(ChemotherapyAdvisor) – Sentinel lymph node (SLN) biopsy results in upstaging of some endometrial cancer cases and should be undertaken even among patients presumed to have low-risk disease, concludes a multicenter study published in the Annals of Surgical Oncology.
“Our study confirms that, because of discrepancies between preoperative staging and definitive histology, lymph node status should be assessed in patients with presumed low- and intermediate risk endometrial cancer,” reported Marcos Ballester, MD, of the Tenon University Hospital in Paris, France, and coauthors. “Ultrastaging detected metastases undiagnosed by conventional histology in 6 (42.8%) of 14 patients with positive SLNs.”
The team’s retrospective multicenter study of 103 women with presumed low- or intermediate-risk endometrial cancer who underwent SLN biopsy and ultrastaging between 2007 and 2011, found that 15.7% of patients had pelvic metastasis, suggesting “that these patients were undertreated and exposed to a risk of recurrence,” the authors reported.
Only 1 of 14 women with no SLN-positive findings was subsequently found to have metastatic lymph nodes, the authors reported. Positive SLN findings were significantly associated with definitive endometrial cancer risk status (P=0.047), lympho-vascular space involvement (P=0.01), and definitive depth of myometrial invasion ≥50% (P=0.01).
Among 56 patients with presumed low-risk tumors based on preoperative staging, 9 patients (16%) were found after definitive histology to have intermediate-risk tumors; 3 patients (5.4%) were found to have high risk cancers.
“Hence, 12 (21.4%) of the 56 patients were upstaged by definitive histology, among whom 3 (25%) had pelvic positive SLNs corresponding to definitive IIIC1 FIGO stage,” they reported.
“Although it has been demonstrated that lymphadenectomy has no benefit for these subgroup(s) of patients, SLN biopsy is a trade-off to adequately stage patients and tailor adjuvant therapies,” the authors concluded.