Factors influencing the adoption of the sentinel lymph node technique for endometrial cancer staging

an international survey of gynecologic oncologists

Jvan Casarin, Francesco Multinu, Nadeem Abu-Rustum, David Cibula, William Arthur Cliby, Fabio Ghezzi, Mario Leitao, Ikuo Konishi, Joo Hyun Nam, Denis Querleu, Pamela T. Soliman, Kathleen J Yost, Amy L. Weaver, Andrea Mariani, Gretchen E. Glaser

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVE: To explore the factors influencing adoption of the sentinel lymph node (SLN) technique for endometrial cancer staging among gynecologic oncologists. METHODS: A self-administered, web-based survey was sent via email (April 20 through May 21, 2017) to all members of European Society of Gynecologic Oncologists, International Gynecologic Cancer Society, and Society of Gynecologic Oncologists. Surgical and pathologic practices related to SLN and reasons for not adopting this technique were investigated. RESULTS: Overall, 489 attending physicians or consultants in gynecologic oncology from 69 countries responded: 201 (41.1%), 118 (24.1%), and 117 (23.9%) from Europe, the USA, and other countries, respectively (10.8% did not report a country). SLN was adopted by 246 (50.3%) respondents, with 93.1% injecting the cervix and 62.6 % using indocyanine green dye. The National Comprehensive Cancer Network SLN algorithm was followed by 160 (65.0%) respondents (USA 74.4%, Europe 55.4%, other countries 71.4%). However, 66.7% completed a backup lymphadenectomy in high-risk patients. When SLN biopsy revealed isolated tumor cells, 13.8% of respondents recommended adjuvant therapy. This percentage increased to 52% if micrometastases were detected. Among the 243 not adopting SLN, 50.2% cited lack of evidence and 45.3% stated that inadequate instrumentation fueled their decisions. CONCLUSIONS: SLN with a cervical injection is gaining widespread acceptance for staging of endometrial cancer among gynecologic oncologists worldwide. Standardization of the surgical approach with the National Comprehensive Care Network algorithm is applied by most users. Management of isolated tumor cells and the role of backup lymphadenectomy for 'high-risk' cases remain areas of investigation.

Original languageEnglish (US)
Pages (from-to)60-67
Number of pages8
JournalInternational journal of gynecological cancer : official journal of the International Gynecological Cancer Society
Volume29
Issue number1
DOIs
StatePublished - Jan 1 2019

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Neoplasm Staging
Endometrial Neoplasms
Lymph Node Excision
Sentinel Lymph Node Biopsy
Neoplasms
Neoplasm Micrometastasis
Indocyanine Green
Consultants
Cervix Uteri
Surveys and Questionnaires
Oncologists
Sentinel Lymph Node
Coloring Agents
Physicians
Injections

Keywords

  • endometrial cancer
  • lymphadenectomy
  • minimally invasive surgery
  • sentinel lymph node
  • survey

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Factors influencing the adoption of the sentinel lymph node technique for endometrial cancer staging : an international survey of gynecologic oncologists. / Casarin, Jvan; Multinu, Francesco; Abu-Rustum, Nadeem; Cibula, David; Cliby, William Arthur; Ghezzi, Fabio; Leitao, Mario; Konishi, Ikuo; Nam, Joo Hyun; Querleu, Denis; Soliman, Pamela T.; Yost, Kathleen J; Weaver, Amy L.; Mariani, Andrea; Glaser, Gretchen E.

In: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, Vol. 29, No. 1, 01.01.2019, p. 60-67.

Research output: Contribution to journalArticle

Casarin, Jvan ; Multinu, Francesco ; Abu-Rustum, Nadeem ; Cibula, David ; Cliby, William Arthur ; Ghezzi, Fabio ; Leitao, Mario ; Konishi, Ikuo ; Nam, Joo Hyun ; Querleu, Denis ; Soliman, Pamela T. ; Yost, Kathleen J ; Weaver, Amy L. ; Mariani, Andrea ; Glaser, Gretchen E. / Factors influencing the adoption of the sentinel lymph node technique for endometrial cancer staging : an international survey of gynecologic oncologists. In: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2019 ; Vol. 29, No. 1. pp. 60-67.
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abstract = "OBJECTIVE: To explore the factors influencing adoption of the sentinel lymph node (SLN) technique for endometrial cancer staging among gynecologic oncologists. METHODS: A self-administered, web-based survey was sent via email (April 20 through May 21, 2017) to all members of European Society of Gynecologic Oncologists, International Gynecologic Cancer Society, and Society of Gynecologic Oncologists. Surgical and pathologic practices related to SLN and reasons for not adopting this technique were investigated. RESULTS: Overall, 489 attending physicians or consultants in gynecologic oncology from 69 countries responded: 201 (41.1{\%}), 118 (24.1{\%}), and 117 (23.9{\%}) from Europe, the USA, and other countries, respectively (10.8{\%} did not report a country). SLN was adopted by 246 (50.3{\%}) respondents, with 93.1{\%} injecting the cervix and 62.6 {\%} using indocyanine green dye. The National Comprehensive Cancer Network SLN algorithm was followed by 160 (65.0{\%}) respondents (USA 74.4{\%}, Europe 55.4{\%}, other countries 71.4{\%}). However, 66.7{\%} completed a backup lymphadenectomy in high-risk patients. When SLN biopsy revealed isolated tumor cells, 13.8{\%} of respondents recommended adjuvant therapy. This percentage increased to 52{\%} if micrometastases were detected. Among the 243 not adopting SLN, 50.2{\%} cited lack of evidence and 45.3{\%} stated that inadequate instrumentation fueled their decisions. CONCLUSIONS: SLN with a cervical injection is gaining widespread acceptance for staging of endometrial cancer among gynecologic oncologists worldwide. Standardization of the surgical approach with the National Comprehensive Care Network algorithm is applied by most users. Management of isolated tumor cells and the role of backup lymphadenectomy for 'high-risk' cases remain areas of investigation.",
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T2 - an international survey of gynecologic oncologists

