Identifying safe diagnostic algorithms for sentinel lymph node mapping in high-risk endometrial cancer: The SENTIREC-endo study

Sarah Marie Bjørnholt; Ole Mogensen; Kirsten Bouchelouche; Sara Elizabeth Sponholtz; Erik Thorlund Parner; Malene Grubbe Hildebrandt; Annika Loft; Gudrun Neumann; Signe Frahm Bjørn; Katja Dahl; Algirdas Markauskas; Ligita Paskeviciute Frøding; Pernille Tine Jensen

doi:10.1016/j.ygyno.2024.01.049

Identifying safe diagnostic algorithms for sentinel lymph node mapping in high-risk endometrial cancer: The SENTIREC-endo study

Sarah Marie Bjørnholt^*, Ole Mogensen, Kirsten Bouchelouche, Sara Elizabeth Sponholtz, Erik Thorlund Parner, Malene Grubbe Hildebrandt, Annika Loft, Gudrun Neumann, Signe Frahm Bjørn, Katja Dahl, Algirdas Markauskas, Ligita Paskeviciute Frøding, Pernille Tine Jensen

^*Corresponding author for this work

1 Citation (Scopus)

Abstract

INTRODUCTION: It is unclear if sentinel node (SLN) mapping can replace pelvic- (PLD) and paraaortic lymphadenectomy (PALD) for high-risk endometrial cancer (EC). A diagnostically safe surgical algorithm, taking failed mapping cases into account, is not defined. We aimed to investigate the diagnostic accuracy of SLN mapping algorithms in women with exclusively high-risk EC.

METHODS: We undertook a prospective national diagnostic cohort study of SLN mapping in women with high-risk EC from March 2017 to January 2023. The power calculation was based on the negative predictive value (NPV). Women underwent SLN mapping, PLD and PALD besides removal of suspicious and any FDG/PET-positive lymph nodes. Accuracy analyses were performed for five algorithms.

RESULTS: 170/216 included women underwent SLN mapping, PLD and PALD and were included in accuracy analyses. 42/170 (24.7%) had nodal metastasis. The algorithm SLN and PLD in case of failed mapping, demonstrated a sensitivity of 86% (95% CI 74-100) and an NPV of 96% (95% CI 91-100). The sensitivity increased to 93% (95% CI 83-100) and the NPV to 98% (95% CI 94-100) if PLD was combined with removal of any PET-positive lymph nodes. Equivalent results were obtained if PLD and PALD were performed in non-mapping cases; sensitivity 93% (95% CI 83-100) and NPV 98% (95% CI 95-100).

CONCLUSION: SLN-mapping is a safe staging procedure in women with high-risk EC if strictly adhering to a surgical algorithm including removal of any PET-positive lymph nodes independent of location and PLD or PLD and PALD in case of failed mapping.

Original language	English
Journal	Gynecologic Oncology
Volume	182
Pages (from-to)	179-187
Number of pages	9
ISSN	0090-8258
DOIs	https://doi.org/10.1016/j.ygyno.2024.01.049
Publication status	Published - Mar 2024

Keywords

Endometrial cancer
High-risk histology
Sentinel node biopsy
Surgical staging, national prospective study

Access to Document

10.1016/j.ygyno.2024.01.049Licence: CC BY

Cite this

Bjørnholt, S. M., Mogensen, O., Bouchelouche, K., Sponholtz, S. E., Parner, E. T., Hildebrandt, M. G., Loft, A., Neumann, G., Bjørn, S. F., Dahl, K., Markauskas, A., Frøding, L. P., & Jensen, P. T. (2024). Identifying safe diagnostic algorithms for sentinel lymph node mapping in high-risk endometrial cancer: The SENTIREC-endo study. Gynecologic Oncology, 182, 179-187. https://doi.org/10.1016/j.ygyno.2024.01.049

