Sentinel lymph node biopsy (SLNB) may be accurate enough to replace lymphadenectomy for detecting nodal involvement in high-grade endometrial cancer, a prospective cohort study suggested. In the multicenter trial, an SLNB algorithm correctly identified nodal metastases in 26 of 27 node-positive patients, for a sensitivity of 96.3% (95% CI 81.0-99.9%), and node-negative disease in 129 of 130 patients, for a negative predictive value of 99.2% (95% CI 95.8-99.9%), reported Sarah Ferguson, MD, of University Health Network/Sinai Health Systems in Toronto, and colleagues. As described in JAMA Surgery, detection rates with SLNB using indocyanine green were: 97.4% per patient (95% CI 93.6-99.3%) Only one of the 156 women in the trial was misclassified as false-negative — a patient with de-differentiated histology, lymphovascular invasion, and myometrial invasion greater than 50%. “These measures are comparable to those observed for breast cancer and melanoma, for which SLNB has become the standard of care, and suggest that endometrial SLNB has the performance characteristics required to be trialled as a replacement for lymphadenectomy,” Ferguson and co-authors wrote. “The SENTOR study also suggests that SLNB may improve the detection of nodal metastases in ways not captured by traditional calculations of diagnostic accuracy.”

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