Sentinel lymph node biopsy in atypical endometrial hyperplasia: impact on staging and adjuvant treatment.
Source: PubMed, NCBI / U.S. National Library of Medicine
This study aimed to evaluate the rate of concurrent endometrial cancer and lymph node metastases in patients undergoing hysterectomy with or without sentinel lymph node biopsy (SLNB) for atypical endometrial hyperplasia (AEH), and to assess the potential impact of lymph node evaluation on adjuvant treatment decisions. Retrospective analysis of 136 patients with a preoperative diagnosis of AEH who underwent hysterectomy with (SLN Group, n = 91) or without (non-SLN Group, n = 45) SLNB between January 2014 and June 2024 at a single institution. The primary endpoint was the rate of upstaging to endometrial cancer and the detection of lymph node metastases. The secondary endpoint was the impact on adjuvant therapy recommendations. At final histopathology, 38.2% of patients were upstaged to endometrial cancer (42.9% in the SLN Group vs. 28.9% in the non-SLN Group; p = 0.108). Among patients who underwent SLNB, the overall detection rate was 91.2% with successful bilateral mapping in 71.4% of cases. Lymph node metastases were detected in 3 patients (3.3% of the SLN Group; 2.2% of the overall AEH cohort): 2 macrometastases and 1 micrometastasis. Of the 52 patients diagnosed with endometrial cancer, 15.4% received adjuvant therapy per international guidelines. The addition of SLNB was not associated with a significant increase in perioperative complications. In this single-institution retrospective series, SLNB proved technically feasible and safe in pati
Abstract
This study aimed to evaluate the rate of concurrent endometrial cancer and lymph node metastases in patients undergoing hysterectomy with or without sentinel lymph node biopsy (SLNB) for atypical endometrial hyperplasia (AEH), and to assess the potential impact of lymph node evaluation on adjuvant treatment decisions. Retrospective analysis of 136 patients with a preoperative diagnosis of AEH who underwent hysterectomy with (SLN Group, n = 91) or without (non-SLN Group, n = 45) SLNB between January 2014 and June 2024 at a single institution. The primary endpoint was the rate of upstaging to endometrial cancer and the detection of lymph node metastases. The secondary endpoint was the impact on adjuvant therapy recommendations. At final histopathology, 38.2% of patients were upstaged to endometrial cancer (42.9% in the SLN Group vs. 28.9% in the non-SLN Group; p = 0.108). Among patients who underwent SLNB, the overall detection rate was 91.2% with successful bilateral mapping in 71.4% of cases. Lymph node metastases were detected in 3 patients (3.3% of the SLN Group; 2.2% of the overall AEH cohort): 2 macrometastases and 1 micrometastasis. Of the 52 patients diagnosed with endometrial cancer, 15.4% received adjuvant therapy per international guidelines. The addition of SLNB was not associated with a significant increase in perioperative complications. In this single-institution retrospective series, SLNB proved technically feasible and safe in patients undergoing surgery for AEH, achieving a high detection rate. Lymph node metastases were identified in a small proportion of cases (3.3%), and SLNB provided staging information that influenced adjuvant treatment in a subset of patients. Due to the study's retrospective design, limited sample size, and group non-comparability, these findings are hypothesis-generating rather than conclusive. Prospective studies are needed to define the role and patient selection criteria for SLNB in AEH.