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Can risk groups accurately predict non‐sentinel lymph node metastasis in sentinel lymph node‐positive endometrial cancer patients? A Turkish Gynecologic Oncology Group Study (TRSGO‐SLN‐004)

AbstractBackground and ObjectivesThe purpose of this study was to find out the risk factors associated with non‐sentinel lymph node metastasis and determine the incidence of non‐sentinel lymph node metastasis according to risk groups in sentinel lymph node (SLN)‐positive endometrial cancer patients.MethodsPatients who underwent at least bilateral pelvic lymphadenectomy after SLN mapping were retrospectively analyzed. Patients were categorized into low, intermediate, high‐intermediate, and high‐risk groups defined by ESMO‐ESGO‐ESTRO.ResultsOut of 395 eligible patients, 42 patients had SLN metastasis and 16 (38.1%) of them also had non‐SLN metastasis. Size of SLN metastasis was the only factor associated with non‐SLN metastasis (p = .012) as 13/22 patients with macrometastasis, 2/10 with micrometastasis and 1/10 with isolated tumor cells (ITCs) had non‐SLN metastasis. Although all 4 metastases (1.8%) among the low‐risk group were limited to SLNs, the non‐SLN involvement rate in the high‐risk group was 42.9% and all of these were seen in patients with macrometastatic SLNs.ConclusionsNon‐SLN metastasis was more frequent in higher‐risk groups and the risk of non‐SLN metastasis increased with the size of SLN metastasis. Proceeding to complete lymphadenectomy when SLN is metastatic should further be studied as the effect of leaving metastatic non‐SLNs in‐situ is not known.

Comparison of two intraoperative examination methods for the diagnosis of sentinel lymph node metastasis in clinically early stage endometrial cancer: A Turkish Gynecologic Oncology Group Study (TRSGO-SLN-003)

This study evaluated diagnostic accuracy of intraoperative sentinel lymph node (SLN) frozen section examination and scrape cytology as a possible solution for management of SLN positive patients. Clinically early-stage endometrial cancer patients who underwent SLN algorithm and intraoperative SLN examination were analyzed. Findings were compared with final pathology results and diagnostic accuracy of frozen section and scrape cytology were evaluated. Of the 208 eligible patients, 100 patients (48 %) had frozen section examination and 108 (52 %) had scrape cytology of the SLN. Intraoperative examination and final pathology were negative for metastasis in 187/208 (90 %) cases. The rest 21 cases had metastatic SLNs according to final pathology. 12 of 21 (57 %) metastases were classified as macrometastasis. Intraoperative examination of SLNs correctly identified 13 cases (true positive) and missed 8 cases (false negative). Five of 8 false negative cases had micrometastasis or isolated tumor cells. Considering identification of macrometastasis, sensitivity and negative predictive value were 85.71 % and 98.94 %, respectively, for the frozen section and 60.00 % and 98.15 %, respectively, for the scrape cytology. Frozen section examination of SLN has higher sensitivity in detecting macrometastasis compared to scrape cytology and it could help the surgeon in decision for further lymphadenectomy intraoperatively.

Risk factors for the involvement of sentinel lymph nodes in endometrial cancer (TRSGO-SLN-010)

This research was undertaken to identify risk factors for the involvement of sentinel lymph nodes (SLNs) in cases of endometrial cancer. From February 2016 to April 2021, the cases of 874 women with endometrial cancer treated with the SLN algorithm at 11 institutions were analyzed in this retrospective study. Clinical and pathologic data were reviewed, and logistic regression was applied to identify predictive factors for SLN involvement. After the exclusion of 81 patients, the remaining cohort of 793 patients was analyzed. The involvement of SLNs occurred in 9.2% of these cases (n = 73). In univariate analysis, the risk of SLN involvement was seen to be significantly higher among patients aged >60 years and those with high-grade tumors, non-endometrioid histology, lymphovascular space invasion, deep myometrial invasion, tumor diameters of ≥2 cm, and cervical stromal invasion. Multivariate analysis identified the occurrence of deep myometrial invasion (OR 2.42, 95% CI 1.29 to 4.56; p = .006), cervical stromal invasion (OR 2.18, 95% CI 1.13 to 4.21; p = .020), and lymphovascular space invasion (OR 7.27, 95% CI 3.82 to 13.81; p < .001) as risk factors independently predictive of SLN involvement in the treatment of endometrial cancer. Deep myometrial invasion, cervical stromal invasion, and lymphovascular space invasion were found to be independently predictive of the involvement of SLNs in cases of endometrial cancer. For cases in which SLN dissection was not or could not be performed, the identified independent risk factors are crucial for guiding adjuvant therapy.