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Multicenter Study
. 2023 Nov;30(12):7653-7662.
doi: 10.1245/s10434-023-14065-3. Epub 2023 Aug 26.

Accuracy and Survival Outcomes after National Implementation of Sentinel Lymph Node Biopsy in Early Stage Endometrial Cancer

Silvia Cabrera  1 , Natalia R Gómez-Hidalgo  2 , Virginia García-Pineda  3 , Vicente Bebia  2 , Sergi Fernández-González  4 , Paula Alonso  5 , Tomás Rodríguez-Gómez  6 , Pere Fusté  7 , Myriam Gracia-Segovia  3 , Cristina Lorenzo  8 , Enrique Chacon  9 , Fernando Roldan Rivas  10 , Octavio Arencibia  11 , Marina Martí Edo  12 , Soledad Fidalgo  13 , Josep Sanchis  14 , Pablo Padilla-Iserte  15 , Manuel Pantoja-Garrido  16 , Sergio Martínez  17 , Ricard Peiró  18 , Cecilia Escayola  19 , M Reyes Oliver-Pérez  20 , Cristina Aghababyan  21 , Carmen Tauste  22 , Sara Morales  23 , Anna Torrent  24 , Jesus Utrilla-Layna  25 , Francesc Fargas  26 , Ana Calvo  27 , Laura Aller de Pace  28 , Antonio Gil-Moreno  2 ; Spain-GOG and the MULTISENT Study Group
Affiliations
Multicenter Study

Accuracy and Survival Outcomes after National Implementation of Sentinel Lymph Node Biopsy in Early Stage Endometrial Cancer

Silvia Cabrera et al. Ann Surg Oncol. 2023 Nov.

Abstract

Background: Sentinel lymph node (SLN) biopsy has recently been accepted to evaluate nodal status in endometrial cancer at early stage, which is key to tailoring adjuvant treatments. Our aim was to evaluate the national implementation of SLN biopsy in terms of accuracy to detect nodal disease in a clinical setting and oncologic outcomes according to the volume of nodal disease.

Patients and methods: A total of 29 Spanish centers participated in this retrospective, multicenter registry including patients with endometrial adenocarcinoma at preoperative early stage who had undergone SLN biopsy between 2015 and 2021. Each center collected data regarding demographic, clinical, histologic, therapeutic, and survival characteristics.

Results: A total of 892 patients were enrolled. After the surgery, 12.9% were suprastaged to FIGO 2009 stages III-IV and 108 patients (12.1%) had nodal involvement: 54.6% macrometastasis, 22.2% micrometastases, and 23.1% isolated tumor cells (ITC). Sensitivity of SLN biopsy was 93.7% and false negative rate was 6.2%. After a median follow up of 1.81 years, overall surivial and disease-free survival were significantly lower in patients who had macrometastases when compared with patients with negative nodes, micrometastases or ITC.

Conclusions: In our nationwide cohort we obtained high sensitivity of SLN biopsy to detect nodal disease. The oncologic outcomes of patients with negative nodes and low-volume disease were similar after tailoring adjuvant treatments. In total, 22% of patients with macrometastasis and 50% of patients with micrometastasis were at low risk of nodal metastasis according to their preoperative risk factors, revealing the importance of SLN biopsy in the surgical management of patients with early stage EC.

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Conflict of interest statement

There is no financial support, commercial association, or other type of funding sources. The authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram for cohort selection. SLN: sentinel lymph node
Fig. 2
Fig. 2
LVSI probability according to the volume of disease in SLN
Fig. 3
Fig. 3
Cancer-specific survival and disease-free survival estimates of node-negative patients (pN0), patients with ITC [pN0(i+)], patients with micrometastases [pN1(mi)], and patients with macrometastases (pN1)
See this image and copyright information in PMC

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