Intraoperative subserosal approach to label sentinel nodes in intermediate and high-risk endometrial cancer

Design: prospective experimental study. Purpose of investigation: The purpose of this study was to evaluate feasibility and reliability of in vivo sentinel lymph node (SLN) mapping in patients with endometrial cancer and to verify a modified method of application of subserosal blue dye. Detection substance was applied subserosally in the uterine edges vicinity the round ligament of uterus and uterine vessels in the isthmic portion of the uterus. Materials and Methods: Eighteen patients with intermediate and high-risk endometrial cancer Stages I- II were subjected to staging laparotomy with intraoperative detection of SLNs and subsequent completion of the pelvic and para-aortic lymphadenectomies. Harvested SLN was routinely examined by classical haematoxylin eosin staining and in case of negativity, immunohistochemistry with anti-keratin antibodies AE1/AE3 was applied. Results: Total of 773 lymph nodes were removed in 18 patients: pelvic 420 (54%) and para-aortic 353 (46%). SLNs were detected in 16 of 18 patients totalling 59 nodes (7.6% of all nodes). Forty-eight were identified in the pelvic area (81%) and 11 nodes (19%) in the para-aortic area. Three metastatic SLNs were found in two patients (11%). No false negative nodes were demonstrated. Conclusion: Experimental study results indicate that the proposed modified approach to label SLNs is applicable. The presented modified approach brings the highest added value namely in women with a myomatous uterus and scars from previous surgical procedures on the uterus.

Endometrial cancer; Sentinel node; Blue dye; Lymphadenectomy; Staging; Laparotomy.

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