Possible Approaches to SentinelNode Detection in Women with Endometrial Cancer: Pilot Study

Overview

Objective:
The aim of the pilot study was to determine the feasiblity of different techniques ofintraoperative lymphatic mapping as a mens of identifying sentinel nodes in endometrial cancerpatients and to develop preliminary experience with the techniques.Design: A prospective pilot study.Setting: Department of Obstetrics and Gynaecology and Department of Nuclear Medicine, Medicalfaculty, Palacky University, Olomouc, CR.Methods: Eleven women with endometrial cancer were entered on this pilot study. In the firstgroup of five patients isosulfan blue dye (2,0 ml) was instilled through the cervical cannula intothe endometrial cavity after the tube ligation. In the second group of five patients isosulfan bluedye (2,0 ml) was injected into the subserosal myometrium at three sites of the fundus. 15 minutesafter the blue dye instillation dye uptake into lymphatic channels was observed in both groups. Inone patient with diagnostic hysteroscopy for suspect endometrial cancer, transcervical submu-cous injection of 100 MBq99mTc-nanocolloid under ultrasonic control was performed. Three lym-phoscintigrams (20, 30 and 40 minutes after injection) were taken.Results: In the first group no dye staining lymphatic channels or lymph nodes were seen. In thesecond group lymphatic channels coursing into the broad ligament were identified. Deposition of dye into lymph nodes was seen in 2 (40%) cases. These nodes were always located in superficialobturator sites bilateraly. In one patient with transcervical submucous injection of 100 MBq99mTc-nanocolloid, separate lymphatic channels along the ovarian vessels and uterine artery wereidentified. Sentinel nodes were depicted in the superficial obturatory, common iliac and paraaor-tic sites on the scan at 20 minutes post injection. Nodes of second, third and other echelon werevisualized on the scintigram 40 minutes post injection.Conclusions: Instillation of isosulfan blue dye into endometrial cavity after tube ligation did notshow any dye uptake in lymphatic channels. Intraoperative lymphatic mapping with injection ofisosulfan blue dye into uterine fundus is feasible in some women. Transcervical submucous injection of99mTc-nanocolloid can serve as an alternate approach in the uterine sentinel nodes detection. The techniques are clearly in a developmental stage and will evolve by exploring differentapproaches.

Key words:
endometrial cancer, sentinel nodes, intraoperative lymphatic mapping, lymphoscintig-raphy