For a study, researchers sought to look at the patterns, features, and oncologic outcomes of sentinel lymph node biopsy for early endometrial cancer. From 2003 to 2018, the observational study examined 83,139 women with endometrial cancer who underwent primary hysterectomy with nodal assessment for T1 disease from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. The primary outcome measures were temporal trends in sentinel lymph node biopsy usage and patient variables related to sentinel lymph node biopsy use, as assessed by multivariable binary logistic regression models. Endometrial cancer-specific mortality linked with sentinel lymph node biopsy was examined as a secondary outcome measure using propensity score inverse probability of treatment weighting.
From 2005 to 2018, the use of sentinel lymph node biopsy grew from 0.2 to 29.7% (P<.001). Endometrioid histologic subtypes had a greater rate of uptake (0.3–31.6% between 2005 and 2018) than non endometrioid histologic subtypes (0.6–21.0% between 2006 and 2018) (both P<.001). In a recent year of surgery, endometrioid histology, well-differentiated tumors, T1a disease, and smaller tumor size were all independently linked with sentinel lymph node biopsy utilization (P<.05). Endometrial cancer-specific mortality was not enhanced by sentinel lymph node biopsy as compared to lymphadenectomy for endometrioid tumors (subdistribution hazard ratio [HR] 0.96, 95% CI 0.82–1.13) or non-endometrioid tumors (subdistribution HR 0.85, 95% CI 0.69–1.04). The rise in sentinel lymph node biopsy led to a 15.3 percentage point (1.4-fold) increase in surgical nodal assessment for low-risk endometrial cancer by 2018 (expected vs observed rates, 37.8 vs 53.1%).
In the United States, the landscape of surgical nodal examination was evolving from lymphadenectomy to sentinel lymph node biopsy for early endometrial cancer, with no evidence of a deleterious effect on cancer-specific survival.