the failure of mapping. OBJECTIVES: To analyze the factors associated with the possible failure of bilateral SLN mapping with indocyanine green (ICG). METHODS: A prospective observational study without control on 110 patients with endometrial cancer apparently confined to the uterus, underwent laparoscopic surgical staging with SLN mapping with ICG. RESULTS: Possible risk factors associated with bilateral mapping failure were analyzed, and a multivariate analysis was performed. The bilateral detection rate for SLNs mapping was 72.7%, whereas at least one SLN was detected in 79.1% of patients. No SLNs were identified in 6.3%. None of the patients or features related to tumor were associated with a risk of failure of the method. The only factor analyzed that was significantly associated with the success of bilateral mapping was the surgeon (p = 0.003). CONCLUSIONS: Neither obesity nor the presence of lymph node metastases was associated with mapping failure. However, there remains a need for further studies to understand all the mechanisms linked to the unsuccessful method results and to reduce the use of systematic lymphadenectomy in the case of mapping failure.