20 december 2024, klockan 09:00

Michele Bollino

 

Implications and results of a further developed sentinel lymph node algorithm in  endometrial cancer

Handledare:
Professor Jan Persson, Lunds universitet

Bihandledare:
PhD Celine Aardal Lönnerfors, Lunds universitet
PhD Barbara Geppert, Lunds universitet

Ordförande: Professor Stefan Hansson, Lunds universitet

Opponent
Professor Francesco Fanfani, Rom

Lokal: Föreläsningssalen vån 3, KK, Klinikgatan 12 Lund

Zoom:
https://lu-se.zoom.us/j/63828423594?pwd=12nDxxPp5eVm9wBsh6mOtxJhs1V3l7.1

Mötes-ID: 638 2842 3594 Lösenkod: 012353

VÄLKOMNA!

 

Abstract:
The overall aim was to evaluate and refine a strict anatomically based surgical sentinel node algorithm (SLN) for detection of metastatic pelvic disease in women with uterine confined endometrial cancer (EC).

Study I: To evaluate the sensitivity of the SLN algorithm for detecting pelvic lymph node metastases (LNMs) in women with high-risk endometrial cancer (HREC). The SLN-ICG algorithm achieved a sensitivity of 98% and a bilateral mapping rate of 95%.

Study II: Investigating the locations of metastatic pelvic SLNs along the upper paracervical lymphatic pathway. 95.7% of women with positive pelvic nodes had at least one metastatic SLN located at a typical position.

Study III: Investigating the prevalence and size of pelvic LNMs and their association with risk factors in a cohort of 1045 women with EC. LNM were detected in 1/10 women with presumed low-grade endometrioid uterine stage 1A cancer compared to 5/10 of women with high-grade EC or non-endometroid stage 1B cancer.

Study IV: investigating the incidence of non-mapped isolated pelvic LNMs at pre-defined typical anatomical positions. 4.3% of node positive women had isolated metastases in a “SLN anatomy”.

The initially found high sensitivity of the SLN algorithm was further increased by approximately 5% by adding removal of non-mapped nodes at typical positions despite ICG-mapping at other positions (the Hybrid algorithm). In case of complete non-mapping, a side specific lymphadenectomy can be replaced by a selective removal of nodes at those typical positions further reducing the risk of lymphedema while retaining knowledge on nodal status. The high rates of pelvic nodal metastases in presumed low risk EC strongly indicates that detection of SLNs using the proposed SLN-algorithm should be offered to all women with EC.