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Sentinel-lymph-node biopsy has edge on lymphadenectomy in endometrial-cancer staging

JAMA Surgery
Reuters Health - 19/11/2020 - In patients with high-grade endometrial cancer, sentinel-lymph-node biopsy (SLNB) has a diagnostic accuracy comparable to that of lymphadenectomy and shows enhanced detection of node-positive disease, according to a prospective study.

SLNB has been proposed as a less invasive strategy for nodal assessment, but whether it can reliably replace lymphadenectomy is unclear, Dr. Sarah E. Ferguson of University Health Network/Sinai Health Systems in Toronto, Canada, and colleagues write in JAMA Surgery.

The researchers studied 156 patients (median age, 65.5 years) with endometrial cancer, of whom 126 (81%) had high-grade disease. All underwent SLNB followed by the reference standard pelvic lymphadenectomy (PLND). In addition, 101 of the patients with high-grade disease also underwent para-aortic lymphadenectomy (PALND).

SLN detection rates were 97.4% per patient, 87.5% per hemipelvis and 77.6% bilaterally. Of the 27 patients (17%) with nodal metastases, all but one were correctly identified by the SLNB algorithm.

The sensitivity was 96%, the false-negative rate was 4% and the negative predictive value was 99%. In addition, seven of these patients (26%) were identified beyond traditional PLND boundaries or required immunohistochemistry for diagnosis.

Thus, say the authors, SLNB appears to be a viable option for the surgical staging of both low- and high-grade endometrial cancer. And, given that the measures "are comparable to those observed for breast cancer and melanoma for which SLNB has become the standard of care," endometrial SLNB should be evaluated as a replacement for lymphadenectomy, they suggest.

However, the team stresses that if SLNB is to be adopted, "surgeons must strictly follow an SLNB algorithm that incorporates both side-specific PLND and PALND for nonmapped hemipelves in patients with high-grade endometrial cancer."

They also suggest that "initial adoption of SLNB occur alongside continued performance of PLND and PALND so that centers can document proficiency."

Dr. Ferguson did not respond to requests for comments.

By Reuters Staff

SOURCE: https://bit.ly/35JL6a4 JAMA Surgery, online November 11, 2020.

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