الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Endometrial cancer is the fifth most common cancer in women,
accounting for an estimated 320,000 new cases globally each year.
Risk factors for endometrial cancer include advancing age, obesity,
diabetes, nulliparity, late menopause, unopposed estrogen replacement
therapy, and tamoxifen use.
The cornerstone of treatment in most women with endometrial
cancer is surgery, involving a total hysterectomy and bilateral salpingooophorectomy,
with or without a lymph node dissection.
After surgery, women may be offered adjuvant treatment, such as
radiotherapy, chemotherapy, or a combination, based on risk factors for
recurrence, such as stage, age, grade, lymphovascular space involvement,
myometrial invasion, and lymph node status.
One of the main independent predictors of survival is the presence of
lymph node metastases; as such, its identification influences the
administration of adjuvant therapies such as radiotherapy, chemotherapy,
or both.
A comprehensive dissection of the lymph nodes was traditionally
suggested to assess for the presence of extra-uterine disease in patients with
apparent early stage endometrial cancer, whereas the recent European
guidelines recommend systematic removal of pelvic and para-aortic nodes
in patients with high-risk endometrial cancer.
However, when compared with simple hysterectomy, the
performance of lymphadenectomy (pelvic alone or pelvic plus para-aortic)
has been shown to prolong operative time, increase costs, and cause
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adverse effects such as lower-extremity lymphedema and current evidence
showed no benefit of complete lymphadnectomy on patient survival.
Sentinel lymph node (SLN) is defined as the first node to receive
drainage from a primary tumor and is the most likely to harbor metastases
in cancers with lymphatic spread, its assessment is another proposed option
which has gained popularity, and for which there is an increasing amount
of supportive data; in 2018 it was added to the National Comprehensive
Cancer Network guidelines.
The most commonly reported tracer(s) used for SLNB are
radioactive technetium (Tc-99m) with or without visible blue dyes, such as
methylene blue or patent blue, and near infrared fluorescence tracers, such
as indocyanine green (ICG).
This prospective diagnostic accuracy study was conducted at
department of obstetrics and gynecology - Faculty of Medicine - Menoufia
University from September 2019 until July 2022.
A total of 23 women diagnosed to have endometrial carcinoma by
histopathological examination were enrolled. All included women
underwent total hysterectomy either through laparotomy or laparoscopy
with bilateral salpingo-oophorectomy, with or without omentectomy. SLN
mapping was planned based on a surgical algorithm. Women with low-risk
disease underwent SLN mapping with pelvic lymphadenectomy only.
Women with intermediate- and high-risk disease underwent SLN mapping
with pelvic lymphadenectomy with or without para-aortic
lymphadenectomy. The peritoneal cavity was inspected for evidence of
metastatic disease, then the sentinel lymph node was identified and
removed after that a full lymph node dissection was performed. Sentinel
lymph nodes were sent for intraoperative frozen section then all specimens
were sent for standard histopathological examination. Histopathological
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examination of the uterus for detection of the depth of invasion and
correlation of these results with lymphadenectomy was performed during
surgical procedure.
This study aimed to evaluate the diagnostic accuracy and clinical
impact of sentinel lymph node mapping in the management of endometrial
cancer.
Our study reported that, SLNB is an efficient diagnostic tool in the
management of endometrial carcinoma with 87.7% diagnostic accuracy,
81.8% sensitivity, 90.0% specificity, 90.0% PPV and 81.8% NPP.
The strengths of current study were due to every effort was made to
ascertain that all follow-up data were documented, and only complete
information was included in data analysis and all clinical assessment and
assessment of study outcomes were done by the same team.
The limitations of current study were due to relatively small sample
size regarding accuracy of study outcomes and wide spread of COVID 19
pandemic at time of study conduction that interfere with contact with
patients
In conclusion, sentinel lymph node biopsy is an efficient diagnostic
tool in the management of endometrial carcinoma. Retroperitoneal
lymphadenectomy increases the intraoperative and postoperative
complications. Sentinel lymph node mapping has lower costs and higher
quality‑adjusted survival. Also, SLN is the most cost‑effective strategy in
the management of low‑risk ECs. Women staged with SLN mapping were
more likely to receive adjuvant treatment compared with women staged
with systemic lymphadenectomy.