Photo Credit: SbytovaMN

A study found omitting sentinel lymph node biopsy is feasible in patients with lower stages of endometrial cancer since lymph node positivity tends to be low.

While evidence supports fluorometric sentinel lymph node biopsy (SLNB) during surgery for endometrial cancer to assess the status of pelvic lymph node metastasis, a recent study in Frontiers in Medicine suggests it can be omitted or swapped with pelvic lymph node dissection.

“Because of the high level of medical proficiency and multidisciplinary collaboration required, numerous hospitals are still unable to fulfill the conditions necessary for performing this procedure of SLNB,” explained lead author Liqiong Huang and colleagues from Shanghai and Chengdu, Sichuan, China. “In this study, we collected perioperative and postoperative follow-up data from patients with endometrial cancer at different stages to evaluate the role of SLNB in endometrial cancer surgery.”

The study included 186 patients who underwent radical hysterectomy for endometrial cancer between January 2018 and April 2022. The researchers divided patients into four groups:

• Group A: 36 patients with stage IA grade 1 and 2 endometrioid endometrial cancer who underwent SLNB
• Group B: 31 patients with stage IA grade 1 and 2 endometrioid endometrial cancer who did not undergo SLNB
• Group C: 52 patients with higher-grade endometrioid endometrial cancer who underwent systematic lymph node dissection based on SLNB findings
• Group D: 67 patients with higher-grade endometrioid endometrial cancer who underwent direct systematic lymph node dissection but not SLNB.

SLNB yielded a sentinel lymph node positivity rate of 5.6% in groups A and B. According to the study, comparison of perioperative outcomes and postoperative follow-up for the groups revealed no significant differences with versus without SLNB.

For patients with higher-grade cancer, the sentinel lymph node positivity rate from SLNB was 38.4%, the study found.

“However, the decision to undergo SLNB did not yield significant differences in perioperative outcomes and postoperative follow-up among these patients,” the researchers wrote.

The authors noted that the study’s fluorescent tracer dose, 0.83 mg/mL, was sufficient to clear the detected sentinel lymph nodes.

“For stage IA grade 1 and 2 endometrioid endometrial cancer, the incidence of lymph node positivity is low, so omitting SLNB in this subpopulation is a feasible option,” researchers wrote. “In other stages…if SLNB is not available, the standard pelvic lymph node dissection procedure remains an option to obtain information about lymph node status, despite the surgical complications associated with this procedure.”