Skip to main content
SpringerLink
Log in

Sentinel Lymph Node in Endometrial Cancer: A Review

  • Gynecologic Cancers (NS Reed, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Lymph node status is a major prognostic factor in endometrial cancer (EC). Sentinel lymph node (SLN) biopsy has been reported in EC for more than 15 years but has not yet been incorporated as a standard-of-care procedure in EC. Complex uterine drainage, the various modalities of tracer injection, and the lack of large prospective series may explain this situation. In this review, we report an SLN detection rate of 81.7 %, a 10.9 % rate of metastatic SLN involvement, and a false-negative rate of 12.3 % in the main clinical trials. Thirty-five percent of SLN metastases were low-volume disease (micrometastases or isolated tumor cells). These data raise the question of the clinical significance of low-volume disease in EC. SLN biopsy could allow upstaging in supposedly low- or intermediate-risk patients in whom adjuvant therapy could be omitted. Further studies are required to precise the interest on the survival of this procedure in this subset of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Siegel R, DeSantis C, Virgo K, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62:220–41.

    Article  PubMed  Google Scholar 

  2. ASTEC/EN.5 Study, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125–36.

    Google Scholar 

  3. Boyle P, Leon ME, Maisonneuve P, Autier P. Cancer control in women. Update 2003. Int J Gynaecol Obstet. 2003;83 Suppl 1:179–202.

    Article  PubMed  Google Scholar 

  4. Cragun JM, Havrilesky LJ, Calingaert B, et al. Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J Clin Oncol. 2005;23:3668–75.

    Article  PubMed  Google Scholar 

  5. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group study. Cancer. 1987;60:2035–41.

    Article  PubMed  CAS  Google Scholar 

  6. Morrow CP, Bundy BN, Kurman RJ, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol. 1991;40:55–65.

    Article  PubMed  CAS  Google Scholar 

  7. Benedetti Panici P, Basile S, Maneschi F, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100:1707–16.

    Article  PubMed  Google Scholar 

  8. Frumovitz M, Singh DK, Meyer L, et al. Predictors of final histology in patients with endometrial cancer. Gynecol Oncol. 2004;95:463–8.

    Article  PubMed  Google Scholar 

  9. Eltabbakh GH, Shamonki J, Mount SL. Surgical stage, final grade, and survival of women with endometrial carcinoma whose preoperative endometrial biopsy shows well-differentiated tumors. Gynecol Oncol. 2005;99:309–12.

    Article  PubMed  Google Scholar 

  10. Ballester M, Dubernard G, Lecuru F, et al. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol. 2011;12:469–76.

    Article  PubMed  Google Scholar 

  11. Ballester M, Dubernard G, Rouzier R, Barranger E, Darai E. Use of the sentinel node procedure to stage endometrial cancer. Ann Surg Oncol. 2008;15:1523–9.

    Article  PubMed  Google Scholar 

  12. Manfredi R, Mirk P, Maresca G, et al. Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology. 2004;231:372–8.

    Article  PubMed  Google Scholar 

  13. Ballester M, Koskas M, Coutant C, et al. Does the use of the 2009 FIGO classification of endometrial cancer impact on indications of the sentinel node biopsy? BMC Cancer. 2010;10:465.

    Article  PubMed  Google Scholar 

  14. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105:103–4.

    Article  PubMed  Google Scholar 

  15. Kitchener HC. Sentinel-node biopsy in endometrial cancer: a win-win scenario? Lancet Oncol. 2011;12:413–4.

    Article  PubMed  Google Scholar 

  16. Burke TW, Levenback C, Tornos C, Morris M, Wharton JT, Gershenson DM. Intraabdominal lymphatic mapping to direct selective pelvic and paraaortic lymphadenectomy in women with high-risk endometrial cancer: results of a pilot study. Gynecol Oncol. 1996;62:169–73.

    Article  PubMed  CAS  Google Scholar 

  17. Bonneau C, Bricou A, Barranger E. Place actuelle de la procédure ganglion sentinelle dans le cancer de l’endomètre. Bull Cancer. 2011;98:133–45.

    PubMed  Google Scholar 

  18. Mais V, Cirronis MG, Piras B, Silvetti E, Cossu E, Melis GB. Intraoperative lymphatic mapping techniques for endometrial cancer. Expert Rev Anticancer Ther. 2011;11:83–93.

    Article  PubMed  Google Scholar 

  19. Robova H, Rob L, Halaska MJ, Pluta M, Skapa P. Current status of sentinel lymph node mapping in the management of endometrial cancer. Expert Rev Anticancer Ther. 2013;13:55–61.

