Sentinel Node Biopsy in Endometrial Cancer
Sentinel Node Biopsy in Endometrial Cancer
The purpose of this study is to determine if there is a difference between the lymphatic
 drainage of the cervix and corpus of the uterus after injecting a radiocolloid in the cervix
 and blue dye in the corpus of the uterus and to investigate the identification rate of
 sentinel nodes using this technique in patients with cancer of the uterus.
About 20 percent of women diagnosed with uterine cancer have spread outside of the uterus,
 mainly to the lymph nodes. If these metastases are recognized these women can still be cured
 with chemotherapy and radiation. Unfortunately different kind of imaging are not very
 sensitive in identifying patients with lymph node metastases and currently a complete removal
 of the lymph nodes in the pelvis and around the aorta is the gold standard diagnostic test.
 Sentinel node biopsy (SLNB) is a surgical technique that aims to identify the nodes that
 drain specifically the area were the tumor is located. A tracer is injected around the tumor
 and then the locoregional lymph nodes are tested for the presence of this tracer (blue dye
 and a radioactive substance). If the sentinel lymph node does not contain cancer, then there
 is a high likelihood that the cancer has not spread to any other area of the body.The
 benefits of doing sentinel node biopsy is that it decreases the potential complications
 associated with the removal of all the lymph nodes. This technique is the standard treatment
 for other cancers as breast cancer and melanoma and is emerging as a promising technique in
 gynecological cancers.

 There is no agreement regarding the best technique to do SLNB in women with uterine cancer
 and this procedure is still at the stage of determining feasibility. Since 1996, there have
 been publications aiming to determine the most appropriate way to do sentinel node in uterine
 cancer. As the uterus cannot be reached preoperatively for tracer injection, the standard
 approach for other tumor sites of preoperative peritumoral injection of Technetium 99
 followed by intraoperative injection of blue dye has needed to be modified. Blue dye with or
 without a radiocolloid have been administered either subserously (the uterus outer layer),
 cervically, dually, and hysteroscopically with a wide range of results in terms of
 identification rates of sentinel nodes. Certain factors as site of injection, volume and
 number of injections, interval time since injection to identification of sentinel nodes and
 surgical approach as laparotomy versus laparoscopy have been associated with the likelihood
 of identifying these nodes.

 This study plans to determine the pattern of lymphatic drainage for the cervix and corpus of
 the uterus by injecting a different tracer in these 2 sites and also to incorporate all
 factors that have been proved to be associated with a better identification rate of sentinel
 nodes in a protocol in order to determine if this technique is feasible and reliable.
Inclusion Criteria:

 1. Women older than 18 years old

 2. Endometrial cancer

 3. Histologies: Grade 2 and 3 endometrioid adenocarcinoma, clear cell and papillary
 serous carcinoma

 4. Suitable candidates for surgery

 5. Clinically stage 1 or confined to the uterus

 Exclusion Criteria:

 1. Grade 1 endometrioid adenocarcinoma

 2. Metastatic disease