Rolul ganglionului-santinelă în tratamentul actual al cancerului de endometru

Abstract

Introduction. Endometrial cancer is the most prevailing gynecological malignancy in developed countries, with an incidence rising annually. For years, systematic lymphadenectomy had been the preferred method for staging purposes, but a less aggressive approach, with no negative impact on the oncologic outcomes, is the current trend in endometrial cancer management. In this review, we aim to evaluate the role of sentinel lymph node (SLN) mapping as an eligible alternative to complete pelvic lymphadenectomy in the surgical staging process, as well as its influence on the adjuvant treatment options. Materials and method. We analyzed the leading international guidelines regarding sentinel lymph node mapping in endometrial cancer, published between 2018 and 2023, as well as several studies that met the inclusion criteria, from the PubMed database, to outline the recommended surgical techniques, the algorithm, the accuracy, and the advantages of the SLN sampling procedure compared to pelvic lymphadenectomy. Results. Most international guidelines conclude that SLN sampling is the desirable alternative to systematic lymphadenectomy. However, it is agreed that, in case of failed SLN mapping, the radical option consisting in complete pelvic lymphadenectomy is recommended. As far as high-risk patients are concerned, most of the reviewed studies and guidelines encourage the use of SLN mapping in the treatment of endometrial cancer. Our findings revealed high sensitivity and detection rates of SLN mapping, influenced especially by the type of tracer used, indocyanine green having the best outcomes. Conclusions. Considering the high sensitivity and the low morbidity rates of the procedure, SLN mapping is soon to become a gold standard practice for the surgical staging process of endometrial cancer in many gynecologic oncology centers. Thus, SLN mapping represents a viable alternative to complete pelvic lymphadenectomy, acknowledging the principles of minimally invasive surgery and personalized medicine, without compromising the oncologic outcomes.