Evaluation of the Sentinel Lymph Node Algorithm With Blue Dye Labeling for Early-Stage Endometrial Cancer in a Multicentric Setting

Vidal, Fabien MD; Leguevaque, Pierre MD, PhD*; Motton, Stephanie MD*; Delotte, Jerome MD; Ferron, Gwenael MD; Querleu, Denis MD, PhD; Rafii, Arash PhD§

International Journal of Gynecological Cancer: September 2013 - Volume 23 - Issue 7 - p 1237–1243
doi: 10.1097/IGC.0b013e31829b1b98
Uterine Cancer

Objectives: Sentinel lymph node (SLN) removal may be a midterm between no and full pelvic dissection in early endometrial cancer. Whereas the use of blue dye alone in SLN detection has a poor accuracy, its integration in an SLN algorithm may yield better results and overcome hurdles such as the requirement of nuclear medicine facility.

Methods: Sixty-six patients with clinical stage I endometrial cancer were prospectively enrolled in a multicentre study between May 2003 and June 2009. Patent blue was injected intraoperatively into the cervix. We retrospectively assessed the accuracy of a previously described SLN algorithm consisting of the following sequence: (1) pelvic node area is inspected for removal of all mapped SLN and (2) excision of every suspicious non-SLN, (3) in the absence of mapping in a hemipelvis, a standard ipsilateral lymphadenectomy is then performed.

Results: Sentinel nodes were identified in 41 patients (62.1%), mostly in interiliac and obturator areas. None was detected in the para-aortic area. Detection was bilateral in 23 cases (56.1%). Seven patients (10.6%) had positive nodes. The false-negative rate was 40% using SLN detection alone. When the algorithm was applied, the false-negative rate was 14.3%. The use of a SLN algorithm would have avoided 53% of lymphadenectomies

Conclusion: Our multicentric evaluation validates the use of a SLN algorithm based on blue-only sentinel node mapping in early-stage endometrial cancer. The application of such SLN algorithm should be evaluated in a prospective context and might lead to decrease unnecessary lymphadenectomies.

From the *Department of General and Gynecologic Surgery, Rangueil Academic Hospital, Toulouse, France; †Department of Obstetrics, Gynecology and Reproductive Medicine, Archet II Hospital, University of Nice-Sophia-Antipolis, Nice, France; ‡Department of Gynecologic Oncology, Claudius Regaud Institute, Toulouse, France; and §Department of Genetic Medicine, Weill Cornell Medical College, Doha, Qatar.

Address correspondence and reprint requests to Fabien Vidal, MD, Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Qatar-Foundation PO Box 24144, Doha, Qatar. E-mail: fmv2001@qatar-med.cornell.edu.

The authors declare no conflicts of interest.

Received February 11, 2013

Accepted May 9, 2013

© 2013 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.