Arch Gynecol Obstet (2017) 296:565–570
Subserosal uterine injection of blue dye for the identiﬁcation
of the sentinel node in patients with endometrial cancer:
a feasibility study
· Nikolaos Thomakos
· Ioanna Koutroumpa
· Maria Sotiropoulou
· Aris Antsaklis
· George Vlachos
· Alexandros Rodolakis
Received: 20 April 2017 / Accepted: 18 July 2017 / Published online: 25 July 2017
© Springer-Verlag GmbH Germany 2017
ﬁrst 15 cases; however, this was not the case for the bilat-
eral detection rate.
Conclusion Our study is in accordance with previous
studies of sentinel node in endometrial cancer and further
demonstrates and enhances the conﬁdence in the technique.
In the current era of an ongoing debate on whether a sys-
tematic lymphadenectomy in patients with endometrial
cancer is still necessary, we believe that the sentinel node is
an acceptable alternative and should be applied routinely in
tertiary centres following a strict algorithm.
Keywords Endometrial cancer · Sentinel node ·
Subserosal injection · Detection rate · Sensitivity ·
The surgical management of early stage endometrial can-
cer confers excellent survival results for aﬀected women. A
5-year survival rate of 95% has been reported for the ear-
liest stage and well-diﬀerentiated type . However, the
gynaecological oncology community has not managed to
reach a consensus on the extent of this surgical approach.
A total hysterectomy and bilateral salpingo-oophorectomy
is considered mandatory; however, the need to accurately
stage the disease by performing pelvic and paraaortic
lymph node dissection is still debatable, even in high-
grade type II disease. This uncertainty is mainly based and
supported by the results of two-randomised trials [2, 3],
showing no survival beneﬁt in endometrial cancer patients
undergoing full pelvic and paraaortic lymphadenectomy.
In addition, performing the latter is demanding, requires
advanced surgical skills, and is related to increased morbid-
ity at no clear beneﬁt.
Objective To deﬁne the detection rate, sensitivity, and
negative predictive value (NPV) of the sentinel node tech-
nique in patients with endometrial cancer.
Methods Patients with endometrial cancer after informed
consent underwent subserosal injection of blue dye dur-
ing hysterectomy in a tertiary gynae/oncology department
between 2010 and 2014. The procedure was performed in
all cases by the same team including two gynae/oncolo-
gist consultants and one trainee. All relevant perioperative
clinicopathological characteristics of the population were
recorded prospectively. The identiﬁed sentinel nodes were
removed separately and a completion bilateral pelvic lym-
phadenectomy followed in all cases. Simple statistics were
used to calculate the sensitivity and NPV of the method on
per patient basis.
Results Fifty-four patients were included in this study. At
least one sentinel node was mapped in 46 patients yield-
ing a detection rate of 85.2%. Bilateral detection of senti-
nel nodes was accomplished in only 31 patients (57.4%).
The mean number of sentinel nodes was 2.6 per patient and
the commonest site of identiﬁcation was the external iliac
artery and vein area (66%). Six patients (11%) had a posi-
tive lymph node, and in ﬁve of them, this was the sentinel
one yielding a sensitivity of 83.3% and an NPV of 97.5%.
The overall detection rate improved signiﬁcantly after the
* Ioannis Biliatis
First Department of Gynaecological Oncology, Alexandra
General Hospital, University of Athens, Athens, Greece
Pathology Department, Alexandra Hospital, Athens, Greece
Poole Hospital NHS Trust, Poole, UK