Clinical and Surgical Evaluation of Sentinel Node Biopsy in Patients with Early-Stage Endometrial Cancer and Atypical Hyperplasia

Abstract

Introduction

The medical and surgical treatment of endometrial cancer (EC) is evolving toward a more patient-centered and personalized approach. The role of laparoscopic sentinel node biopsy (SNB) for early-stage EC is unclear, and very few data are available for atypical endometrial hyperplasia (AEH). The present study investigated the effectiveness of SNB combined with laparoscopic hysterectomy in patients with early-stage EC and AEH.

Patients and Methods

This was a retrospective, single-center cohort study for the period from January 2018 to December 2023. A total of 102 patients with atypical hyperplasia (n = 20) and early-stage EC (n = 82) findings on diagnostic curettage underwent pelvic sentinel node biopsy during the final operation.

Results

Eleven patients (55%) who had initially been diagnosed with AEH were found to have EC in the final pathology report. No lymph node metastases were detected in patients who had initially been diagnosed with AEH; a 3.6% rate of positive SNBs was found in patients with EC. Changes in tumor grade occurred in 31.3% of the patients and changes in FIGO stage in 33%. Bilateral sentinel node (SN) mapping was successful in 94.1% of the patients. The postoperative outcomes were comparable to those of routine clinical practice without SNB.

Conclusions

SNB can be safely offered to patients who have precursor lesions and early-stage EC without notably extending surgical times or increasing postoperative morbidity. This approach can be considered and is safe for patients diagnosed with AEH, but it appears to have a rather small impact on these patients.

Zusammenfassung

Einleitung

Die medizinisch-chirurgische Behandlung des Endometriumkarzinoms (EK) verändert sich hin zu einer mehr patientenorientierten und personalisierten Vorgehensweise. Die Rolle der laparoskopisch durchgeführten Sentinel-Lymphknoten-Biopsie (SNB) bei EK im Frühstadium ist noch unklar, und es gibt nur wenige Daten zur atypischen Endometriumhyperplasie (AEH). Die vorliegende Studie untersuchte die Effektivität von SNB in Kombination mit einer laparoskopischen Hysterektomie bei Patientinnen mit EK im Frühstadium und AEH.

Patientinnen und Methoden

Es handelt sich um eine retrospektive monozentrische Kohortenstudie, die zwischen Januar 2018 bis Dezember 2023 durchgeführt wurde. Insgesamt erhielten 102 Patientinnen mit dem Befund der atypischen Hyperplasie (n = 20) und EK im Frühstadium (n = 82) nach diagnostischer Abrasio während der endgültigen Operation eine Sentinel-Lymphknoten-Biopsie.

Ergebnisse

Bei 11 Patientinnen (55%), die ursprünglich mit AEH diagnostiziert wurden, wurde gemäß dem abschließenden Pathologiebericht ein EK identifiziert. Es wurden keine Lymphknotenmetastasen bei Patientinnen gefunden, deren ursprüngliche Diagnose AEH lautete; die Rate der positiven SNB bei Patientinnen mit EK betrug 3,6%. Bei 31,3% der Patientinnen kam es zu einer Veränderung des Tumorgrads und bei 33% zu einer Änderung des FIGO-Stadiums. Das bilaterale Sentinel-Lymphknoten-Mapping war bei 94,1% der Patientinnen erfolgreich. Die postoperativen Ergebnisse aller Patientinnen waren mit denen eines routinemäßigen chirurgischen Eingriffs ohne Durchführung einer SNB vergleichbar.

Schlussfolgerungen

Die SNB kann problemlos bei Patientinnen mit Vorläuferläsionen und EK im Frühstadium durchgeführt werden, ohne dass sich die Operationszeit wesentlich verlängert oder sich die postoperative Morbidität erhöht. Während diese Vorgehensweise für Patientinnen mit einer Diagnose von AEH als sicher betrachtet werden kann und ist, scheint sie nur geringe Auswirkungen auf diese Patientinnen zu haben.

Keywords

atypical endometrial hyperplasia - endometrial cancer - sentinel node biopsy - indocyanine green - surgery

Schlüsselwörter

atypische Endometriumhyperplasie - Endometriumkarzinom - Sentinel-Lymphknoten-Biopsie - Indocyaningrün - chirurgischer Eingriff

Publication History

Received: 29 January 2024

Accepted after revision: 20 March 2024

Article published online:
29 May 2024

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