Bjørnholt, SM, Mogensen, O, Bouchelouche, K, Sponholtz, SE, Parner, ET, Hildebrandt, MG, Loft, A, Neumann, G, Bjørn, SF, Dahl, K, Markauskas, A, Frøding, LP & Jensen, PT 2024, 'Identifying safe diagnostic algorithms for sentinel lymph node mapping in high-risk endometrial cancer: The SENTIREC-endo study', Gynecologic Oncology, vol. 182, pp. 179-187. https://doi.org/10.1016/j.ygyno.2024.01.049

@article{e45b4200ec2a4be8a319e1b29a0a268c,

title = "Identifying safe diagnostic algorithms for sentinel lymph node mapping in high-risk endometrial cancer: The SENTIREC-endo study",

abstract = "INTRODUCTION: It is unclear if sentinel node (SLN) mapping can replace pelvic- (PLD) and paraaortic lymphadenectomy (PALD) for high-risk endometrial cancer (EC). A diagnostically safe surgical algorithm, taking failed mapping cases into account, is not defined. We aimed to investigate the diagnostic accuracy of SLN mapping algorithms in women with exclusively high-risk EC.METHODS: We undertook a prospective national diagnostic cohort study of SLN mapping in women with high-risk EC from March 2017 to January 2023. The power calculation was based on the negative predictive value (NPV). Women underwent SLN mapping, PLD and PALD besides removal of suspicious and any FDG/PET-positive lymph nodes. Accuracy analyses were performed for five algorithms.RESULTS: 170/216 included women underwent SLN mapping, PLD and PALD and were included in accuracy analyses. 42/170 (24.7%) had nodal metastasis. The algorithm SLN and PLD in case of failed mapping, demonstrated a sensitivity of 86% (95% CI 74-100) and an NPV of 96% (95% CI 91-100). The sensitivity increased to 93% (95% CI 83-100) and the NPV to 98% (95% CI 94-100) if PLD was combined with removal of any PET-positive lymph nodes. Equivalent results were obtained if PLD and PALD were performed in non-mapping cases; sensitivity 93% (95% CI 83-100) and NPV 98% (95% CI 95-100).CONCLUSION: SLN-mapping is a safe staging procedure in women with high-risk EC if strictly adhering to a surgical algorithm including removal of any PET-positive lymph nodes independent of location and PLD or PLD and PALD in case of failed mapping.",

keywords = "Endometrial cancer, High-risk histology, Sentinel node biopsy, Surgical staging, national prospective study",

author = "Bj{\o}rnholt, {Sarah Marie} and Ole Mogensen and Kirsten Bouchelouche and Sponholtz, {Sara Elizabeth} and Parner, {Erik Thorlund} and Hildebrandt, {Malene Grubbe} and Annika Loft and Gudrun Neumann and Bj{\o}rn, {Signe Frahm} and Katja Dahl and Algirdas Markauskas and Fr{\o}ding, {Ligita Paskeviciute} and Jensen, {Pernille Tine}",

note = "Copyright {\textcopyright} 2024. Published by Elsevier Inc.",

year = "2024",

month = mar,

doi = "10.1016/j.ygyno.2024.01.049",

language = "English",

volume = "182",

pages = "179--187",

journal = "Gynecologic Oncology",

issn = "0090-8258",

publisher = "Academic Press",

}

TY - JOUR

T1 - Identifying safe diagnostic algorithms for sentinel lymph node mapping in high-risk endometrial cancer

