Diagnostic Accuracy and Clinical Impact of Sentinel Lymph Node Sampling in Endometrial Cancer at High Risk of Recurrence: A Meta-Analysis
Purpose. To assess the value of sentinel lymph node (SLN) sampling in high risk endometrial cancer according to the ESMO-ESGO-ESTRO classification. Methods. We performed a comprehensive search on PubMed for clinical trials evaluating SLN sampling in patients with high risk endometrial cancer: stage...
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MDPI AG
2020-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/12/3874 |
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| author | Lise Lecointre Massimo Lodi Émilie Faller Thomas Boisramé Vincent Agnus Jean-Jacques Baldauf Benoît Gallix Chérif Akladios |
| author_facet | Lise Lecointre Massimo Lodi Émilie Faller Thomas Boisramé Vincent Agnus Jean-Jacques Baldauf Benoît Gallix Chérif Akladios |
| author_sort | Lise Lecointre |
| collection | DOAJ |
| description | Purpose. To assess the value of sentinel lymph node (SLN) sampling in high risk endometrial cancer according to the ESMO-ESGO-ESTRO classification. Methods. We performed a comprehensive search on PubMed for clinical trials evaluating SLN sampling in patients with high risk endometrial cancer: stage I endometrioid, grade 3, with at least 50% myometrial invasion, regardless of lymphovascular space invasion status; or stage II; or node-negative stage III endometrioid, no residual disease; or non-endometrioid (serous or clear cell or undifferentiated carcinoma, or carcinosarcoma). All patients underwent SLN sampling followed by pelvic with or without para-aortic lymphadenectomy. Results. We included 17 original studies concerning 1322 women. Mean detection rates were 89% for unilateral and 68% for bilateral. Pooled sensitivity was 88.5% (95%CI: 81.2–93.2%), negative predictive value was 96.0% (95%CI: 93.1–97.7%), and false negative rate was 11.5% (95%CI: 6.8; 18.8%). We noted heterogeneity in SLN techniques between studies, concerning the tracer and its detection, the injection site, the number of injections, and the surgical approach. Finally, we found a correlation between the number of patients included and the SLN sampling performances. Discussion. This meta-analysis estimated the SLN sampling performances in high risk endometrial cancer patients. Data from the literature show the feasibility, the safety, the limits, and the impact on surgical de-escalation of this technique. In conclusion, our study supports the hypothesis that SLN sampling could be a valuable technique to diagnose lymph node involvement for patients with high risk endometrial cancer in replacement of conventional lymphadenectomy. Consequently, randomized clinical trials are necessary to confirm this hypothesis. |
| first_indexed | 2024-03-10T14:28:48Z |
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| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-03-10T14:28:48Z |
| publishDate | 2020-11-01 |
| publisher | MDPI AG |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-0f00131e27434f068637d8990b5d9dd32023-11-20T22:44:36ZengMDPI AGJournal of Clinical Medicine2077-03832020-11-01912387410.3390/jcm9123874Diagnostic Accuracy and Clinical Impact of Sentinel Lymph Node Sampling in Endometrial Cancer at High Risk of Recurrence: A Meta-AnalysisLise Lecointre0Massimo Lodi1Émilie Faller2Thomas Boisramé3Vincent Agnus4Jean-Jacques Baldauf5Benoît Gallix6Chérif Akladios7Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, FranceDepartment of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, FranceDepartment of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, FranceDepartment of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, FranceInstitut hospitalo-universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, 67081 Strasbourg, FranceDepartment of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, FranceI-Cube UMR 7357-Laboratoire des Sciences de L’ingénieur, de L’informatique et de L’imagerie, Université de Strasbourg, 67081 Strasbourg, FranceDepartment of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, FrancePurpose. To assess the value of sentinel lymph node (SLN) sampling in high risk endometrial cancer according to the ESMO-ESGO-ESTRO classification. Methods. We performed a comprehensive search on PubMed for clinical trials evaluating SLN sampling in patients with high risk endometrial cancer: stage I endometrioid, grade 3, with at least 50% myometrial invasion, regardless of lymphovascular space invasion status; or stage II; or node-negative stage III endometrioid, no residual disease; or non-endometrioid (serous or clear cell or undifferentiated carcinoma, or carcinosarcoma). All patients underwent SLN sampling followed by pelvic with or without para-aortic lymphadenectomy. Results. We included 17 original studies concerning 1322 women. Mean detection rates were 89% for unilateral and 68% for bilateral. Pooled sensitivity was 88.5% (95%CI: 81.2–93.2%), negative predictive value was 96.0% (95%CI: 93.1–97.7%), and false negative rate was 11.5% (95%CI: 6.8; 18.8%). We noted heterogeneity in SLN techniques between studies, concerning the tracer and its detection, the injection site, the number of injections, and the surgical approach. Finally, we found a correlation between the number of patients included and the SLN sampling performances. Discussion. This meta-analysis estimated the SLN sampling performances in high risk endometrial cancer patients. Data from the literature show the feasibility, the safety, the limits, and the impact on surgical de-escalation of this technique. In conclusion, our study supports the hypothesis that SLN sampling could be a valuable technique to diagnose lymph node involvement for patients with high risk endometrial cancer in replacement of conventional lymphadenectomy. Consequently, randomized clinical trials are necessary to confirm this hypothesis.https://www.mdpi.com/2077-0383/9/12/3874endometrial cancersentinel lymph nodehigh risk |
| spellingShingle | Lise Lecointre Massimo Lodi Émilie Faller Thomas Boisramé Vincent Agnus Jean-Jacques Baldauf Benoît Gallix Chérif Akladios Diagnostic Accuracy and Clinical Impact of Sentinel Lymph Node Sampling in Endometrial Cancer at High Risk of Recurrence: A Meta-Analysis Journal of Clinical Medicine endometrial cancer sentinel lymph node high risk |
| title | Diagnostic Accuracy and Clinical Impact of Sentinel Lymph Node Sampling in Endometrial Cancer at High Risk of Recurrence: A Meta-Analysis |
| title_full | Diagnostic Accuracy and Clinical Impact of Sentinel Lymph Node Sampling in Endometrial Cancer at High Risk of Recurrence: A Meta-Analysis |
| title_fullStr | Diagnostic Accuracy and Clinical Impact of Sentinel Lymph Node Sampling in Endometrial Cancer at High Risk of Recurrence: A Meta-Analysis |
| title_full_unstemmed | Diagnostic Accuracy and Clinical Impact of Sentinel Lymph Node Sampling in Endometrial Cancer at High Risk of Recurrence: A Meta-Analysis |
| title_short | Diagnostic Accuracy and Clinical Impact of Sentinel Lymph Node Sampling in Endometrial Cancer at High Risk of Recurrence: A Meta-Analysis |
| title_sort | diagnostic accuracy and clinical impact of sentinel lymph node sampling in endometrial cancer at high risk of recurrence a meta analysis |
| topic | endometrial cancer sentinel lymph node high risk |
| url | https://www.mdpi.com/2077-0383/9/12/3874 |
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