Sentinel lymph node biopsy decreases lymphedema for patients with endometrial cancer

June 26, 2021

A study by Mayo Clinic Gynecologic Oncology, published in 2021 in the International Journal of Gynecological Cancer, found that using sentinel lymph node biopsy (SLNB) instead of lymphadenectomy to stage endometrial cancer led to significantly lower rates of lower extremity lymphedema.

The study's findings

The study included consecutive patients who received minimally invasive staging surgery for recently diagnosed endometrial cancer at Mayo Clinic's campus in Rochester, Minnesota, between January 2009 and June 2016. Investigators sent a 13-question survey developed at Mayo Clinic to screen for lower extremity lymphedema and confirm any diagnoses of the condition.

Data from a total of 378 patients were analyzed. Of these patients, 127 (33.5%) underwent SLNB, and 251 (66.4%) had bilateral lymphadenectomy either before SLNB became Mayo Clinic protocol or as an SLNB fallback option. Overall, the prevalence of lower extremity lymphedema in all women studied was 41.5% (157 of 378 patients). Notably, the lymphadenectomy cohort had a significantly higher rate of lower extremity lymphedema, at 49.4%. The researchers found a 26.0% rate of lower extremity lymphedema in the SLNB cohort, which Gretchen E. Glaser, M.D., a gynecologic oncologist at Mayo Clinic's campus in Rochester, Minnesota, and study first author, considers baseline risk.

The research team's adjusted odds ratio for lymphedema development based on staging method was 2.75 in a multivariable analysis adjusted for patient BMI, congestive heart failure, diabetes, International Federation of Gynecology and Obstetrics grade, and having received external beam radiation.

This adds to the knowledge contributed previously with the FIRES trial findings published in The Lancet Oncology in March 2017, which showed both sensitivity and predictability for staging endometrial cancer with SLNB.

The findings and impact for patients

Dr. Glaser is thrilled with the results because of what it means for patients with endometrial cancer. She notes that now, there is not only efficacy data standing behind SLNB but also data to show the lack of SLNB-related lymphedema risk in these patients. Dr. Glaser indicates she was not surprised by the results. "Anecdotally, that's what we thought — that risk of lymphedema was much lower with sentinel lymph node biopsy than lymphadenectomy," she says. "But this helps us counsel patients with evidence."

Dr. Glaser says there are very few disadvantages to SLNB for endometrial cancer staging. However, there are significant benefits:

  • The procedure has 97% sensitivity to detect node-positive disease
  • The negative predictive value is 99.6%

"These are fantastic results," says Dr. Glaser. "Sentinel lymph node biopsy is really acceptable when weighing risks and benefits."

Mayo Clinic started performing SLNB in late 2013 and uses it to stage essentially all patients with endometrial cancer. Dr. Glaser says most major medical institutions are performing SLNB now. However, not all hospitals are using SLNB. She explains that there may be issues with lack of proper equipment and less experience with the SLNB procedure.

The findings in light of endometrial cancer's cure rate

There are great outcomes for endometrial cancer currently, according to Dr. Glaser. A very high proportion of patients have no cancer outside the uterus, and it's highly curable with surgery. "Most people with endometrial cancer who undergo treatment do not die of their disease," says Dr. Glaser.

In light of the fact that patients with endometrial cancer may live long lives cancer-free after surgery, quality of life takes on greater meaning, she indicates. In the past, when standard therapy included full lymphadenectomy, patients sometimes experienced lymphedema, which is chronic.

"Lymphedema really affects patients' quality of life, with ongoing treatments and symptoms such as limb size changes, pain, itching and infections," says Dr. Glaser. "Now we can really preserve their quality of life and get them back to their usual activities with fewer side effects. This is huge: a real benefit to women with this disease."

Overcoming barriers for endometrial cancer care

Dr. Glaser says she sometimes hears about patients who are hesitant to travel as far as Rochester, Minnesota, for endometrial cancer care.

Dr. Glaser suggests that it can be worth the temporary inconvenience of travel to a large academic medical center like Mayo Clinic, where endometrial cancer treatment is common and not the exception, and gynecologic oncologists can work for the best possible outcome with minimal complications, especially those that will have potential lifelong impact.

For more information

Glaser GE, et al. Reduced lymphedema after sentinel lymph node biopsy versus lymphadenectomy for endometrial cancer. International Journal of Gynecological Cancer. 2021;31:85.

Rossi EC, et al. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): A multicentre, prospective, cohort study. The Lancet Oncology. 2017;18:384.