CASE REPORT – OPEN ACCESS International Journal of Surgery Case Reports 4 (2013) 697–699
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Uterine lymphatic drainage is unaffected from injection technique and operators: Identical sentinel node detection in two cases of endometrial cancer Alessandro Buda a,∗ , Federica Elisei b , Carlotta Dolci b , Marco Cuzzocrea a , Rodolfo Milani a a b
Department of Obstetrics and Gynecology, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy Department of Nuclear Medicine, Bioimaging Molecular Centre, San Gerardo Hospital, University of Milan-Bicocca, Milan, Italy
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Article history: Received 15 March 2013 Received in revised form 24 April 2013 Accepted 30 April 2013 Available online 22 May 2013 Keywords: Sentinel node mapping Endometrial cancer Reproducibility
a b s t r a c t INTRODUCTION: Sentinel node (SN) mapping with cervical injection of 99 m-technetium (99 mTc) albumin nanocolloid in early endometrial cancer has been shown to be feasible and data emerging from recent large series support the incorporation of SN mapping algorithm in endometrial cancer staging. PRESENTATION OF CASE: We report two cases of SN mapping which demonstrated identical migration of both radioactive technetium and blue dye in the same patients that were re-injected because surgical intervention was postponed due to transitory cardiac contraindications. DISCUSSION: As clearly demonstrated in cervical cancer, SN mapping through intracervical injection of both radioactive technetium and blue dye seems to be effective and easy to perform, providing good results in patients with endometrial cancer. Our report highlights the reproducibility of SN mapping that has been strongly confirmed in both patients, even if re-injections were performed by different operators. Preoperative SPECT/CT imaging seems to enhance accuracy in SN localization and also improves its intraoperative detection in early endometrial cancer. CONCLUSION: The anatomically defined bilateral uterus drainage strongly confirms the reproducibility of SN mapping, that seems to be unaffected by after injection technique or operators. © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. Open access under CC BY-NC-ND license.
1. Introduction The prognostic relevance of assessing lymphnode status in endometrial cancer is debated, since results from randomized studies have shown no evidence of survival benefit of pelvic lymphadenectomy.1 However the studies did not take in account the role of sentinel nodemapping in reducing the morbidity of lymphadenectomy, whereas identifying the subgroup of patients who will benefit from adjuvant therapy. Sentinel node mapping is a well established practice for breast cancer and melanoma and it’s becoming the standard of care for early vulvar cancer.2 Recently a multicenter study supported the SN biopsy in patients with early endometrial cancer.3 In this report we refer the high reproducibility of the sentinel node technique in two cases of endometrial cancer. 2. Case report Two women in their sixth decade came to our attention with postmenopausal bleeding. Initial evaluation consisted of pelvic ultrasound followed by office hysteroscopy with endometrial
∗ Corresponding author at: Department of Obstetrics and Gynecology, Via Pergolesi, 33, 20900 Monza, MB, Italy. Tel.: +39 0392339434; fax: +39 0392339433. E-mail address:
[email protected] (A. Buda).
biopsy. The pathologic specimens revealed a grade 1 and grade 2 endometriod adenocarcinomas. Magnetic resonance demonstrated infiltration
