Retrospective Study

Patient, disease and surgeon predictors of successful bilateral sentinel lymph node mapping for endometrial cancer: A retrospective, multicenter analysis

Mary Towner, Kaylee Underkoffler, Anze Urh, Katina Robison and Richard G Moore*

Published: 14 July, 2022 | Volume 5 - Issue 3 | Pages: 072-079

Objective: Sentinel lymph node mapping is an acceptable standard for lymph node evaluation in patients with endometrial cancer. The purpose of this study was to evaluate the adoption of this technique at two academic institutions, including which patient and disease features are associated with rates of successfully identifying sentinel lymph nodes with fluorescent mapping. In addition, we sought to characterize if and how surgeons experience the technique related to successful bilateral sentinel lymph node mapping. 
Methods: A retrospective chart review was performed of patients at two academic institutions who underwent sentinel lymph node mapping prior to a minimally invasive hysterectomy for endometrial cancer over the first 30 months during which the technique was adopted at each institution. A modified Poisson regression model was used to determine the relationships between patient, disease, and surgeon factors on outcomes of sentinel lymph node mapping. 
Results: A total of 460 charts were reviewed. The mean age was 64 and the median body mass index was 34.2. The most disease was stage I (83%), endometrioid (89%), and Grade I (64%). The bilateral sentinel lymph node mapping success rate was 65%, while unilateral or bilateral success occurred in 91% of cases. Sentinel lymph node mapping was significantly more likely to be successful in premenopausal women (RR 1.25; 95% CI 1.07 - 1.46; p = 0.005) and Asian women (RR 1.48; 95% CI 1.3-1.68; p < 0.001). BMI was not significantly predictive of mapping success (RR 1.03; 95% CI 1.00 - 1.07; p = 0.05). Increasing surgeon experience with the technique did predict successful bilateral sentinel lymph node mapping (RR 1.02; 95% CI 1.00 - 1.03; p = 0.02).
Conclusion: Premenopausal status and surgeon experience with the technique increases the likelihood of bilateral sentinel lymph node detection for endometrial cancer.

Read Full Article HTML DOI: 10.29328/journal.cjog.1001111 Cite this Article Read Full Article PDF


