Эффективность биопсии сигнальных лимфатических узлов у больных раком эндометрия промежуточного риска: результаты трехлетних наблюдений

Efficacy of Sentinel Lymph Node Biopsy in Patients with Intermediate-Risk Endometrial Cancer: Results of a Three-Year Follow-Up. (2026). Voprosy Onkologii, 72(2), OF-2611. https://doi.org/10.37469/0507-3758-2026-72-2-OF-2611

Abstract

Introduction. The incidence of lymph node metastasis in intermediate-risk endometrial cancer (EC) is no more than 10 %. This low rate has made the extent of lymphadenectomy a subject of debate, prompting the present study.

Aim. To evaluate the efficacy of sentinel lymph node biopsy (SLNB) using the fluorescent tracer indocyanine green (ICG) for the surgical staging of intermediate-risk EC.

Materials and Methods. The study included 104 patients with intermediate-risk EC treated at the Department of Oncogynecology, N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia, between January 2022 and September 2025. Patients were randomized 1:1 into two groups: Group 1 (n = 51, 49 %) underwent hysterectomy with adnexectomy plus SLNB; Group 2 (n = 53, 51 %) underwent the same procedure plus systematic lymphadenectomy (pelvic ± para-aortic). Sentinel lymph nodes were examined in total using ultrastaging. Adjuvant therapy was administered as part of combined treatment after surgery, and disease status was monitored in accordance with clinical guidelines of the Ministry of Health of the Russian Federation.

Results. Metastases to regional lymph nodes were detected in 8 (7.7 %) of 104 patients post-surgery, leading to disease restaging and intensification of adjuvant therapy. No recurrences were recorded in this node-positive cohort during follow-up. Metastases were confirmed by SLNB in 7 (6.7 %) patients and by systematic lymphadenectomy in 1 (0.9 %) patient. Among the remaining pN0 patients, 5 (4.8 %) cases of disease recurrence were observed during follow-up: 2 of 51 (3.9 %) in the SLNB group and 3 of 53 (5.7 %) in the systematic lymphadenectomy group.

Conclusion. The development of recurrence was primarily associated with the presence of risk factors (such as lymphovascular space invasion), the type of adjuvant therapy administered, and molecular profile (MMRd, p53abn, NSMP), rather than with the extent of lymph node dissection. At the same time, the use of SLNB resulted in a significant, statistically confirmed reduction in the incidence of specific postoperative complications (e.g., lymphocyst formation, lymphedema) compared with systematic lymphadenectomy.

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