Martinelli F, et al. – Aim was to examine detection–rate(DR) and diagnostic–accuracy (A) of sentinel–nodes(SLNs) mapping following hysteroscopic–injection of tracer, as well as, to compare DR and A between tracers: ICG and Tc99m. For SLNs mapping in endometrial cancer, hysteroscopic–injection of tracer was as accurate as cervical injection with a higher DR in the aortic area. Bilateral–DR was improved by ICG.

Methods

• Endometrial-cancer patients who underwent SLNs mapping after hysteroscopic-peritumoral-injection of tracer ± lymphadenectomy, were assessed.
• DR (overall-bilateral-aortic) and A in the entire cohort were analyzed.
• In addition, tracers were compared.

Results

• Experts regulated 202 procedures from January/2005 to February/2017.
• As per observations, mean age:60 years (28–82); mean BMI: 26.8 kg/m2 (15–47).
• Hysterectomy and mapping procedure were performed laparoscopically in 133 cases (65.8%).
• 93.2% was the overall-DR of the technique (179/192) (10 cases were excluded: 9 for technical-equipment failure; 1 for vagal reaction).
• Results reported bilateral pelvic mapping in 59.7% of cases (107/179) and was more frequent in the ICG group (72.8% vs 53.3%; p: 0.012).
• SLNs were mapped both in pelvic and aortic nodes, in 50.8% of cases (91/179), and in 5 cases (2.8%) it was only mapped in the aortic area.
• 3.7 (1–8) was the mean number of detected SLNs.
• They observed nodal involvement in 22 patients (12.3%): 10-(45.5%)-macrometastases; 5-(22.7%)-micrometastases; 7-(31.8%)-ITCs.
• In 6 cases (27.3%) only aortic nodes were positive.
• On the other hand, in 5 cases (22.7%) both pelvic and aortic nodes and in 11 cases (50%) only pelvic nodes were involved.
• All in the Tc99m group, three false-negative results were found.
• Furthermore, all had isolated aortic metastases with negative pelvic nodes.
• 86.4% (95%CI: 68.4–100) was the overall-sensitivity, and 96.4% (95%CI 86.7–100) was the overall-negative-predictive-value (NPV).
• There were no differences in terms of overall-DR, overall-sensitivity and overall-NPV between the two tracers.