    Article  PubMed  CAS  Google Scholar 

  20. Echt ML, Finan MA, Hoffman MS, Kline RC, Roberts WS, Fiorica JV. Detection of sentinel lymph nodes with lymphazurin in cervical, uterine, and vulvar malignancies. South Med J. 1999;92:204–8.

    Article  PubMed  CAS  Google Scholar 

  21. Frumovitz M, Bodurka DC, Broaddus RR, et al. Lymphatic mapping and sentinel node biopsy in women with high-risk endometrial cancer. Gynecol Oncol. 2007;104:100–3.

    Article  PubMed  Google Scholar 

  22. Lopes LA, Nicolau SM, Baracat FF, et al. Sentinel lymph node in endometrial cancer. Int J Gynecol Cancer. 2007;17:1113–7.

    Article  PubMed  CAS  Google Scholar 

  23. Torné A, Pahisa J, Vidal-Sicart S, et al. Transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR): a new method for sentinel lymph node detection in endometrial cancer. Gynecol Oncol. 2013;128:88–94.

    Article  PubMed  Google Scholar 

  24. Altgassen C, Pagenstecher J, Hornung D, Diedrich K, Hornemann A. A new approach to label sentinel nodes in endometrial cancer. Gynecol Oncol. 2007;105:457–61.

    Article  PubMed  CAS  Google Scholar 

  25. Robova H, Charvat M, Strnad P, et al. Lymphatic mapping in endometrial cancer: comparison of hysteroscopic and subserosal injection and the distribution of sentinel lymph nodes. Int J Gynecol Cancer. 2009;19:391–4.

    Article  PubMed  Google Scholar 

  26. Li B, Li XG, Wu LY, et al. A pilot study of sentinel lymph nodes identification in patients with endometrial cancer. Bull Cancer. 2007;94:E1–4.

    PubMed  Google Scholar 

  27. Mariani A, Dowdy SC, Cliby WA, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008;109:11–8.

    Article  PubMed  Google Scholar 

  28. How J, Lau S, Press J, et al. Accuracy of sentinel lymph node detection following intra-operative cervical injection for endometrial cancer: a prospective study. Gynecol Oncol. 2012;127:332–7.

    Article  PubMed  Google Scholar 

  29. Barlin JN, Khoury-Collado F, Kim CH, et al. The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. Gynecol Oncol. 2012;125:531–5.

    Article  PubMed  Google Scholar 

  30. Altgassen C, Hertel H, Brandstadt A, et al. Multicenter validation study of the sentinel lymph node concept in cervical cancer: AGO Study Group. J Clin Oncol. 2008;26:2943–51.

    Article  PubMed  Google Scholar 

  31. Lecuru F, Mathevet P, Querleu D, et al. Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol. 2011;29:1686–91.

    Article  PubMed  Google Scholar 

  32. Perrone AM, Casadio P, Formelli G, et al. Cervical and hysteroscopic injection for identification of sentinel lymph node in endometrial cancer. Gynecol Oncol. 2008;111:62–7.

    Article  PubMed  Google Scholar 

  33. Solima E, Martinelli F, Ditto A, et al. Diagnostic accuracy of sentinel node in endometrial cancer by using hysteroscopic injection of radiolabeled tracer. Gynecol Oncol. 2012;126:419–23.

    Article  PubMed  Google Scholar 

  34. Niikura H, Okamoto S, Yoshinaga K, et al. Detection of micrometastases in the sentinel lymph nodes of patients with endometrial cancer. Gynecol Oncol. 2007;105:683–6.

    Article  PubMed  Google Scholar 

  35. Kang S, Yoo HJ, Hwang JH, Lim MC, Seo SS, Park SY. Sentinel lymph node biopsy in endometrial cancer: meta-analysis of 26 studies. Gynecol Oncol. 2011;123:522–7.

    Article  PubMed  Google Scholar 

  36. Mariani A, Webb MJ, Keeney GL, Aletti G, Podratz KC. Endometrial cancer: predictors of peritoneal failure. Gynecol Oncol. 2003;89:236–42.

    Article  PubMed  Google Scholar 

  37. Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet. 2010;375:1165–72.

    Article  PubMed  Google Scholar 

  38. Jafferbhoy S, McWilliams B. Clinical significance and management of sentinel node micrometastasis in invasive breast cancer. Clin Breast Cancer. 2012;12:308–12.

    Article  PubMed  Google Scholar 

  39. de Boer M, van Deurzen CH, van Dijck JA, et al. Micrometastases or isolated tumor cells and the outcome of breast cancer. N Engl J Med. 2009;361:653–63.

    Article  PubMed  Google Scholar 

  40. Pepels MJ, de Boer M, Bult P, et al. Regional recurrence in breast cancer patients with sentinel node micrometastases and isolated tumor cells. Ann Surg. 2012;255:116–21.

