Sentinel node biopsy helps to diagnose spread of endometrial cancer. A case report

Background: The sentinel lymph node (SLN) could improve the staging of endometrial cancer.

Case: In a patient with endometrial cancer, preoperative lymphoscintigraphy showed a highly radioactive SLN in the left external iliac chain and a radioactive SLN in the right external iliac chain and at the promontory. Intraoperative lymphatic mapping using blue dye and a hand-held gamma probe showed the same nodes, as well as a blue node near the vena cava. Selective removal of these nodes allowed detection of a micrometastasis in the left external iliac node. Pelvic node dissection was performed, and a micrometastasis was found in a left non sentinel iliac node.

Conclusion: The presence in our patient of micrometastases in a SLN and in a non-SLN belonging to the same chain confirms the value of SLN detection for diagnosing tumor spread.

Endometrial cancer; Sentinel node biopsy; Combined detection; Lymphoscintigraphy; Micrometastasis

[1] Gould E.A., Winship T., Philbin P.H., Kerr H.H.: "Observations on a'sentinel node'in cancer of the parotid". Cancer, 1960, 13, 77.

[2] Giuliano A.E.: "Lymphatic mapping and sentinel lymphadenectomy for breast cancer". Ann. Surg., 1994, 220, 391.

[3] de Hullu J.A., Doting E., Piers D.A. et al.: "Sentinel lymph node identification with technetium-99m-labeled nanocolloid in squamous cell cancer of the vulva". J. Nucl. Med., 1998, 39, 1381.

[4] Burke T.W.. Levenback C.. Tomos C., Morris M., Wharton J.T., Gershenson D.M.: ·'Intraabdominal lymphatic mapping to direct selective pelvic and paraaortic lymphadenectomy in women with high-risk endometrial cancer: results of a pilot study". Gynecol Oncol., 1996, 62, 169.

[5] Holub Z., Jabor A., Kliment L.: "Comparison of two procedures for sentinel lymph node detection in patients with endometrial cancer: a pilot study". Eur. J. Gynaecol. Oneal., 2002, 23, 53.

[6] Pelosi E., Arena V., Baudino B., Bello M., Gargiulo T., Giusti et al.: "Preliminary study of sentinel node identification with 99mTc colloid and blue dye in patients with endometrial cancer". Tumori, 2002, 88, S9.

[7] Pelosi E., Arena V., Baudino B., Bello M., Giusti M., Gargiulo T et al.: "Pre-operative lymphatic mapping and intra-operative sentinel lymph node detection in early stage endometrial cancer" Nucl. Med. Commun.. 2003, 24, 971.

[8] Niikura H., Okamura C., Akahira J., Takano T.; Ito K., Okamura K. et al.: "Sentinel lymph node detection in early cervical cancer with combination 99mTc phytate and patent blue". Gynecol Oneal., 2004, 94, 528.

[9] Holub Z., Kliment L., Lukac J., Voracek J.: "Laparoscopicallyassisted intraoperative lymphatic mapping in endometrial cancer preliminary results". Eur. J. Gynaecol. Oneal., 2001, 22, 118.

[10] Yabushita H.. Shimazu M., Yamada H., Sawaguchi K., Nogush1 M，Nakanishi M.: "Occult lymph node metastases detected by cytokeratin immunohistochemistry predict recurrence in node negative endometrial cancer". Gynecol. Oncol., 2001, 80, 139.

[11] Lelievre L., Camatte S., Le Frere-belda M.A., Kerrou K., Froissart M., Taurelle R. et al.: "Sentinel lymph node biopsy in cervix and corpus uteri cancers". Int. J. Gynecol. Cancer, 2004, 14, 271.

[12] Federation nationale des centres de Jutte contre le cancer. Standards, options et recommandations. Cancers de l'endometre. Paris John Libbey Euronext, 2001.

[13] Mariani A., Webb M.J., Keeney G.L., Podratz K.C.: "Routes of lymphatic spread: a study of 112 consecutive patients with endometrial cancer". Gynecol. Oncol., 2001, 81, 100.

[14] Gonzalez Bosquet J., Keeney G.L., Mariani A., Webb M.J., Cliby W.A.: "Cytokeratin staining of resected lymph nodes may improve the sensitivity of surgical staging for endometrial cancer" Gynecol. Oncol., 2003, 91, 518.

[15] Millis R., Springhall R., Lee A., Ryder K., Rytina E., Fentiman S "Occult axillary lymph node metastases are of no prognostic significance in breast cancer". Br. J. Cancer, 2002, 86, 396.

[16] Colleoni M., Rotmensz N., Peruzzoti G., Maisonneuve P., Mazzarol G., Pruneri G. et al.: "Size of breast cancer metastases in axillary lymph nodes: clinical relevance of minimal lymph node involvement". J. Clin. Oneal., 2005, 23, 1379.

[17] Cserni G., Gregori D., Merletti F., Sapino A., Mano M., Ponti A et al.: "Meta-analysis of non-sentinel node metastases associated with micro-metastatic szentinel nodes in breast cancer". Br. J. Surgery, 2004, 91, 1245.

[18] Chapgar A., Middleton L., Sahin A., Meric-Bernstam F., Kuerer H., Feig B. et al.: "Clinical outcome of patients with lymph nodenegative breast acrcinoma who have sentinel lymph node micrometastases detected by immunohistochemistry". Cancer, 2005, 103, 1581.