Diagnostic accuracy of sentinel node in endometrial cancer by using hysteroscopic injection of radiolabeled tracer

Eugenio Solima, Fabio Martinelli, Antonino Ditto, Marco MacCauro, Marialuisa Carcangiu, Luigi Mariani, Shigeki Kusamura, Rosanna Fontanelli, Barbara Grijuela, Francesco Raspagliesi

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Objective: Retrospective and perspective series have shown the feasibility of sentinel lymph-node (SLN) identification of pelvic nodes in endometrial cancer using a cervical injection of tracers. We designed a perspective study to assess the detection rate and diagnostic accuracy of the SLN procedure by means of hysteroscopic injection of a radiolabeled tracer in endometrial cancer patients. Methods: Patients with endometrial cancer underwent hysteroscopic technetium injection. SLN assessment was performed intraoperatively. A systematic pelvic and paraaortic dissection was carried out thereafter. SLNs were examined by standard and immunochemistry methods. The primary endpoint was estimation of sensitivity and negative predictive value (NPV) of sentinel-node biopsy. Results: From 2005 to 2010, 80 consecutive patients entered the study. No severe complications occurred during or after the injection or during surgical SLN biopsy. At least one SLN was detected in 76 of the 80 eligible patients. Fifty nine patients were evaluable according to the study protocol. Ten of these patients (17%) had node metastases. Thirty-three patients (56%) had SLN in the para-aortic area. NPV was 98% (95% CI 89.4-100) and sensitivity 90% (55.5-99.8). Conclusions: SLN detection for endometrial cancer patients has a high sensitivity and NPV when injection is carried out by hysteroscopy. The occurrence of a 56% of sentinel node in paraaortic area may suggest a better sensitivity in this area using hysteroscopic injection compared to cervical injection.

Original languageEnglish
Pages (from-to)419-423
Number of pages5
JournalGynecologic Oncology
Volume126
Issue number3
DOIs
Publication statusPublished - Sep 2012

Fingerprint

Endometrial Neoplasms
Injections
Immunochemistry
Sentinel Lymph Node Biopsy
Hysteroscopy
cyhalothrin
Technetium
Sentinel Lymph Node
Dissection
Neoplasm Metastasis
Biopsy

Keywords

  • Endometrial cancer
  • Hysteroscopy
  • Paraaortic nodes involvement
  • Perspective study
  • Sensitivity
  • Sentinel node

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Oncology

Cite this

Diagnostic accuracy of sentinel node in endometrial cancer by using hysteroscopic injection of radiolabeled tracer. / Solima, Eugenio; Martinelli, Fabio; Ditto, Antonino; MacCauro, Marco; Carcangiu, Marialuisa; Mariani, Luigi; Kusamura, Shigeki; Fontanelli, Rosanna; Grijuela, Barbara; Raspagliesi, Francesco.

In: Gynecologic Oncology, Vol. 126, No. 3, 09.2012, p. 419-423.

Research output: Contribution to journalArticle

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AU - Carcangiu, Marialuisa

AU - Mariani, Luigi

AU - Kusamura, Shigeki

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N2 - Objective: Retrospective and perspective series have shown the feasibility of sentinel lymph-node (SLN) identification of pelvic nodes in endometrial cancer using a cervical injection of tracers. We designed a perspective study to assess the detection rate and diagnostic accuracy of the SLN procedure by means of hysteroscopic injection of a radiolabeled tracer in endometrial cancer patients. Methods: Patients with endometrial cancer underwent hysteroscopic technetium injection. SLN assessment was performed intraoperatively. A systematic pelvic and paraaortic dissection was carried out thereafter. SLNs were examined by standard and immunochemistry methods. The primary endpoint was estimation of sensitivity and negative predictive value (NPV) of sentinel-node biopsy. Results: From 2005 to 2010, 80 consecutive patients entered the study. No severe complications occurred during or after the injection or during surgical SLN biopsy. At least one SLN was detected in 76 of the 80 eligible patients. Fifty nine patients were evaluable according to the study protocol. Ten of these patients (17%) had node metastases. Thirty-three patients (56%) had SLN in the para-aortic area. NPV was 98% (95% CI 89.4-100) and sensitivity 90% (55.5-99.8). Conclusions: SLN detection for endometrial cancer patients has a high sensitivity and NPV when injection is carried out by hysteroscopy. The occurrence of a 56% of sentinel node in paraaortic area may suggest a better sensitivity in this area using hysteroscopic injection compared to cervical injection.

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