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
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.
CITA DEL ARTÍCULO Ann Surg Oncol. 2023 Aug 26. doi: 10.1245/s10434-023-14065-3