T2 - The SENTIREC-endo study

AU - Bjørnholt, Sarah Marie

AU - Mogensen, Ole

AU - Bouchelouche, Kirsten

AU - Sponholtz, Sara Elizabeth

AU - Parner, Erik Thorlund

AU - Hildebrandt, Malene Grubbe

AU - Loft, Annika

AU - Neumann, Gudrun

AU - Bjørn, Signe Frahm

AU - Dahl, Katja

AU - Markauskas, Algirdas

AU - Frøding, Ligita Paskeviciute

AU - Jensen, Pernille Tine

PY - 2024/3

Y1 - 2024/3

N2 - INTRODUCTION: It is unclear if sentinel node (SLN) mapping can replace pelvic- (PLD) and paraaortic lymphadenectomy (PALD) for high-risk endometrial cancer (EC). A diagnostically safe surgical algorithm, taking failed mapping cases into account, is not defined. We aimed to investigate the diagnostic accuracy of SLN mapping algorithms in women with exclusively high-risk EC.METHODS: We undertook a prospective national diagnostic cohort study of SLN mapping in women with high-risk EC from March 2017 to January 2023. The power calculation was based on the negative predictive value (NPV). Women underwent SLN mapping, PLD and PALD besides removal of suspicious and any FDG/PET-positive lymph nodes. Accuracy analyses were performed for five algorithms.RESULTS: 170/216 included women underwent SLN mapping, PLD and PALD and were included in accuracy analyses. 42/170 (24.7%) had nodal metastasis. The algorithm SLN and PLD in case of failed mapping, demonstrated a sensitivity of 86% (95% CI 74-100) and an NPV of 96% (95% CI 91-100). The sensitivity increased to 93% (95% CI 83-100) and the NPV to 98% (95% CI 94-100) if PLD was combined with removal of any PET-positive lymph nodes. Equivalent results were obtained if PLD and PALD were performed in non-mapping cases; sensitivity 93% (95% CI 83-100) and NPV 98% (95% CI 95-100).CONCLUSION: SLN-mapping is a safe staging procedure in women with high-risk EC if strictly adhering to a surgical algorithm including removal of any PET-positive lymph nodes independent of location and PLD or PLD and PALD in case of failed mapping.

AB - INTRODUCTION: It is unclear if sentinel node (SLN) mapping can replace pelvic- (PLD) and paraaortic lymphadenectomy (PALD) for high-risk endometrial cancer (EC). A diagnostically safe surgical algorithm, taking failed mapping cases into account, is not defined. We aimed to investigate the diagnostic accuracy of SLN mapping algorithms in women with exclusively high-risk EC.METHODS: We undertook a prospective national diagnostic cohort study of SLN mapping in women with high-risk EC from March 2017 to January 2023. The power calculation was based on the negative predictive value (NPV). Women underwent SLN mapping, PLD and PALD besides removal of suspicious and any FDG/PET-positive lymph nodes. Accuracy analyses were performed for five algorithms.RESULTS: 170/216 included women underwent SLN mapping, PLD and PALD and were included in accuracy analyses. 42/170 (24.7%) had nodal metastasis. The algorithm SLN and PLD in case of failed mapping, demonstrated a sensitivity of 86% (95% CI 74-100) and an NPV of 96% (95% CI 91-100). The sensitivity increased to 93% (95% CI 83-100) and the NPV to 98% (95% CI 94-100) if PLD was combined with removal of any PET-positive lymph nodes. Equivalent results were obtained if PLD and PALD were performed in non-mapping cases; sensitivity 93% (95% CI 83-100) and NPV 98% (95% CI 95-100).CONCLUSION: SLN-mapping is a safe staging procedure in women with high-risk EC if strictly adhering to a surgical algorithm including removal of any PET-positive lymph nodes independent of location and PLD or PLD and PALD in case of failed mapping.

KW - Endometrial cancer

KW - High-risk histology

KW - Sentinel node biopsy

KW - Surgical staging, national prospective study

UR - http://www.scopus.com/inward/record.url?scp=85184779981&partnerID=8YFLogxK

U2 - 10.1016/j.ygyno.2024.01.049

DO - 10.1016/j.ygyno.2024.01.049

M3 - Journal article

C2 - 38335900

SN - 0090-8258

VL - 182

SP - 179

EP - 187

JO - Gynecologic Oncology

JF - Gynecologic Oncology

ER -

Identifying safe diagnostic algorithms for sentinel lymph node mapping in high-risk endometrial cancer: The SENTIREC-endo study

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this