Aim of the study: to investigate the incidence of non-mapped isolated metastatic pelvic lymph nodes at pre-defined anatomical positions. Patients and Methods: Between June 2019 and January 2024, women with uterine-confined endometrial cancer (EC) deemed suitable for robotic surgery and the detection of pelvic sentinel nodes (SLNs) were included. An anatomically based, published algorithm utilizing indocyanine green (ICG) as a tracer was adhered to. In women where no ICG mapping occurred in either the proximal obturator and/or the interiliac positions, defined as “typical positions”, those nodes were removed and designated as “SLN anatomy”. Ultrastaging and immunohistochemistry were applied to all SLNs. The proportion of isolated metastatic “SLN anatomy” was evaluated. Results: A non-mapping of either the obturator or interiliac area occurred in 180 of the 620 women (29%). In total, 114 women (18.4%) were node-positive and five of these women (4.3%) had isolated metastases in an “SLN anatomy”, suggesting a similar lower sensitivity of the ICG-only algorithm. Conclusion: In an optimized SLN algorithm for endometrial cancer, to avoid undetected nodal metastases in 4.3% of node-positive women, if mapping fails in either the proximal obturator or interiliac area, nodes should be removed from those defined anatomic positions, despite mapping at other positions.
研究目的：探讨在预定解剖位置未显影的孤立性盆腔淋巴结转移的发生率。患者与方法：纳入2019年6月至2024年1月期间适合接受机器人手术且检测到盆腔前哨淋巴结（SLN）的子宫局限性子宫内膜癌（EC）女性患者。采用已发表的基于解剖结构的吲哚菁绿（ICG）示踪剂算法。对于近端闭孔区和/或髂间区（定义为“典型位置”）未出现ICG显影的患者，切除该位置淋巴结并标记为“前哨淋巴结解剖位置”。对所有前哨淋巴结进行超分期和免疫组化检测。评估孤立性转移的“前哨淋巴结解剖位置”比例。结果：在620例女性患者中，180例（29%）出现闭孔区或髂间区未显影。总计114例（18.4%）患者淋巴结阳性，其中5例（4.3%）在“前哨淋巴结解剖位置”存在孤立性转移，提示单纯ICG算法的灵敏度较低且相似。结论：在优化的子宫内膜癌前哨淋巴结算法中，为避免4.3%淋巴结阳性患者的淋巴结转移漏诊，若近端闭孔区或髂间区显影失败，即使其他位置显影成功，仍应切除这些定义解剖位置的淋巴结。
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