Role of sentinel lymph node dissection
In early-stage EC, systematic LND plays a role in complementing
preoperative imaging and is fundamental to guide adjuvant treatment.
Sentinel lymph nodes (SLN) are the first to be involved with metastatic
cancer cells and therefore require detailed examination known as
ultrastaging(56). This procedure involves SLN
dissection (SLND) and biopsy guided by SLN mapping(3).
A variety of SLN algorithms have shown similar diagnostic accuracies to
MRI(57) and systematic LND(58),
therefore ESMO-ESGO-ESTRO 2016 recognises SLND as a relatively novel
alternative to systematic LND.
Since 2016, the significance of SLND due to its enhanced benefits have
been further substantiated. In high-risk patients, SLN mapping has shown
high detection rates of LN metastases(59). However,
this study demonstrated a false-negative rate of 22%, perhaps due to
its small (n = 53), single-centre study design. The Fluorescence Imaging
for Robotic Endometrial Sentinel lymph node biopsy (FIRES) trial is the
largest multicentre prospective study to date investigating the accuracy
of SLND in multi-risk stage I patients. They concluded that their SLN
algorithm presented high diagnostic accuracy with a much reduced
false-negative rate of 3%(60). A further study
directly compared SLND to LND(49). It reported reduced
rates of readmission as well as decreased incidence of postoperative
complications in the SLND group. In contrast, high grade and
non-endometroid EC patients (confirmed on final histology) displayed
failure in the mapping process(61). Overall, SLND has
shown promising results in early-stage EC however, better recognition
and adoption may aid optimisation of SLN
algorithms(3,60).