    Article  PubMed  Google Scholar 

  41. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305:569–75.

    Article  PubMed  CAS  Google Scholar 

  42. Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252:426–32. discussion 432.

    PubMed  Google Scholar 

  43. Erkanli S, Bolat F, Seydaoglu G. Detection and importance of micrometastases in histologically negative lymph nodes in endometrial carcinoma. Eur J Gynaecol Oncol. 2011;32:619–25.

    PubMed  CAS  Google Scholar 

  44. McCoy A, Finan MA, Boudreaux FT, et al. The incidence and clinical significance of lymph node micrometastases determined by immunohistochemical staining in stage I - lymph node negative endometrial cancer. Histol Histopathol. 2012;27:181–5.

    PubMed  Google Scholar 

  45. Bats AS, Clément D, Larousserie F, Le Frère-Belda MA, Pierquet-Ghazzar N, Hignette C, Lécuru F. Does sentinel node biopsy improve the management ofendometrial cancer? Data from 43 patients. J Surg Oncol 2008;97:141–5.

  46. Delpech Y, Cortez A, Coutant C, Callard P, Uzan S, Darai E, Barranger E. The sentinel node concept in endometrial cancer: histopathologic validation by serial section and immunohistochemistry. Ann Oncol. 2007;1799–803.

  47. Holub Z, Jabor A, Lukac J, Kliment L. Laparoscopic detection of sentinel lymph nodes using blue dye in women with cervical and endometrial cancer. Med Sci Monit 2004;CR587–91.

  48. Pelosi E, Arena V, Baudino B, Bellò M, Giusti M, Gargiulo T, Palladin D, Bisi G. Pre-operative lymphatic mappig and intra-operative sentinel lymp node detection in early stage endometrial cancer. Nucl Med Commun. 2003;24:971–5.

    Google Scholar 

  49. Delaloye JF, Pampallona S, Chardonnens E, Fiche M, Lehr HA, DeGrandi P, Delaloye AB. Intraoperative lymphatic mapping and sentinel node biopsy using hysteroscopy in patients with endometrial cancer. Gynecol Oncol 2007;106:89–93.

    Google Scholar 

  50. Maccauro M, Lucignani G, Aliberti G, Villano C, Castellani MR, Solima E, Bombardieri E. Sentinel lymp node detection following the hysteroscopic peritumoural injection of 99mTc-labelled albumin nanocolloid in endometrial cancer. Eur J Nucl Med Mol Imaging. 2005;32:569–74.

    Google Scholar 

  51. Fersis N, Gruber I, Relakis K, Friedrich M, Becker S, Wallwiener D, Wagner U. Sentinel node identifiacation and intraoperative lymphatic mapping. First results of a pilot study in patients with endometrial cancer. Eur J Gynaelcol Oncol. 2004;25:339–42.

    Google Scholar 

  52. Niikura H, Okamura C, Utsunomiya H, Yoshinaga K, Akahira J, Ito K, Yaegashi N. Sentinel lymph node detection in patients with endometrial cancer. Gynecol Oncol. 2004;92:669–74.

    Google Scholar 

Download references

Acknowledgment

Lorna Saint Ange is thanked for editing the manuscript.

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Cyril Touboul, Enrica Bentivegna, Catherine Uzan, Sebastien Gouy, Patricia Pautier, Catherine Lhommé, Pierre Duvillard, Christine Haie-Meder, and Philippe Morice declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France

    Cyril Touboul, Enrica Bentivegna, Catherine Uzan, Sebastien Gouy & Philippe Morice

  2. Department of Oncology, Gustave Roussy Cancer Campus, Villejuif, France

    Patricia Pautier & Catherine Lhommé

  3. Department of Pathology, Gustave Roussy Cancer Campus, Villejuif, France

    Pierre Duvillard

  4. Department of Radiotherapy, Gustave Roussy Cancer Campus, Villejuif, France

    Christine Haie-Meder

  5. University Paris Sud, University de Kremlin Bicetre, Gustave Roussy Cancer Campus, Villejuif, France

    Philippe Morice

  6. Unit INSERM 10-30, Villejuif, France

    Catherine Uzan & Philippe Morice

  7. Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805, Villejuif, France

    Philippe Morice

Authors
  1. Cyril Touboul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Enrica Bentivegna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Catherine Uzan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sebastien Gouy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patricia Pautier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Catherine Lhommé
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pierre Duvillard
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christine Haie-Meder
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Philippe Morice
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philippe Morice.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Touboul, C., Bentivegna, E., Uzan, C. et al. Sentinel Lymph Node in Endometrial Cancer: A Review. Curr Oncol Rep 15, 559–565 (2013). https://doi.org/10.1007/s11912-013-0345-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11912-013-0345-1

Keywords

Search

Navigation