Sentinel lymph node mapping in endometrial cancer: A comparison of main national and international guidelines.

Aharon Dick, Tamar Perri, Liron Kogan, Benny Brandt, Raanan Meyer, Gabriel Levin

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2022 Jul 05

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To compare national and international guidelines regarding sentinel lymph node (SLN) mapping in endometrial cancer. A descriptive comparative study of the National Comprehensive Cancer Network (NCCN), the Society of Gynecologic Oncology (SGO), the European Society of Gynecological Oncology (ESGO), the British Gynecological Cancer Society (BGCS), and the Japan Society of Gynecologic Oncology (JSGO) guidelines. There is a broad consensus that SLN mapping is an appropriate alternative to pelvic lymphadenectomy for uterine-confined endometrioid endometrial cancer (five of five guidelines). It is broadly accepted that a full lymphadenectomy should be performed in case of failed SLN mapping (four of five guidelines), and that mapping with the fluorescent dye indocyanine green is superior to other methods (four of five guidelines). It is agreed that the cervix is the preferable site for dye injection (four of five guidelines), and pathology ultrastaging is advocated by most guidelines (three of five guidelines). Regarding high-risk patients (i.e., high-grade histology and non-endometroid carcinomas), some guidelines accept (three of five), but others currently do not advocate (one of five guidelines), SLN mapping as a sole method for lymph node evaluation. There is no consensus regarding para-aortic lymph node evaluation in pelvic SLN-positive patients. Guidelines for SLN mapping are comparable with regards to surgical technique, ultrastaging, and management in case of failed mapping. Nevertheless, some variations exist regarding the management of high-grade histology and positive pelvic lymph nodes. © 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

Citation

Aharon Dick, Tamar Perri, Liron Kogan, Benny Brandt, Raanan Meyer, Gabriel Levin. Sentinel lymph node mapping in endometrial cancer: A comparison of main national and international guidelines. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2022 Jul 05;160(1):220-225