Sentinel Node Biopsy in Endometrial Cancer With Dual Cervical and Fundal Indocyanine Green Injection.

PURPOSE: The aim of this study was describe a novel sentinel lymph node (SLN) tracer injection procedure featuring dual cervical and fundal indocyanine green (ICG) injection for endometrial cancer and results of SLN biopsy. METHODS: Between June 26, 2014 and October 31, 2016, 111 patients underwent laparoscopic surgery for endometrial cancer at our institution. In all cases, we performed SLN biopsy with dual cervical and fundal ICG injection. All SLNs were processed with an ultrastaging technique. A total of 69 patients also underwent total pelvic and paraaortic lymphadenectomy. RESULTS: The detection rates were as follows: 92.79% (103/111) overall for SLNs; 89.19% (99/111) overall for pelvic SLNs; 61.26% (68/111) for bilateral SLNs; 59.46% (66/111) for paraaortic SLNs, and 4% (4/111) for isolated paraaortic SLNs. We found macroscopic lymph node metastasis in 11 patients (9.9%) and microdisease in lymph nodes in another 10 patients, raising the overall rate of lymph node involvement to 18.92%. There was 1 false-negative (negative SLN biopsy but positive aortic lymphadenectomy) and another positive case in 1 undetected SLN. The sensitivity of detection was 94.44%, specificity 100%, negative predictive value 97.83%, and negative likelihood ratio 0.06 for intermediate and high-risk endometrial cancer groups. CONCLUSIONS: The SLN biopsy with both cervical and fundal ICG injection offers good overall detection rates and improved mapping of the aortic area. The SLN ultrastaging increases the number of nodes considered positive.

Robotic retroperitoneal paraaortic lymphadenectomy at Donostia University Hospital.

The purpose of this study was to describe our robotic retroperitoneal para-aortic lymphadenectomy technique and its associated outcomes as well as the advantages and disadvantages. We prospectively collected data on all retroperitoneal aortocaval lymphadenectomy procedures performed at Donostia University Hospital from December 2011 to April 2013 using the da Vinci S robotic system (Intuitive Surgical, Sunnyvale,CA). A total of 13 of these procedures were performed. The mean patient age was 60.3 years (SD, 10.18). Most patients were obese with a mean body mass index of 31.95 kg/m(2) (SD, 5), and 9 had endometrial cancer. Five individuals were restaged: 4 because of lymphovascular space invasion and 1 because of lymphovascular space invasion with G3 histology. There were 2 cases of Fédération Internationale de Gynécologie et d'Obstétrique stage IB endometrial cancer: 1 of papillary serous histology and 1 of G3. Two patients had advanced cervical cancer, and 2 had early-stage ovarian cancer. The median para-aortic lymph node yield was 12 (range, 4-21). In 3 patients, it was necessary to convert the procedure to transperitoneal access because of technical difficulties; 1 of these required laparotomy. The mean surgical time was 323 minutes (SD, 58) although this included additional complex procedures. Robotic para-aortic retroperitoneal lymphadenectomy is feasible and offers the advantages of retroperitoneal access.

¿Se puede conocer el tamaño del adenocarcinoma de endometrio con histeroscopia? / Can hysteroscopy determine the size of endometrial adenocarcinoma?

Objetivo. El objetivo de este estudio es conocer la capacidad que tiene la histeroscopia para diagnosticar el tamaño tumoral en el adenocarcinoma de endometrio. Material y métodos. Estudio prospectivo de cohortes de 34 pacientes con diagnóstico de sospecha de adenocarcinoma o de adenocarcinoma realizado en la consulta externa de histeroscopia del Hospital Donostia, en el que se analizan los hallazgos histológicos de los tumores diagnosticados histeroscópicamente como igual o menor de 2cm, como mayor de 2cm, o como difusos. Resultados. La prevalencia de tumores mayores de 2cm fue del 85,29% (intervalo de confianza del 95%, 68,1-94,4). Se diagnosticaron correctamente el 79,41% de las lesiones (IC del 95%, 61,5-90,6). La sensibilidad de la histeroscopia para detectar tumores de más de 2cm fue del 86,21% (IC del 95%, 67,4-95,4), pero su especificidad fue tan solo del 40% (IC del 95%, 7,2-82,9). La razón de probabilidades diagnósticas positivas fue del 89,29% (IC del 95%, 70,6-97,1), multiplicándose por 1,44 la posibilidad de tener un tumor mayor de 2 cm si la prueba era positiva (IC del 95%, 0,69-2,98), mientras que se multiplicaba por 0,34 si la prueba resultaba negativa (IC del 95%, 0,08-1,41). La razón de probabilidades diagnósticas negativa del 33,33% (IC del 95%, 6-75,8). Conclusiones. La histeroscopia tiene un alto valor predictivo positivo para el diagnóstico del tamaño tumoral cuando la lesión es mayor de 2 cm y cuando afecta de manera difusa a la cavidad uterina. Además, no añade coste ni complicaciones en el protocolo diagnóstico del cáncer de endometrio. La histeroscopia puede ser de utilidad en la planificación quirúrgica de la paciente (AU)

Objective. The aim of this study was to assess the value of hysteroscopy in determining tumoral size in endometrial adenocarcinoma. Material and methods. We carried out a prospective cohort study of 34 patients with suspected endometrial adenocarcinoma who underwent outpatient hysteroscopy in Hospital Donostia. Tumors were classified as larger or smaller than 2cm, or diffuse. These classifications were compared with subsequent histopathological results. Results. In our series, 85.29% (95% CI 68.1-94.4) of tumors were>2cm. Hysteroscopy correctly classified 79.41% of the lesions (95% CI 61.5-90.6). The sensitivity of hysteroscopy in correctly classifying tumors>2cm was 86.21% (95% CI 67.4-95.4), but specificity was only 40% (CI 95% 7.2-82.9). The positive diagnostic likelihood ratio was 89.29% (95% CI 70.6-97.1%). The chance of having a tumor>2cm was multiplied by 1.44 if hysteroscopy classified it as such (95% CI 0.62-2.98), and by 0.34 if it did not (95% CI 0.08-1.41). The negative likelihood ratio was 33.33% (95% CI 6-75.8%). Conclusion. Hysteroscopy has a high positive predictive value in diagnosing tumors larger than 2cm or with diffuse involvement of the uterine cavity. This procedure does not involve additional costs or complications to the diagnostic protocol for endometrial cancer and can be highly useful in surgical planning (AU)