Sentinel Lymph Node Biopsy Effective for Endometrial Cancer Staging

Sentinel lymph node mapping with indocyanine green accurately diagnoses metastatic disease in patients with endometrial cancer and may safely replace lymphadenectomy in the staging of this disease, according to a study published in The Lancet Oncology.¹

Complete lymphadenectomy is the standard for detecting endometrial cancer metastases, though recent evidence suggests that sentinel lymph node mapping may be an effective alternative staging technique.

To measure the sensitivity and negative predictive value of sentinel lymph node mapping compared with lymphadenectomy in detecting metastatic disease, investigators enrolled 385 patients with clinical stage I endometrial cancer of all histologies and grades undergoing robotic staging.

In the multicenter, open-label, FIRES study (ClinicalTrials.gov Identifier: NCT01673022), patients received a standardized cervical injection of indocyanine green and sentinel lymph node mapping using robotic-assisted fluorescence imaging followed by pelvic lymphadenectomy with or without para-aortic lymphadenectomy.

Results showed that 86% of the 340 patients who underwent sentinel lymph node mapping with complete pelvic lymphadenectomy had successful mapping of at least 1 sentinel lymph node. Twelve percent had positive nodes, including 36 patients who had at least 1 mapped sentinel lymph node.

Investigators identified nodal metastases in the sentinel lymph nodes in 35 of these 36 patients, resulting in a sensitivity to detect node-positive disease of 97.2% (95% CI, 85.0-100), suggesting that sentinel lymph node biopsy will not detect metastases in 3% of patients with node-positive disease. The negative predictive value was 99.6% (95% CI, 97.9-100).

Four patients had grade 3 to 4 or serious postoperative neurologic disorders and respiratory distress or failure each, and 1 patient had a ureteral injury during sentinel-lymph-node dissection.

Reference

1. Rossi EC, Kowalski LD, Scalici J, et al. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol. 2017 Jan 31. doi: 10.1016/S1470-2045(17)30068-2 [Epub ahead of print]