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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2020 Feb 18

DOI: 10.23736/S1824-4785.20.03246-X


language: English

Predictive factors of preoperative sentinel lymph node detection in intermediate and high-risk endometrial cancer

Martina A. ANGELES 1, 2 , Federico MIGLIORELLI 3, Luisa F. LEÓN RAMÍREZ 4, Cristina ROS 1, Andrés PERISSINOTTI 5, 6, Andrés TAPIAS 5, Sebastián CASANUEVA-ELICEIRY 5, Jaume PAHISA 1, 7, Aureli TORNÉ 1, 7, Sergi VIDAL- SICART 5, 7, Marta DEL PINO 1, 7, Pilar PAREDES 5, 7

1 Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Barcelona, Spain; 2 Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France; 3 Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal des Vallées de l’Ariège, St Jean de Verges, France; 4 Nuclear Medicine Department, Hospital Rey Juan Carlos, Madrid, Spain; 5 Department of Nuclear Medicine, Hospital Clínic of Barcelona, Barcelona, Spain; 6 Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER- BBN), Barcelona, Spain; 7 Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain


BACKGROUND: In endometrial cancer (EC), sentinel lymph node (SLN) mapping has emerged as an alternative to systematic lymphadenectomy. Little is known about factors that might influence SLN preoperative detection. The aim of our study is to evaluate the clinical and technical variables that may influence on the success of SLN detection in preoperative lymphatic mapping in patients with intermediate and high-risk EC when performing Transvaginal Ultrasound-guided Myometrial Injection of Radiotracer (TUMIR).
METHODS: Between March 2006 and March 2017, we prospectively enrolled patients with histologically confirmed EC with intermediate or high-risk of lymphatic involvement. All women underwent SLN detection by using TUMIR approach. After radiotracer injection, pelvic and abdominal planar and SPECT/CT images were acquired to obtain a preoperative lymphoscintigraphic mapping. Pattern of drainage was registered and analyzed to identify the factors directly involved in drainage. Sonographer learning curves to perform TUMIR approach were created following Cumulative Sum and Wright methods. Univariate and multivariate analyses were performed using logistic regression.
RESULTS: During study period, 123 patients were included. SLN preoperative detection rate was 70.7%. Age under 75 years at diagnosis (p<0.01), radiotracer injection above 4ml -high- volume- (p<0.01), and tumoral size below 2 cm (p=0.04) were associated with higher SLN preoperative detection rate. Twenty-five procedures were necessary to attain an adequate performance in TUMIR approach.
CONCLUSIONS: The higher SLN preoperative detection rate in women with intermediate and high-risk endometrial cancer after TUMIR approach was related with younger age, smaller tumors and high-volume injection of radiotracer. Sonographers are required to perform 25 procedures before acquiring an expertise in radiotracer injection.

KEY WORDS: Influencing factors; Learning curve; Lymphoscintigraphic mapping; TUMIR; Ultrasound radiotracer injection

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