AU - Casarin, Jvan

AU - Multinu, Francesco

AU - Abu-Rustum, Nadeem

AU - Cibula, David

AU - Cliby, William Arthur

AU - Ghezzi, Fabio

AU - Leitao, Mario

AU - Konishi, Ikuo

AU - Nam, Joo Hyun

AU - Querleu, Denis

AU - Soliman, Pamela T.

AU - Yost, Kathleen J

AU - Weaver, Amy L.

AU - Mariani, Andrea

AU - Glaser, Gretchen E.

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N2 - OBJECTIVE: To explore the factors influencing adoption of the sentinel lymph node (SLN) technique for endometrial cancer staging among gynecologic oncologists. METHODS: A self-administered, web-based survey was sent via email (April 20 through May 21, 2017) to all members of European Society of Gynecologic Oncologists, International Gynecologic Cancer Society, and Society of Gynecologic Oncologists. Surgical and pathologic practices related to SLN and reasons for not adopting this technique were investigated. RESULTS: Overall, 489 attending physicians or consultants in gynecologic oncology from 69 countries responded: 201 (41.1%), 118 (24.1%), and 117 (23.9%) from Europe, the USA, and other countries, respectively (10.8% did not report a country). SLN was adopted by 246 (50.3%) respondents, with 93.1% injecting the cervix and 62.6 % using indocyanine green dye. The National Comprehensive Cancer Network SLN algorithm was followed by 160 (65.0%) respondents (USA 74.4%, Europe 55.4%, other countries 71.4%). However, 66.7% completed a backup lymphadenectomy in high-risk patients. When SLN biopsy revealed isolated tumor cells, 13.8% of respondents recommended adjuvant therapy. This percentage increased to 52% if micrometastases were detected. Among the 243 not adopting SLN, 50.2% cited lack of evidence and 45.3% stated that inadequate instrumentation fueled their decisions. CONCLUSIONS: SLN with a cervical injection is gaining widespread acceptance for staging of endometrial cancer among gynecologic oncologists worldwide. Standardization of the surgical approach with the National Comprehensive Care Network algorithm is applied by most users. Management of isolated tumor cells and the role of backup lymphadenectomy for 'high-risk' cases remain areas of investigation.

AB - OBJECTIVE: To explore the factors influencing adoption of the sentinel lymph node (SLN) technique for endometrial cancer staging among gynecologic oncologists. METHODS: A self-administered, web-based survey was sent via email (April 20 through May 21, 2017) to all members of European Society of Gynecologic Oncologists, International Gynecologic Cancer Society, and Society of Gynecologic Oncologists. Surgical and pathologic practices related to SLN and reasons for not adopting this technique were investigated. RESULTS: Overall, 489 attending physicians or consultants in gynecologic oncology from 69 countries responded: 201 (41.1%), 118 (24.1%), and 117 (23.9%) from Europe, the USA, and other countries, respectively (10.8% did not report a country). SLN was adopted by 246 (50.3%) respondents, with 93.1% injecting the cervix and 62.6 % using indocyanine green dye. The National Comprehensive Cancer Network SLN algorithm was followed by 160 (65.0%) respondents (USA 74.4%, Europe 55.4%, other countries 71.4%). However, 66.7% completed a backup lymphadenectomy in high-risk patients. When SLN biopsy revealed isolated tumor cells, 13.8% of respondents recommended adjuvant therapy. This percentage increased to 52% if micrometastases were detected. Among the 243 not adopting SLN, 50.2% cited lack of evidence and 45.3% stated that inadequate instrumentation fueled their decisions. CONCLUSIONS: SLN with a cervical injection is gaining widespread acceptance for staging of endometrial cancer among gynecologic oncologists worldwide. Standardization of the surgical approach with the National Comprehensive Care Network algorithm is applied by most users. Management of isolated tumor cells and the role of backup lymphadenectomy for 'high-risk' cases remain areas of investigation.

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