Sentinel lymph node biopsy was identified based on the presence of a CPT code for radiopharmaceutical mapping (38792, 38900, 78195, 78800, 78801) or of a hospital charge code for a substance used for sentinel lymph node biopsy (technetium-99, isosulfan blue, patent blue, sulphan blue, or indocyanine green). The cohort was stratified based on performance of lymphadenectomy. To limit the number of women with carcinomatosis, patients who underwent concurrent extended abdominal surgery (small or large bowel resection, splenectomy, diaphragm resection, liver resection, and bladder resection) were excluded. Patients were stratified based on the route of hysterectomy into the following groups: abdominal hysterectomy (ICD-9 68.3, 68.39, 68.4, 68.49, 68.6, 68.69, 68.9), laparoscopic hysterectomy (ICD-9 68.31, 68.41, 68.51, 68.61, 68.71) and robotically assisted hysterectomy (any hysterectomy code in combination with ICD-9 17.4x). Women with a diagnosis of uterine cancer (ICD-9 179, 182.x) who underwent hysterectomy from January 2011 to March 2015 were analyzed. 5, 6 Given the limited data and uncertainty surrounding SLN biopsy for endometrial cancer, we examined the patterns and predictors of use of SLN biopsy in women with newly diagnosed endometrial cancer undergoing surgery. 11 Further, as randomized trials have been unable to demonstrate a survival benefit even with full lymphadenectomy, some have questioned why SLN biopsy would be utilized at all for apparent early-stage endometrial cancer. While some studies have examined the performance of SLN biopsy compared to lymphadenectomy, whether SLN biopsy can be used in lieu of lymphadenectomy and in which patients is unknown. 13– 15ĭespite the potential benefits of SLN biopsy for endometrial cancer, the appropriate role of the procedure is uncertain. 11, 12 SLN biopsy has been extensively validated for a number of other solid tumors and is now in the standard of care in breast cancer, vulvar cancer, and melanoma. 7– 10 The principle of SLN biopsy relies on removal of a small number of lymph nodes that are the first drainage basins from a tumor and thus the most likely to harbor tumor cells. To limit the potential short and long-term morbidity of lymphadenectomy, sentinel lymph node (SLN) biopsy has been proposed for endometrial cancer. 5, 6 Importantly, these studies also demonstrated that lymphadenectomy was associated with an increased risk of complications and called into question the value of the procedure. 1– 4 More recently, however, randomized trials have failed to show a survival benefit for lymphadenectomy. 1, 2 Node dissection provides important prognostic information, may help guide adjuvant treatment, and has been suggested in some studies to have a therapeutic effect. Although lymphadenectomy is commonly performed as part of the surgical treatment of endometrial cancer, the role of the procedure remains controversial.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |