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Archives of Gynecology and Obstetrics

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01-03-2017 | Gynecologic Oncology

Application of sentinel lymph node dissection in gynecological cancers: results of a survey among German hospitals

Authors: Rüdiger Klapdor, Hermann Hertel, Philipp Soergel, Matthias Jentschke, Peter Hillemanns

Published in: Archives of Gynecology and Obstetrics | Issue 3/2017

Abstract

Purpose

Evaluating the application of the sentinel lymph node dissection (SLND) in gynecological cancers among German hospitals.

Methods

Between March and June 2016 an online questionnaire on SLND in gynecologic cancers was sent by email to all German gynecologic cancer centers, all university hospitals and general hospitals for which an email address was available. The survey contained 61 questions regarding the SLND in vulvar, cervical, endometrial and ovarian cancer.

Results

In total, 63 clinics, including 13 (20.6%) university hospitals, 28 (44.4%) hospitals offering maximum care and 22 (34.9%) general hospitals, responded to the questionnaire. Most clinics (46/63, 73%) performed SLND in vulvar cancer with a median amount of 7.8 (range 1–43) SLND per year. 56.5% of the clinics included patients according to the German national guidelines and performed ultrastaging of negative SLN. Furthermore, 18/63 (28.5%) of the responding clinics applied SLND in cervical cancer including 7 (77.8%) centers which conducted isolated SLND without radical pelvic lymph node dissection (LND). Preoperative imaging with planar lymphoscintigraphy (LSG) was applied in 12/18 (66.7%) of the clinics. SLND in endometrial cancer was reported by 4/63 (6.4%) hospitals. Three of them (75%) regularly performed a subsequent radical pelvic LND. One clinic (1.5%) reported SLND in ovarian cancer in combination with radical LND.

Conclusion

Especially in vulvar and cervical cancer, isolated SLND appears to be partially implemented in the routine surgical treatment. However, this survey illustrates a wide heterogeneity regarding inclusion criteria and application of the SLND approach.

Cheng G, Kurita S, Torigian DA et al (2011) Current status of sentinel lymph-node biopsy in patients with breast cancer. Eur J Nucl Med Mol Imaging 38(3):562–575. doi:10.1007/s00259-010-1577-z CrossRefPubMed

Gangi A, Essner R, Giuliano AE (2014) Long-term clinical impact of sentinel lymph node biopsy in breast cancer and cutaneous melanoma. Q J Nucl Med Mol Imaging 58(2):95–104PubMed

Bats AS, Mathevet P, Buenerd A et al (2013) The sentinel node technique detects unexpected drainage pathways and allows nodal ultrastaging in early cervical cancer: insights from the multicenter prospective SENTICOL study. Ann Surg Oncol 20(2):413–422. doi:10.1245/s10434-012-2597-7 CrossRefPubMed

Cibula D, Oonk MHM, Abu-Rustum NR (2015) Sentinel lymph node biopsy in the management of gynecologic cancer. Curr Opin Obstet Gynecol 27(1):66–72. doi:10.1097/GCO.0000000000000133 CrossRefPubMed

Altgassen C, Hertel H, Brandstadt A et al (2008) Multicenter validation study of the sentinel lymph node concept in cervical cancer: AGO Study Group. J Clin Oncol 26(18):2943–2951. doi:10.1200/JCO.2007.13.8933 CrossRefPubMed

Ballester M, Dubernard G, Lécuru F et al (2011) Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol 12(5):469–476. doi:10.1016/S1470-2045(11)70070-5 CrossRefPubMed

der Zee Van, Ate GJ, Oonk MH, Hullu De, Joanne A et al (2008) Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol 26(6):884–889. doi:10.1200/JCO.2007.14.0566 CrossRefPubMed

Levenback CF, Ali S, Coleman RL et al (2012) Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study. J Clin Oncol 30(31):3786–3791. doi:10.1200/JCO.2011.41.2528 CrossRefPubMedPubMedCentral

Barlin JN, Khoury-Collado F, Kim CH et al (2012) The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. Gynecol Oncol 125(3):531–535. doi:10.1016/j.ygyno.2012.02.021 CrossRefPubMed

10.

Onkologie L (2014) (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Diagnostik, Therapie und Nachsorge der Patientin mit Zervixkarzinom, Langversion, 1.0, AWMF-Registernummer: 032/033OL. http://leitlinienprogramm-onkologie.de/Leitlinien.7.0.html (Stand: 04.07.2016)

11.

Schnurch HG, Ackermann S, Alt CD et al. (2016) Diagnosis, Therapy and Follow-up Care of Vulvar Cancer and its Precursors. Guideline of the DGGG and DKG (S2k-Level, AWMF Registry Number 015/059, November 2015. Geburtshilfe Frauenheilkd 76(10):1035–1049. doi: 10.1055/s-0042-103728

12.

Levenback C, Burke TW, Gershenson DM et al (1994) Intraoperative lymphatic mapping for vulvar cancer. Obstet Gynecol 84(2):163–167PubMed

13.

te Grootenhuis NC, van der Zee A, van Doorn HC et al (2016) Sentinel nodes in vulvar cancer: long-term follow-up of the GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V) I. Gynecol Oncol 140(1):8–14. doi:10.1016/j.ygyno.2015.09.077 CrossRef

14.

Oonk MH, van Hemel BM, Hollema H et al (2010) Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-V, a multicentre observational study. Lancet Oncol 11(7):646–652. doi:10.1016/S1470-2045(10)70104-2 CrossRefPubMed

15.

Klapdor R, Hertel H, Soergel P et al (2016) Groin recurrences in node negative vulvar cancer patients after sole sentinel lymph node dissection. Int J Gynecol Cancer. doi:10.1097/IGC.0000000000000860

16.

Lecuru F, Mathevet P, Querleu D et al (2011) Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol 29(13):1686–1691. doi:10.1200/JCO.2010.32.0432 CrossRefPubMed

17.

Horn L-C, Hentschel B, Fischer U et al (2008) Detection of micrometastases in pelvic lymph nodes in patients with carcinoma of the cervix uteri using step sectioning: frequency, topographic distribution and prognostic impact. Gynecol Oncol 111(2):276–281. doi:10.1016/j.ygyno.2008.07.017 CrossRefPubMed

18.

Erkanli S, Bolat F, Seydaoglu G (2011) Detection and importance of micrometastases in histologically negative lymph nodes in endometrial carcinoma. Eur J Gynaecol Oncol 32(6):619–625PubMed

19.

Slama J, Dundr P, Dusek L et al (2013) High false negative rate of frozen section examination of sentinel lymph nodes in patients with cervical cancer. Gynecol Oncol 129(2):384–388. doi:10.1016/j.ygyno.2013.02.001 CrossRefPubMed

20.

Smith B, Backes F (2015) The role of sentinel lymph nodes in endometrial and cervical cancer. J Surg Oncol 112(7):753–760. doi:10.1002/jso.24022 CrossRefPubMed

21.

Ruscito I, Gasparri ML, Braicu EI et al (2016) Sentinel node mapping in cervical and endometrial cancer: indocyanine green versus other conventional dyes-A meta-analysis. Ann Surg Oncol. doi:10.1245/s10434-016-5236-x

22.

How J, Gotlieb WH, Press JZ et al (2015) Comparing indocyanine green, technetium, and blue dye for sentinel lymph node mapping in endometrial cancer. Gynecol Oncol 137(3):436–442. doi:10.1016/j.ygyno.2015.04.004 CrossRefPubMed

23.

Pandit-Taskar N, Gemignani ML, Lyall A et al (2010) Single photon emission computed tomography SPECT-CT improves sentinel node detection and localization in cervical and uterine malignancy. Gynecol Oncol 117(1):59–64. doi:10.1016/j.ygyno.2009.12.021 CrossRefPubMed

24.

van de Lande J, Torrenga B, Raijmakers PG et al (2007) Sentinel lymph node detection in early stage uterine cervix carcinoma: a systematic review. Gynecol Oncol 106(3):604–613. doi:10.1016/j.ygyno.2007.05.010 CrossRefPubMed

25.

Lennox GK, Covens A (2016) Can sentinel lymph node biopsy replace pelvic lymphadenectomy for early cervical cancer? Gynecol Oncol. doi:10.1016/j.ygyno.2016.08.337 PubMed

26.

Buda A, Crivellaro C, Elisei F et al (2016) Impact of indocyanine green for sentinel lymph node mapping in early stage endometrial and cervical cancer: comparison with conventional radiotracer (99 m)Tc and/or Blue Dye. Ann Surg Oncol 23(7):2183–2191. doi:10.1245/s10434-015-5022-1 CrossRefPubMed

27.

Jewell EL, Huang JJ, Abu-Rustum NR et al (2014) Detection of sentinel lymph nodes in minimally invasive surgery using indocyanine green and near-infrared fluorescence imaging for uterine and cervical malignancies. Gynecol Oncol 133(2):274–277. doi:10.1016/j.ygyno.2014.02.028 CrossRefPubMed

28.

Mucke J, Klapdor R, Schneider M et al (2014) Isthmocervical labelling and SPECT/CT for optimized sentinel detection in endometrial cancer: technique, experience and results. Gynecol Oncol 134(2):287–292. doi:10.1016/j.ygyno.2014.05.001 CrossRefPubMed

29.

Frumovitz M, Bodurka DC, Broaddus RR et al (2007) Lymphatic mapping and sentinel node biopsy in women with high-risk endometrial cancer. Gynecol Oncol 104(1):100–103. doi:10.1016/j.ygyno.2006.07.033 CrossRefPubMed

30.

Burke TW, Levenback C, Tornos C et al (1996) Intraabdominal lymphatic mapping to direct selective pelvic and paraaortic lymphadenectomy in women with high-risk endometrial cancer: results of a pilot study. Gynecol Oncol 62(2):169–173. doi:10.1006/gyno.1996.0211 CrossRefPubMed

31.

ASTEC study group, Kitchener H, Swart AM et al (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): A randomised study. Lancet 373(9658):125–136. doi:10.1016/S0140-6736(08)61766-3 CrossRef

32.

Benedetti Panici P, Basile S, Maneschi F et al (2008) Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100(23):1707–1716. doi:10.1093/jnci/djn397 CrossRefPubMed

33.

Hassanzadeh M, Hosseini FE, Yousefi Z et al (2016) Lymphatic mapping and sentinel node biopsy in ovarian tumors: a study using intra-operative Tc-99m-Phytate and lymphoscintigraphy imaging. J Ovarian Res 9(1):55. doi:10.1186/s13048-016-0265-4 CrossRefPubMedPubMedCentral

34.

Panici PB, Maggioni A, Hacker N et al (2005) Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomized clinical trial. J Natl Cancer Inst 97(8):560–566. doi:10.1093/jnci/dji102 CrossRefPubMed

35.

Khoury-Collado F, Glaser GE, Zivanovic O et al (2009) Improving sentinel lymph node detection rates in endometrial cancer: how many cases are needed? Gynecol Oncol 115(3):453–455. doi:10.1016/j.ygyno.2009.08.026 CrossRefPubMed

36.

Azghadi S, Daly M, Mayadev J (2016) Practice patterns of radiation field design for sentinel lymph node-positive early-stage breast cancer. Clin Breast Cancer. doi:10.1016/j.clbc.2016.05.009 PubMed

37.

Mammary Fold Academic and Research Collaborative (2016) Variation in the management of ductal carcinoma in situ in the UK: results of the mammary fold national practice survey. Eur J Surg Oncol 42(8):1153–1161. doi:10.1016/j.ejso.2016.05.024 CrossRef

38.

Vugts G, Maaskant-Braat AJG, de Roos WK et al (2016) Management of the axilla after neoadjuvant chemotherapy for clinically node positive breast cancer: a nationwide survey study in The Netherlands. Eur J Surg Oncol 42(7):956–964. doi:10.1016/j.ejso.2016.03.023 CrossRefPubMed

Title: Application of sentinel lymph node dissection in gynecological cancers: results of a survey among German hospitals
Authors: Rüdiger Klapdor
Hermann Hertel
Philipp Soergel
Matthias Jentschke
Peter Hillemanns
Publication date: 01-03-2017
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 3/2017
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-016-4279-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Application of sentinel lymph node dissection in gynecological cancers: results of a survey among German hospitals

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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