Highlights
- •Sentinel node mapping allows identification of extrauterine (i.e. lymphatic) disease.
- •Cervical (CI) and hysteroscopic (HI) injections are to perform sentinel node mapping.
- •CI and HI injections provide a similar detection rate in the para-aortic area.
- •In comparison with HI injection, CI injection correlates with a higher pelvic sentinel node detection rate.
Abstract
Aim
During the last years, the role of sentinel lymph node mapping (SLNM) for endometrial
cancer (EC) surgical treatment has increased in popularity. However, several controversies
remain about different technical steps of SLNM. Thus, a randomised control trial was
designed to compare cervical (CI) and hysteroscopic (HI) indocyanine green (ICG) injection
for SLNM of newly diagnosed EC undergoing surgical staging. The primary end-point
of the study was to compare these two techniques in terms of para-aortic detection
rate.
Methods
Patients with apparent stage I or II histologically confirmed EC undergoing surgery
were included in the study. This randomised trial distinguished patients in two study
groups according to two different techniques of ICG SLNM: CI versus HI injection.
Patients who met the inclusion criteria were randomly assigned to CI or HI injection
in a 1:1 ratio. The central randomisation system allocated patient randomisation numbers
sequentially in the order in which the patients were enrolled. This randomised trial
was not blinded for either patients or the surgeons.
Results
From March 2017 until April 2019, a total of 165 patients were randomised in this
study: 85 (51.5%) in the CI group and 80 (48.5%) in the HI group. After randomisation,
14 (8.5%) patients were excluded from the study. Finally, 151 patients were included
in the analysis: 82 (54.3%) in the CI group and 69 (45.7%) in the HI group. Hysteroscopy
injection shows an ability to detect Sentinel nodes (SNLs) in the para-aortic area
of about 10% greater compared with CI injection, although this difference did not
reach statistical significance. The HI technique was superior in detecting isolated
para-aortic SLNs (5.8% Versus 0%). The CI injection was correlated with higher SLN
detection rates at the pelvic level compared with HI injection. Pelvic and overall
detection was higher in the CI group.
Conclusions
The present study supports the adoption of CI instead of HI injection because the
former allows better identification of sentinel nodes (especially in the pelvic area).
Detection of SLN in the para-aortic area was slightly higher in patients receiving
a HI injection, but the difference with the CI route was not statistically significant.
Keywords
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Article info
Publication history
Published online: October 04, 2020
Accepted:
August 22,
2020
Received in revised form:
August 18,
2020
Received:
May 4,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
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- Corrigendum to “Hysteroscopic versus cervical injection for sentinel node detection in endometrial cancer: A multicenter prospective randomised controlled trial from the Multicenter Italian Trials in Ovarian cancer (MITO) study group” [European Journal of Cancer. Volume 140, November 2020, Pages 1-10]European Journal of CancerVol. 144