PCOS; Phenotypes; Oocyte; Competence; Embryo


  1. Mikuta JJ. International Federation of Gynecology and Obstetrics staging of endometrial cancer 1988. Cancer. 1993 Feb 15;71(4 Suppl):1460-3. doi: 10.1002/cncr.2820710409. PMID: 8431880.
  2. Rossi EC, Kowalski LD, Scalici J, Cantrell L, Schuler K, Hanna RK, Method M, Ade M, Ivanova A, Boggess JF. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol. 2017 Mar;18(3):384-392. doi: 10.1016/S1470-2045(17)30068-2. Epub 2017 Feb 1. PMID: 28159465.
  3. Bogani G, Murgia F, Ditto A, Raspagliesi F. Sentinel node mapping vs. lymphadenectomy in endometrial cancer: A systematic review and meta-analysis. Gynecol Oncol. 2019 Jun;153(3):676-683. doi: 10.1016/j.ygyno.2019.03.254. Epub 2019 Apr 2. PMID: 30952370.
  4. Tanner EJ, Sinno AK, Stone RL, Levinson KL, Long KC, Fader AN. Factors associated with successful bilateral sentinel lymph node mapping in endometrial cancer. Gynecol Oncol. 2015 Sep;138(3):542-7. doi: 10.1016/j.ygyno.2015.06.024. Epub 2015 Jun 19. PMID: 26095896.
  5. Tortorella L, Casarin J, Multinu F, Cappuccio S, McGree ME, Weaver AL, Langstraat CL, Keeney GL, Kumar A, Melis GB, Angioni S, Scambia G, Mariani A, Glaser GE. Sentinel lymph node biopsy with cervical injection of indocyanine green in apparent early-stage endometrial cancer: predictors of unsuccessful mapping. Gynecol Oncol. 2019 Oct;155(1):34-38. doi: 10.1016/j.ygyno.2019.08.008. Epub 2019 Aug 8. PMID: 31402166.
  6. Holloway RW, Abu-Rustum NR, Backes FJ, Boggess JF, Gotlieb WH, Jeffrey Lowery W, Rossi EC, Tanner EJ, Wolsky RJ. Sentinel lymph node mapping and staging in endometrial cancer: A Society of Gynecologic Oncology literature review with consensus recommendations. Gynecol Oncol. 2017 Aug;146(2):405-415. doi: 10.1016/j.ygyno.2017.05.027. Epub 2017 May 28. PMID: 28566221; PMCID: PMC6075736.
  7. Khoury-Collado F, Glaser GE, Zivanovic O, Sonoda Y, Levine DA, Chi DS, Gemignani ML, Barakat RR, Abu-Rustum NR. Improving sentinel lymph node detection rates in endometrial cancer: how many cases are needed? Gynecol Oncol. 2009 Dec;115(3):453-5. doi: 10.1016/j.ygyno.2009.08.026. Epub 2009 Sep 19. PMID: 19767064.
  8. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016 Jan-Feb;66(1):7-30. doi: 10.3322/caac.21332. Epub 2016 Jan 7. PMID: 26742998.
  9. Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E. Endometrial cancer. Lancet. 2016 Mar 12;387(10023):1094-1108. doi: 10.1016/S0140-6736(15)00130-0. Epub 2015 Sep 6. PMID: 26354523.
  10. Carlson JW, Kauderer J, Hutson A, Carter J, Armer J, Lockwood S, Nolte S, Stewart BR, Wenzel L, Walker J, Fleury A, Bonebrake A, Soper J, Mathews C, Zivanovic O, Richards WE, Tan A, Alberts DS, Barakat RR. GOG 244-The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients. Gynecol Oncol. 2020 Feb;156(2):467-474. doi: 10.1016/j.ygyno.2019.10.009. Epub 2019 Dec 16. PMID: 31837831; PMCID: PMC7018616.
  11. ASTEC study group, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009 Jan 10;373(9658):125-36. doi: 10.1016/S0140-6736(08)61766-3. Epub 2008 Dec 16. Erratum in: Lancet. 2009 May 23;373(9677):1764. PMID: 19070889; PMCID: PMC2646126.
  12. Hogberg T. Adjuvant chemotherapy in endometrial cancer. Int J Gynecol Cancer. 2010 Oct;20(11 Suppl 2):S57-9. doi: 10.1111/IGC.0b013e3181f749fd. PMID: 20975363.
  13. Rungruang B, Olawaiye AB. Comprehensive surgical staging for endometrial cancer. Rev Obstet Gynecol. 2012;5(1):28-34. PMID: 22582124; PMCID: PMC3349921.
  14. Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, Podratz KC. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008 Apr;109(1):11-8. doi: 10.1016/j.ygyno.2008.01.023. Epub 2008 Mar 4. PMID: 18304622; PMCID: PMC3667391.
  15. Hamilton CA, Pothuri B, Arend RC, Backes FJ, Gehrig PA, Soliman PT, Thompson JS, Urban RR, Burke WM. Endometrial cancer: A society of gynecologic oncology evidence-based review and recommendations. Gynecol Oncol. 2021 Mar;160(3):817-826. doi: 10.1016/j.ygyno.2020.12.021. Epub 2021 Jan 27. PMID: 33516529.
  16. Soliman PT, Westin SN, Dioun S, Sun CC, Euscher E, Munsell MF, Fleming ND, Levenback C, Frumovitz M, Ramirez PT, Lu KH. A prospective validation study of sentinel lymph node mapping for high-risk endometrial cancer. Gynecol Oncol. 2017 Aug;146(2):234-239. doi: 10.1016/j.ygyno.2017.05.016. Epub 2017 May 18. PMID: 28528918; PMCID: PMC5860676.
  17. Vargiu V, Rosati A, Capozzi VA, Sozzi G, Gioè A, Berretta R, Chiantera V, Scambia G, Fanfani F, Cosentino F. Impact of Obesity on Sentinel Lymph Node Mapping in Patients with apparent Early-Stage Endometrial Cancer: The ObeLyX study. Gynecol Oncol. 2022 May;165(2):215-222. doi: 10.1016/j.ygyno.2022.03.003. Epub 2022 Mar 18. PMID: 35314087.
  18. Sozzi G, Fanfani F, Berretta R, Capozzi VA, Uccella S, Buono N, Giallombardo V, Di Donna MC, Monterossi G, Restaino S, Capasso I, Dinoi G, Scambia G, Chiantera V. Laparoscopic sentinel node mapping with intracervical indocyanine green injection for endometrial cancer: the SENTIFAIL study - a multicentric analysis of predictors of failed mapping. Int J Gynecol Cancer. 2020 Nov;30(11):1713-1718. doi: 10.1136/ijgc-2020-001724. Epub 2020 Aug 31. PMID: 32868384.
  19. Van Arsdale A, Miller DT, Kuo DY, Isani S, Sanchez L, Nevadunsky NS. Association of obesity with survival in patients with endometrial cancer. Gynecol Oncol. 2019 Jul;154(1):156-162. doi: 10.1016/j.ygyno.2019.03.258. Epub 2019 May 3. PMID: 31060820.
  20. Mundt AJ, Waggoner S, Yamada D, Rotmensch J, Connell PP. Age as a prognostic factor for recurrence in patients with endometrial carcinoma. Gynecol Oncol. 2000 Oct;79(1):79-85. doi: 10.1006/gyno.2000.5917. PMID: 11006036.


Figure 1

Figure 1

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More